Nasal Fracture Treatment in Sydney

A nasal fracture (broken nose) is the most common facial fracture, typically caused by sports injuries, falls or assaults. Early assessment by an ENT specialist within 7 to 10 days is important because displaced fractures can be realigned in a simple procedure during the first two weeks, avoiding the need for more complex surgery later.

What Is a Nasal Fracture?

A nasal fracture is a break in the nasal bones, the two thin bones that form the bridge of the nose. In more severe injuries, the nasal septum (the cartilage and bone partition dividing the nose into two sides) can also be fractured or displaced. The nose is the most prominent part of the face and, because the nasal bones are thin, relatively minor force can cause a fracture.

Nasal fractures range from simple, undisplaced cracks that heal without intervention to significantly displaced fractures that cause visible deformity and breathing obstruction. The severity depends on the direction and force of the impact.

Symptoms of a Broken Nose

After nasal trauma, the following symptoms suggest a fracture:

Immediate swelling and bruising of the nose, which may extend under both eyes (raccoon eyes)
Nosebleed (epistaxis) at the time of injury
Visible crookedness, deviation or flattening of the nasal bridge
Pain and tenderness when touching the nose
A crunching or grinding sensation (crepitus) when the nose is gently pressed
Nasal obstruction or difficulty breathing through one or both sides of the nose
Watery discharge from the nose (which rarely may indicate a cerebrospinal fluid leak in severe injuries)

Significant swelling can mask the true degree of displacement. It is therefore important to be reassessed once the swelling subsides, ideally within 5 to 7 days of injury, so that any displacement can be properly evaluated.

Causes

Common causes of nasal fractures include:

Sports injuries: contact sports such as rugby, football, basketball, boxing and martial arts
Falls: particularly in children, the elderly, and during physical activities
Assaults: a punch or blow to the face
Motor vehicle accidents: dashboard or airbag impact
Workplace injuries: struck by objects or equipment

Diagnosis

At Central Sydney ENT, nasal fracture assessment includes:

Clinical examination: Your ENT surgeon will inspect the external shape of the nose, feel for bony irregularities, and examine the inside of the nose with a headlight and nasal speculum. This internal examination is essential to check for a septal haematoma (blood collection within the septum), which requires urgent drainage to prevent cartilage damage.

Assessment of the septum: A deviated or fractured septum may contribute to nasal obstruction and can influence whether closed reduction alone will be sufficient or whether additional septal work is needed.

Imaging: Plain X-rays of the nasal bones can confirm a fracture, though the diagnosis is primarily clinical. A CT scan is reserved for more complex injuries where other facial fractures are suspected, or when surgical planning for delayed reconstruction is required.

Treatment Options

Immediate First Aid

In the first 48 hours after injury, apply ice wrapped in a cloth for 15 to 20 minutes at a time to reduce swelling. Keep the head elevated. Take simple pain relief such as paracetamol. Avoid blowing the nose forcefully, as this can worsen swelling and introduce air into the soft tissues.

Conservative Management

If the nasal bones are not displaced and the septum is straight, no active treatment is needed beyond pain relief and monitoring. Most swelling settles over two to three weeks, and the fracture heals over four to six weeks.

Closed Reduction (Manipulation Under Anaesthesia)

For displaced nasal fractures, a closed reduction is the standard treatment when performed within 10 to 14 days of injury. The procedure involves gently manipulating the nasal bones back into position using specialised instruments, performed under general anaesthesia or local anaesthesia with sedation. An external nasal splint is applied for approximately one week to support the bones as they heal.

Closed reduction is a brief procedure, typically taking 15 to 30 minutes, and most patients go home the same day. Our rhinology and facial surgery specialists, including Dr Rahuram Sivasubramaniam, Dr Arjuna Ananda and Dr Jareen Ebenezer, perform nasal fracture reduction regularly.

Septorhinoplasty (Delayed Correction)

If a nasal fracture has already healed in a displaced position (beyond the two-week window for closed reduction), or if the initial reduction does not fully correct the deformity, a septorhinoplasty may be recommended. This is a more comprehensive surgical procedure that reshapes the nasal bones and straightens the septum to restore both appearance and breathing function. Septorhinoplasty is typically performed three to six months after the original injury, once all swelling has resolved.

Septal Haematoma Drainage

A septal haematoma is a collection of blood between the cartilage and the lining of the septum. It is a surgical emergency because, if untreated, the blood supply to the cartilage is compromised, leading to cartilage death, infection (septal abscess), and permanent collapse of the nasal bridge (saddle nose deformity). Drainage is performed urgently under local anaesthesia.

When to See an ENT Specialist

Seek assessment by an ENT specialist if:

Your nose appears crooked or deviated after an injury
You have difficulty breathing through your nose after facial trauma
You have ongoing nosebleeds following an injury
Swelling is increasing rather than settling in the days after injury
You have clear, watery fluid draining from the nose (possible CSF leak)
A child has sustained nasal trauma: septal haematoma must be excluded promptly

Time is critical: ideally be seen within 7 days of injury so that closed reduction can be performed within the optimal two-week window.

Related Conditions

Nasal fractures are related to other conditions treated at Central Sydney ENT:

Deviated Septum: nasal fractures commonly cause or worsen septal deviation, contributing to chronic nasal obstruction
Nosebleeds (Epistaxis): recurrent nosebleeds can follow nasal fractures, particularly when the septum is damaged
Chronic Sinusitis: post-traumatic nasal obstruction and septal deviation can impair sinus drainage

Common Questions

Nasal Fracture FAQ

How soon after breaking my nose should I see a specialist? +

You should see an ENT specialist within 7 to 10 days of the injury. A closed reduction (manipulation of the nasal bones back into position) is ideally performed within 10 to 14 days, before the bones begin to set in their displaced position. After this window, corrective surgery (septorhinoplasty) may be needed, which is usually deferred for 3 to 6 months.

How do I know if my nose is broken? +

Signs of a broken nose include significant swelling and bruising, visible crookedness or deviation, a nosebleed at the time of injury, difficulty breathing through the nose, tenderness when touching the nose, and a crunching or grinding sensation. An ENT specialist can confirm the diagnosis through clinical examination, often supported by imaging.

What is a closed reduction for a nasal fracture? +

A closed reduction is a procedure to realign the displaced nasal bones without making any incisions. It is performed under general or local anaesthesia. The surgeon uses gentle manipulation and specialised instruments to push the bones back into their correct position. A nasal splint is applied externally for about one week to hold the bones in place while they heal.

What happens if a broken nose is not treated? +

An untreated displaced nasal fracture can heal in a crooked position, causing permanent nasal deformity, chronic nasal obstruction, and breathing difficulty. A septal haematoma (blood collection inside the septum), if missed, can lead to infection and loss of septal cartilage, resulting in a saddle nose deformity. Early assessment is important to avoid these complications.

Does Central Sydney ENT treat broken noses? +

Yes. Central Sydney ENT surgeons treat nasal fractures including closed reduction within the optimal two-week window and delayed septorhinoplasty for fractures that have healed in a displaced position. We see patients across seven Sydney locations including Burwood, Campbelltown, Gregory Hills, Ultimo, Drummoyne, Hunters Hill and Miranda.