Check Up : Does she need surgery to fix her broken nose?

September 20, 2017

Sandra broke her nose while playing netball and her nasal septum has shifted.

It's all healed up now and she's not experiencing any problems breathing. But fixing the nasal septum will require surgery. She feels okay, and finding the funds for surgery would be onerous.

Can she just ignore this episode and get on with her life?

If the shift in the nasal septum is minor, then the answer is probably yes. But there is no seeing down the future and allergic rhinitis and sinus issues may also feel 'different' in the future, with a sensation of blockage on the narrower side of the nose.

Ideally, it's always best to return the body to as normal as possible after an injury. But, in truth, it is the ear, nose and throat (ENT) doctor who should best answer Sandra's question.

When a nose 'breaks', it usually bleeds. Blood can come from the inside of the nose where it is fractured or from outside from lacerations and abrasions to the nasal region.

Also, the alignment of the nose often changes as it is pushed off from the centre of the face, asymmetrically. This observation should be made as soon as possible by looking in a mirror before swelling to the area occurs.

The nasal airway may also be obstructed, making it difficult to breathe through the nostrils and the area may become discoloured. Of course, the area is painful and tender to touch.

Any force which can break the nose can also possibly cause brain concussion, so a brain CT scan is advised later to rule out more serious head injury.

When the nasal injury occurs, a towel or gauze should be applied across the nasal bridge with mild pressure to help stop any bleeding.

The person should sit with head bent forward to ensure that any blood runs out and not down the back of the throat. If the person is on the ground, roll them on to their side to allow the blood to drain out on to the ground.

If a head injury is suspected, call emergency services immediately! Symptoms of a concussion would include:

• Headache

• Dizziness

• Confusion

• Nausea

• Ringing in the ears

Once the bleeding has stopped, an ice pack should be applied to the nose to reduce swelling to the face.

When the nose is broken, it should be repositioned in the emergency room by the emergency physician or by an ENT specialist within three to seven days of the injury to avoid surgical repair. After this time, healing is occurring and surgical repair may be required to reset the fracture straight. An athlete should wear a face guard for up to six weeks after a nasal fracture to ensure full healing without risk of damaging the nose again.

If persistent draining of clear fluid through the nostril occurs after nasal fracture, a skull fracture has possibly been missed with drainage of cerebrospinal fluid.

This should be taken very seriously as it can lead to meningitis or even death! See a physician immediately!

Having said all this, most broken noses will heal without problems, and when problems do develop they will more commonly include:

• A crooked or bent nose

• Nasal stuffiness or trouble breathing

• Infection of the nose, sinuses or facial bones

• Deviated nasal septum

• Perforation of the nasal septum

• Brain infection such as meningitis or brain abscess

Other treatment of the broken nose will include:

• Nasal decongestants

• Painkillers

• Nasal packing

• Nasal splint

• Antibiotics

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