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Nasal Fracture in Children | Cedars-Sinai

ABOUT CAUSES DIAGNOSIS TREATMENT NEXT STEPS

What is a nasal fracture in children?

A nasal fracture is a break in one or more of the bones of the nose, caused by trauma. It’s also called a broken nose.

There are 2 nasal bones side by side in the nose. These bones form the bridge of the nose. They help support the upper part of the nose. They also help support the cartilage that forms the lower part of the nose.

A nasal fracture is a break in one of the nasal bones or in one or more of the bones that make up your nasal septum. The septum separates the left and right sides of your nose. It's made of cartilage and parts of several other nasal bones. These are the ethmoid bone, the vomer bone, the maxillary bone, and the palatine bone.

Nasal fractures are more common in adults than in children. Children’s nasal bones are harder to fracture. Nasal fracture is fairly uncommon in young children because they don't take part in the activities that can cause a nasal fracture. The risk increases with age. More boys than girls get nasal fractures. The nasal bone is one of the most commonly fractured bones of the face. The lower part of the nasal bone is thinner than the upper part and breaks more easily.

What causes a nasal fracture in a child?

Trauma to the nose causes nasal fracture. This might come from various sources such as:

Falls
Contact sports
Weight lifting
Automobile injuries
Child abuse

Most nasal trauma doesn't cause nasal fracture. Many children have other injuries to the nose, like deviation of the septum.

What are the symptoms of a nasal fracture in a child?

Symptoms of a nasal fracture might include:

Nosebleed
Swelling
Bruising of the nose
Bruising under the eye
Tenderness when touching the nose
Crunching sound when touching the nose
Trouble breathing out of the nose
Deformity of the nose

Usually, the injury to the nose is obvious.

How is a nasal fracture diagnosed in a child?

Your child’s healthcare provider will ask about your child's health history, and about the details of the trauma. Your child will also need a thorough medical exam. This will include both an internal and external exam of the nose. Because nasal fracture often happens with other injury, your child will need a thorough exam assessing other possible areas of injury, like the eyes and teeth.

Plain X-rays don't usually aid in diagnosis. Your child may need another type of imaging such as CT scan to provide more information about the damage.

A primary care healthcare provider, emergency room healthcare provider, or pediatrician (healthcare provider who specializes in children’s healthcare) often makes the first diagnosis. However, most children need to see an ear, nose, and throat healthcare provider (otolaryngologist) for treatment.

How is a nasal fracture treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

Children should sit upright for a time after the injury, to help reduce swelling and pooling of blood in the nose. Initial treatment might include pain medicines and ice.

Some children with severe injuries need to see an ear, nose, and throat healthcare provider immediately. Others will need to see an ear, nose, and throat healthcare provider after a few days. The delay allows the swelling to go down, so the healthcare provider can evaluate and recommend further steps.

Many children need “reduction” of the nasal fracture as part of their treatment. This just means that a healthcare provider needs to realign the bones, if they are out of place. Your child might need this right away or later at a follow-up appointment. Your healthcare provider might do this by physically moving the bones back into place (“closed reduction”). Less commonly, surgery is needed (“open reduction”). Because this can be painful, healthcare providers usually do this when the child is asleep under general anesthesia. After reduction, the nose usually needs a splint.

After the reduction, your child’s nose may not look exactly the way it did before. Rhinoplasty surgery (nose surgery) may help restore a more cosmetic appearance.

If your child’s nasal fracture is more severe, he or she might need a more complicated surgery immediately after the injury. Septorhinoplasty can help restore the cosmetic appearance of the nose, as well as restoring a displaced nasal septum and blocked nasal airway.

What are possible complications of a nasal fracture in a child?

Nasal fracture in children sometimes results in complications, though your healthcare team will work hard to prevent these. Your child’s risk for complications may vary according to age and the extent of injury. Some possible complications include:

Septal abscess
Septal hematoma
Severe nosebleed
Infection of the brain or tissues around the brain
Tear duct obstruction
Abnormal connection between the nasal cavity and the mouth
Underdevelopment of the maxillary bone (making the middle of the face look sunken)
Cosmetic imperfections

These complications often need additional treatment, like antibiotics for a septal abscess, or surgical drainage of a septal hematoma. In infants, nasal fracture can also cause trouble breathing because infants can't breathe through their mouths. These children need immediate treatment.

How can I help my child live with a nasal fracture?

After a nasal fracture, the nose needs time to heal. The nose is easy to reinjure during this time. For this reason, most healthcare providers recommend that children stay away from all sports for at least 2 weeks. Your child needs to avoid contact sports (like football or wrestling) for at least 6 weeks.

When should I call my child's healthcare provider?

Call the healthcare provider if any your child’s nose continues to bleed, if he or she has a fever or chills, or shows confusion or unconsciousness.

Key points about nasal fracture in children

A nasal fracture is a break in one or more of the bones of the nose, caused by trauma.

