A fractured nose is a common problem in children. When it first happens, the nose may bleed. Make sure that you press on the soft fleshy part of the nose and press for at least 5 minutes. Fractured noses can also be associated with other facial fractures, so if there has been trauma to the nose and face it is usually best to attend the Emergency Department. They will help with first aid, and make sure that no other injuries are present.
How will fractured nose be managed?
When it first happens, swelling soon sets in. Because of the swelling, it will be difficult for the ENT surgeon to assess the shape of the nose. Therefore, the ENT clinic will usually see you 5-10 days after the injury. By this stage the swelling should have gone down and we will be able to see the bones of the nose. If the bones look twisted or bent, the surgeon can reposition (manipulate) the bones to get them into a straighter position. This can be done under local or general anaesthetic, depending on the child's age. The surgeon will use their hands to push the nose into a better position! After this is done, there may be more swelling and bruising again, and it is best to avoid contact sports for about 6 weeks because the nose will be more vulnerable to a minor injury.
Sometimes the problem lies with the cartilages in the nose, rather than the bones. It is more difficult to manipulate those, and sometimes it may not be possible for us to reposition the nose. It is not possible for us to guarantee a perfect appearance following manipulation, but hopefully it will be better.
If the nose cannot be manipulated into a better position, then correction of the deformity will require a full nose job (septorhinoplasty). This would need to wait until the child is fully grown. We do not usually operate on the nose that is still growing. The surgeon can position the nose into a perfect position surgically, but as the child grows the nose can grow out of shape again. Or the surgery could itself affect the growth of the nose in a negative way. So it is best to wait until teh child becomes and adult.
What to watch out for
Something that sadly happens all too often is a delay in manipulation. The manipulation needs to happen within 2-3 weeks, any later than that and the bones heal and fuse and manipulation becomes impossible. So it is really important that you bear that in mind. Make sure you attend Emergency Department straight away, and if a fractured nose is suspected, you should expect an appointment in ENT clinic 5-10 days after injury. If your child is young and a general anaesthetic is needed, that should happen within 2-3 weeks of injury. If you do not think that the treating teams are offering you that, please ask them to explain the plans, and ask why manipulation is being delayed beyond the time where it would usually be undertaken.
Does my child need X rays? Does everyone need manipulation?
X rays of the nose are not required, although if there is concern about other facial fractures your child may have X rays of their face. We do not do X rays because they do not change management. What matters is how the nose looks. If the nose is perfectly straight, no manipulation is needed, even if nose has been broken. X rays involve radiation, and although the risks of that are tiny, we do not do them unless it will change management.
Not everyone needs manipulation. Often the swelling settles down, and the nose looks perfectly back to normal. No further action will be required. Sometimes the nose is out of shape, but manipulation is not suitable, as outlined above, in which case again this will not be offered.