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Nasal Fracture In Children


What is a nasal fracture?

A nasal fracture (broken nose) is a crack or break in the bones or cartilage of your child's nose. Cartilage is tough tissue that covers the end of a bone. Your child may have a break in the upper nose (bridge), the side, or in the septum. The septum is in the middle of the nose and divides his nostrils.

What causes a nasal fracture?

Nasal fractures are caused by a hard hit to the nose. They commonly occur from motor vehicle crashes, sports injuries, falls, and fights.

What are the signs and symptoms of a nasal fracture?

  • Deformed nose: Your child's nose may look like it has moved out of place. It may bend toward 1 side of his face or look wider than usual. You may hear a scraping sound when his nose moves.
  • Bloody nose: A bloody nose is a common sign of a nasal fracture. Your child may lose only small amounts of blood, or he may bleed heavily. The amount of blood will depend on how badly his nose was broken.
  • Bruises and swelling: Your child's nose will begin to swell within 1 to 2 hours of his injury. He may have black eyes because of bruising under his eyes.

How is a nasal fracture diagnosed?

Your child's caregiver will ask you and your child when, where, and how the injury occurred. If the injury is from a car accident, he may ask if your child was wearing a seatbelt or if an airbag hit him. Tell your child's caregiver about any past nose surgeries or injuries. Caregivers may take photos of your child's face. They may also ask for a recent photo of your child before his injury.

  • Nasal exam: Your child will be given pain medicine before his caregiver touches and looks at the outside and inside of his nose. He will use tools to remove blood clots and check for large hematomas (collections of blood).
  • X-rays: X-rays may be done to help find any other injuries to your child's face and head.
  • A CT , or CAT scan, takes pictures of your child's body. Your child may be given contrast liquid before the scan. Tell a healthcare provider if your child has ever had an allergic reaction to contrast liquid.

How is a nasal fracture treated?

Caregivers may use any of the following to treat your child's nasal fracture:

  • Medicines:
    • Antibiotics: This medicine is given to help prevent or treat an infection caused by bacteria.
    • Pain medicine: Your child may need medicine to take away or decrease pain. Know how often your child should get the medicine and how much. Watch for signs of pain in your child. Tell caregivers if his pain continues or gets worse.
    • Decongestant: This medicine decreases nasal swelling and helps make breathing easier.
  • Wound care: Caregivers will use medicines, tools, or gauze inside the nose to stop the bleeding. Wounds on the face will also be cleaned and treated. Any hematomas your child may have inside his nose will be drained. Caregivers may place packing (gauze or other material) inside the nostrils to soak up blood.
  • Reduction: Some nasal fractures must be moved back into place (reduction). Caregivers may perform reduction right away if your child's injury is new. You and your child might be asked to return for treatment within 2 to 4 days if your child's nose has swollen. Caregivers will numb your child's nose to reduce pain before the reduction. The medicine is given with a shot, through pads placed on his skin, or through an IV. Caregivers may use tools that move your child's nose without incisions (cuts) in his skin. This is called closed reduction. His nasal fracture may instead be repaired through incisions. This is called open reduction.
  • Drains: Drains are thin rubber tubes put into your child's nose to drain fluid from around an incision. The drains are taken out when the incision stops draining.
  • Splints or packing: Splints or packing may be used to help keep your child's nose in place for 7 to 10 days after a reduction. Ask your caregiver to show you how to care for your child's splint or packing.

What are the risks of a nasal fracture?

  • Your child may have an allergic reaction to the medicines used to treat his nasal fracture. Even after a closed or open reduction, your child's nose may be misshapen. He may need more than 1 surgery.
  • Without treatment, your child's nose may not grow properly as he gets older. Your child may have other fractures in his face and head that can worsen without care. Poor healing may lead to long-term problems with nose breathing and sinus infections. Your child may need surgery to correct these problems. Fractures in the face and head can cause cerebrospinal fluid (CSF) from your child's brain to leak out of from his nose. Infections can occur even with treatment. Any hematomas that form can lead to serious infections. These infections may be life-threatening if they spread deeper into your child's skull or brain.

How do I care for my child's nasal fracture at home?

  • Your child may need more rest than he realizes as he heals. Quiet play will keep your child safely busy so he does not become restless and risk hurting himself. Have your child read or draw quietly when he is awake. Follow instructions for how much rest your child should get while he heals.
  • Ice: Place an ice pack over your child's nose to help decrease pain and swelling. Ask your child's caregiver how long and how often to use the ice pack.
  • Rinses: Remove blood and crusting inside your child's nose with water or saline (salt water). Ask your caregiver to show you how to rinse your child's nose.
  • Wound care: Ask your caregiver to show you how to care for your child's drains, splint, or packing.

When should I follow up with my child's caregiver?

Your child may need to see a specialist 2 to 4 days later for treatment. Follow-up care is needed months or even years later to watch for and correct problems with healing and growth. Ask your child's caregiver if your child should see a specialist.

How can I help prevent further injury to my child's nose?

  • Protect your child's nose: Protect his nose to prevent bleeding, bruising, or another fracture. If your child plays sports, ask your caregiver if he can wear a face mask to shield his nose.
  • Avoid nose blowing: Your child's nose could move out of place before it heals. Ask your caregiver when he can safely blow his nose again.

When should I contact my child's caregiver?

Contact your child's caregiver if:

  • Your child has a fever.
  • Your child keeps having nosebleeds.
  • Your child's headache is getting worse, even after he takes pain medicine.
  • Your child's skin feels itchy, swollen, or has a rash.
  • Your child's splint, drain, or packing is loose.
  • You have questions about your child's condition or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

  • You think someone has harmed your child.
  • Clear fluid is leaking from your child's nose.
  • Your child has grape-like swelling inside his nose.
  • Your child has double vision or has problems moving his eyes.
  • Your child is having problems breathing, smelling, or talking.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.