Falls, sports, and automobile accidents are common causes of nasal fracture.
Your child may need to have his or her nose put back in alignment, usually under general anesthesia.
Specific treatment for nasal fracture varies according to the nature of the injury, how long ago it happened, and other associated injuries.
Your child may need additional surgery to help restore the nose’s cosmetic appearance.
For several weeks after the injury, it's important to be especially careful not to reinjure the nose.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.

Nose Injury

Is this your child's symptom?

Injuries to the inside or outside of the nose

Types of Nose Injuries

Nosebleed. Even minor nose injuries cause a nosebleed. The bleeding will stop with the correct technique. If the bleeding persists, the child needs to be seen.
Swollen Nose. Swelling and bruising of the outer nose without a fracture is common. It can be mistaken for a broken nose. The swelling will be gone in 4 or 5 days. Then the shape of the nose will look normal. But the bruising may take 2 weeks to clear.
Fracture of the Nose. Severe fractures of the nose (crooked nose) are usually reset the same day. This requires surgery in the operating room. Most surgeons don't repair mild fractures until 5 to 7 days after the injury. Caution: a nasal fracture must be re-set before 10 days.
Nasal Septal Hematoma (Serious). A blood clot of the central wall of the nose. It needs to be drained. If not, there's a risk of cartilage damage. That would lead to a deformed nose.

When to Call for Nose Injury

Call 911 Now

Major bleeding that can't be stopped
Passed out (fainted) or too weak to stand
You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

Nosebleed that won't stop after 10 minutes of squeezing the nose correctly
Pointed object put in the nose and caused pain or bleeding
Skin is split open or gaping and may need stitches
Severe pain and not better 2 hours after taking pain medicine
Deformed or crooked nose (not just swelling)
Skin is cut and No past tetanus shots. Note: tetanus is the "T" in DTaP, TdaP, or Td vaccines.
Breathing through the nose is completely blocked
Age less than 1 year old
Nose becomes infected (fever, a yellow discharge, redness)
You think your child has a serious injury
You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

Shape of the nose has not come back to normal after 4 days
Dirty cut or hard to clean and no tetanus shot in more than 5 years
Clean cut and no tetanus shot in more than 10 years
You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

You have other questions or concerns

Self Care at Home

Minor nose injury

Seattle Children's Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Bellevue
Everett
Federal Way
Seattle

Care Advice for Minor Nose Injury

Nosebleed - How to Stop:
- To stop a nosebleed, squeeze the soft parts of the lower nose together. Gently press them against the center wall.
- Do this for 10 minutes to put pressure on the bleeding point.
- Use the thumb and index finger in a pinching manner.
- If the bleeding continues, move your point of pressure.
- Have your child sit up and breathe through the mouth during this procedure.
Skin Bleeding - How to Stop:
- For any skin bleeding, put direct pressure on the wound.
- Use a gauze pad or clean cloth.
- Press for 10 minutes or until the bleeding has stopped.
Clean the Cut:
- After the skin bleeding has stopped, wash the area. Clean with soap and water for 5 minutes.
- If a large area, use an antibiotic ointment (such as Polysporin). No prescription is needed.
- Then, cover with a bandage (such as Band-Aid) for 1 day.
Cold Pack for Pain:
- For pain or swelling, use a cold pack. You can also use ice wrapped in a wet cloth.
- Put it on the nose for 20 minutes.
- Repeat in 1 hour, then as needed. Caution: Avoid frostbite.
Pain Medicine:
- To help with the pain, give an acetaminophen product (such as Tylenol).
- Another choice is an ibuprofen product (such as Advil).
- Use as needed.
Concerns About Missing a Minor Nasal Fracture:
- If a swollen nose is the only finding, usually it's not broken.
- Even if it's broken, standard practice is to delay correction for a few days. This allows the swelling to go away. Reason: The swelling interferes with seeing the shape of the nose.
- X-rays are often not helpful. Reason: Most of the nose is cartilage. Injuries to the cartilage do not show up on X-ray.
- Looking at the nose after the swelling is gone is preferred. You can usually do this by day 4 or 5. This is the best way to tell if it is fractured. It will look different than it used to. Delayed correction also helps the surgeon better see what needs to be corrected.
- Caution: If the nose is broken, a surgeon must re-set it. This should be done before the 10th day.
What to Expect:
- Nose pain and swelling usually peak on day 2.
- They go away over 3 or 4 days.
Call Your Doctor If:
- Pain becomes severe
- Nasal passage becomes blocked
- Shape of the nose has not come back to normal after 4 days
- Signs of infection occur (a yellow discharge, more tender to touch or fever)
- You think your child needs to be seen
- Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 02/15/2023

Last Revised: 12/30/2022

Injury of the nose in a child

The nose is the most protruding, relief and noticeable part of the face. Therefore, in the structure of traumatic injuries of the ENT organs, the trauma of the nose occupies a leading position.

The causes of a nose injury in a child are very diverse: domestic, criminal, sports, combat, auto injury, etc. Serious damage to the nose can occur in the first minutes of life when the baby passes through the birth canal if the mother does not properly manage the birth.

