Nasal fracture and septal haematoma !

A broken nose is the most common facial fracture. A blood clot in the septum must be found and drained fast or the cartilage dies and the nose collapses.

Updated 2026-11-01

Structures involved

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Why it happens

What it is

A fracture of the nasal bones, often with injury to the nasal septum and cartilages, caused by a blow to the nose. Septal haematoma is a collection of blood between the septal cartilage and its lining (perichondrium); it cuts off the blood supply to the cartilage and is an emergency within the injury.

Who gets it

The nasal bones are the most frequently fractured bones of the face because they project forward and are thin. Fractures are most common in young men and result from assaults, sports, road traffic crashes (including motorcycle crashes, very frequent in Colombia) and falls. In children, the nose is more cartilaginous, so septal injuries and haematomas can occur without obvious fracture; child abuse must be considered.

Causes

Interpersonal violence
Contact sports (football, martial arts, boxing)
Road traffic and motorcycle crashes
Falls, including falls in older adults and toddlers
Work-related injuries

Risk factors

Young male sex
Contact sports without face protection
Alcohol use and exposure to violence
Motorcycle use without a full-face helmet
Anticoagulant use (larger haematoma) and previous nasal surgery

Pathophysiology

A lateral blow displaces the nasal bones toward the opposite side; a frontal blow flattens them and can drive force into the septum and the naso-orbito-ethmoid complex. The septal cartilage receives its nutrition from the overlying perichondrium; bleeding that lifts the perichondrium off the cartilage forms a haematoma, and without drainage the cartilage necroses within days and may become infected (septal abscess), leading to septal perforation and a saddle nose deformity.

Classification

Undisplaced or displaced nasal bone fracture
Simple or comminuted
With or without septal fracture or dislocation
Isolated or part of a more complex facial fracture (naso-orbito-ethmoid, Le Fort)
Open (skin laceration) or closed

Symptoms and signs

Pain, swelling and tenderness over the nasal bridge after trauma
Nosebleed (epistaxis)
Visible deviation or flattening of the nose
Crepitus or mobility of the nasal bones
Bruising around the eyes
Nasal obstruction; with septal haematoma, a bilateral, soft, bluish-red swelling of the septum that is fluctuant to palpation

Diagnosis

Clinical: Clinical diagnosis: inspection for deviation, palpation for tenderness and crepitus, and mandatory anterior rhinoscopy with suction and good light to look for septal haematoma. Because swelling hides deformity, the nose is often reassessed after 3 to 7 days.
Tests: Testing of clear nasal fluid for beta-2 transferrin if a cerebrospinal fluid leak is suspected.
Imaging: Plain X-rays add little for isolated nasal fractures. CT of the face when other facial, orbital or skull base fractures are suspected.

Differential diagnosis

Nasal contusion without fracture
Naso-orbito-ethmoid or other midface fracture
Orbital blowout fracture
Basilar skull fracture with cerebrospinal fluid rhinorrhoea
Pre-existing deviation of the nose or septum
Septal abscess (fever and pain after an untreated haematoma)

Goal of treatment

Control bleeding, detect and drain septal haematoma, exclude associated injuries, and restore the nasal airway and shape.

Treatment

Acute: Assess airway and associated head, eye and facial injuries first; control epistaxis with pressure, topical vasoconstrictor and nasal packing if needed.
Procedure: Septal haematoma: urgent incision and drainage, then nasal packing or septal splints to prevent reaccumulation, with antibiotic cover and early follow-up.
Conservative: Undisplaced fractures: cold compresses, head elevation, analgesia and avoiding contact sports for several weeks.
Procedure: Displaced fractures: closed reduction, ideally within about 2 weeks in adults and sooner in children, before the bones set, followed by an external splint.
Surgical: Open reduction or later septorhinoplasty for severe septal deformity, failed closed reduction or persistent obstruction or deformity.

Complications

Septal abscess
Septal perforation and saddle nose deformity from cartilage necrosis
Persistent deviation and nasal obstruction
Impaired midfacial growth in children
Cerebrospinal fluid leak, meningitis and cavernous sinus spread with complex injuries
Nasolacrimal duct obstruction after naso-orbito-ethmoid fractures

Prognosis

Most isolated nasal fractures heal well; timely reduction gives good cosmetic and functional results. Missed septal haematoma is the main cause of preventable long-term deformity.

Prevention

Face protection in contact sports
Seat belts and full-face motorcycle helmets
Fall prevention in older adults and young children
Violence prevention

Test yourself

Think of the answer, then tap the question to see it.

Which finding must always be looked for inside the nose after nasal trauma?

Septal haematoma.

Why is untreated septal haematoma dangerous?

Cartilage necrosis and abscess lead to septal perforation and saddle nose deformity.

Ideal timing for closed reduction of a displaced nasal fracture in an adult?

After swelling settles, within about 2 weeks.

Clear watery rhinorrhoea after facial trauma suggests what, and which marker confirms it?

Cerebrospinal fluid leak; beta-2 transferrin.

Are plain X-rays needed for an isolated nasal fracture?

Usually not; diagnosis is clinical, CT is used for suspected complex facial fractures.

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Educational information, not medical advice. For any symptom, see a health professional.

Sources: Facial trauma (MedlinePlus, US National Library of Medicine, 2026).

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Representative model, for educational purposes only.

Nasal bones highlighted on the Durgical 3D model