Fractured Nose and Nosebleeds: What You Need to Know

So what do you do if you accidentally fracture your nose in Singapore? As an ENT specialist in Singapore, we see a few nasal injury cases every month. Both children and adults may suffer possible nasal fractures after trauma. Sometimes, the nasal fractures happen after a traumatic fight or argument. More often, nasal fractures occur after an accidental fall. We also see many MMA fighters who present with broken noses. They also suffer swollen ear deformities known as ear pseudocysts. Fractured nose and nosebleeds are common problems in the sporting world.

If you turn up at the emergency department with a nasal or facial injury, the duty of the on-call A&E doctor is to screen for worrying injuries such as bleeding from the brain and orbital (eye) fractures. The doctor will manage more serious injuries first before your nasal fracture.

Yes, A&E will arrange an X-ray of your nose if the doctor suspects an underlying nasal fracture. They will refer you to your ENT specialist in Singapore for further assessment. It is best to turn up around Day 3 to 5 after your nasal injury, to allow initial soft tissue swelling to subside. Nosebleeds often occur after a fractured nose but sometimes, nosebleeds don't always stop on their own.

If you have a fractured nose and nosebleeds which don't stop with simple pressure, you need to visit the A&E. If we can find the bleeding point to cauterise to stop the bleeding, we do it in A&E. But if the bleeding from your nose is too heavy, then we may need to insert temporary special sponge packing into your nose. If the nosebleed still doesn't stop, then you may need to have your nose examined under general anaesthesia to stop the bleeding.

Nosebleeds after a fractured nose may come from the front part of the nose or from a major artery at the back. Sometimes, you may need septoplasty surgery to correct a deviated nasal septum which is restricting the nasal passage access.

Septoplasty is a common nasal surgery to open up your nasal airway to help you breathe more clearly. Many ENT patients in Singapore come to see us with persistently blocked nose and difficulty breathing. They may also suffer loud snoring at night because they breathe through their mouth all the time.

Nasal fractures usually take about 2 weeks to heal. Displacement of the nasal fracture with broken fragments of nasal bone misaligned, may mean you need a manipulation of your nasal fracture. This is a safe quick procedure under a very short anaesthesia to straighten the crooked broken nasal bones.

This procedure usually should be carried out within 2 weeks of the nasal injury (sometimes 3 weeks is possible) to re-align the broken nasal bones before they start to knit and heal in the incorrect position, ideally the earlier the better. The patient can go home the very same day after they have woken up from their short general anaesthesia. They have to wear a special nasal splint to protect their fractured nose while the bones heal up completely (see picture below).

Later on, if the patient still has a blocked nose that he can't breathe through, then a septoplasty or a full septorhinoplasty ("nose job") may be required. The objective is always to open up the narrow nasal airways to help the patient breathe better. Breathe well, sleep well, live well!