Nasal Fracture in Children

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 two 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

• Weightlifting

• 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 a 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, surgeons 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, they might need a more complicated surgery immediately after the injury. Septorhinoplasty can help restore the cosmetic appearance of the nose, as well as restore 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 the 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 your child’s nose continues to bleed, if they have a fever or chills, or they show 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 their 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 child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• 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 for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s 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 your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.