Signs of a nose injury in a child

A fracture of the skeleton of the nose in your child can be suspected if, after the injury, severe nosebleeds are noted, swelling and a change in the shape of the nose appear, the skin of the back of the nose is dissected, a pain symptom is expressed. Alarming symptoms are also bruises around both eyes and liquid sticky discharge from the nose: it is possible that a trauma to the nose is accompanied by a fracture of the base of the skull. The increase in swelling and redness of the nose, accompanied by an increase in body temperature, indicate infection of injured tissues.

Treatment of trauma of the nose

Treatment of traumatic deformities of the nose in children - surgical reduction of displaced fragments of the nasal skeleton under general anesthesia, followed by tamponade of the nose to fix the correct position of the fragments. The best cosmetic results of surgical treatment are observed in the first 10 days after the injury. Later, the fragments begin to grow together in the wrong position and their reduction becomes problematic.

TO	AFTER

Peculiarities of nose injury in children

A feature of childhood nose injury is that, due to the small anatomical dimensions of the nose and rapidly developing traumatic edema, external deformity is hardly noticeable externally. Therefore, after any, even seemingly insignificant bruise of the nose, the child should be shown to the otorhinolaryngologist without delay. In addition, if your child's nose injury was intentionally inflicted by the offender and a trial is planned, then it is necessary to undergo a medical examination of the severity of the injuries. Early examination of the nasal cavity with endoscopic optics and X-ray examination allow timely detection of outwardly hidden damage and timely start of their treatment. Otherwise, with age, during the growth of the damaged skeleton of the nose, its external deformation may develop, and the progressive curvature of the broken nasal septum may completely turn off nasal breathing.

Do not be upset if, for some reason, the surgical treatment of a nasal skeleton fracture that your child needs was not carried out in a timely manner. The children's department of our Center has long developed and successfully uses original methods for correcting deformities of the septum and external nose (rhinoseptoplasty), adapted for children of different ages after a previous injury.

Make an appointment at the reception of our Center to Dr. med. Sciences Rybalkin S.V. you can call: 8(499) 968-69-12.

Injuries of the nose - symptoms and treatment

The nose is most susceptible to various injuries due to its structure and location. In case of injury, the bone and cartilage structures of the nose, as well as soft tissues, can be damaged. This often results in a concussion or contusion of the brain.

Symptoms

Types

Causes

Complications

When a person receives a nose injury, a person experiences severe pain, since the nose, like other parts of the face, has many nerve endings. Soft tissue injury causes swelling and hematoma formation. The following symptoms indicate the presence of serious damage to the structures of the nose:

Bleeding from the nose. Severe and prolonged bleeding from the nose during an injury is not always due to the degree of damage. It can be provoked by hypertension or blood clotting disorders.
Hematoma formation. If the blood vessels are damaged, blood can both flow out of the nasal passages and accumulate in the soft tissues. Most often, small hematomas go away on their own, but with extensive hemorrhages, inflammation can occur. In some cases, large hematomas cause problems with nasal breathing.
Changing the shape of the nose. This symptom indicates serious damage to the bony structures of the nose and often requires immobilization or surgical treatment. These injuries often occur after severe bruises or falls, so they are often accompanied by a concussion, and therefore require careful diagnosis and subsequent treatment. When concussion patients are worried about headache, dizziness, nausea, weakness, loss of consciousness.

Injuries of the nose can be open, which violate the integrity of the skin, as well as closed, located inside and not causing visible damage to the skin.

According to the severity of the nose injury, they are classified:

Soft tissue injuries resulting from a bruise, abrasion, stab wound.
Injuries affecting the cartilage of the nose with a fracture of the nasal septum.
Fractures of the bones of the nose are the most severe damage to the structure of the nose, in which displacement of bone fragments, damage to the paranasal sinuses and other disorders can occur.

According to statistics, men are the undisputed leaders in nose injuries. In the "risk group" are hyperactive children, people involved in martial arts, as well as military personnel. Injuries can occur at home, at work, while playing sports; children often get injured during active games.

Fractures of the bones of the roof of the nose or nasal septum can lead to the following disorders - displacement of the nose from the midline, the formation of a hump, changes in the shape of the nose (expansion, flattening or flattening of the nose, retraction of the back down), and the bony support of the nose may become soft. Frostbite, inhalation of steam or chemical (toxic) substances can lead to injuries to the nose.

Diagnosis of nasal injuries

When a patient visits a doctor, an external examination and palpation of the organ is performed. To determine the degree of damage to bone structures, to identify pathological changes in soft tissues or blood vessels, X-ray diagnostics of the nose and skull, as well as CT or MRI, are performed.

Treatment of a nose injury at the Gaide Clinic

Therapeutic measures vary depending on the degree of damage to the nose due to the injury. In case of bruising of soft tissues, without visible damage to bone structures, cold application is recommended. Superficial wounds and abrasions are treated with antiseptics, and a sterile dressing is applied.

If the bones of the nose are broken or displaced and if there is severe bleeding, seek immediate medical attention. The doctor must stop the bleeding and determine the degree of damage to bone structures, treatment tactics, and also exclude concussion and other complications.