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What happens when you break your nose?

A direct blow to the nose results in one or a combination of the following scenarios:

1. Nosebleed
2. Bruised nose (Contusion)
3. Broken Nose (Fracture)
4. Damaged nasal septum (Septum is the cartilage structure that separates the nasal passages)

A broken nose will result in a crack or break of the nasal bones and in most cases there is usually damage to the nasal septum.

An injury to the nose is characterised by the following symptoms:
1. Pain
2. Bleeding
3. Swelling
4. Sometimes deformity or crookedness
5. Difficulty breathing through the nose
6. If the doctor tries to move the nose and it is broken a grating or grinding noise can be heard

In mild fractures, the injury causes only some mild swelling and a brief nosebleed, so you may be unaware of the break unless your nose heals with a slight deformity. In severe fractures, however, the nose can be obviously deformed or shifted out of its normal midline position immediately after impact. There also may be a severe nosebleed, a blocked nostril or air-flow problems related to a deviated septum (a shift of the nasal septum toward the left or right nostril).

What should you do if you suspect that you have broken your nose?
In the majority of cases players will present with a painful nose that is bleeding. If you are fortunate enough to have a doctor or paramedic available at the field they will attempt to stop the bleeding and once this is under control they will assess the nose in order to establish if there is any further damage to the nose (fracture). As long as there is blood you can leave the field without any stress that you may be putting your team at a disadvantage because you can be substituted and head off to the blood bin for management.
If you are not as fortunate to have medical personal at the field to assist you then you must remove yourself from the field of play and get the bleeding under control.

What must you do in order to manage the blood nose?
Pinch your nostrils firmly together just below the nasal bones for 10 minutes or until the bleeding stops.  Applying ice to the nose helps to stop the bleeding as well as assists in managing the pain. It is advisable to sit upright and lean forward breathing through your mouth at all times.
If the bleeding doesn't stop with pressure, your may need to put a gauze or cotton wool plug in your nose to stop the bleeding.
After the nosebleed stops, try not to blow your nose because the bleeding may start again. Avoid taking aspirin or other anti-inflammatory medicines because they may make bleeding worse.

Can you return to the match?
First and foremost you must have the bleeding under control in the allotted 15 minutes. If you cannot stop the nose from bleeding it is advisable that you sit out for the rest of the game. Another big consideration to make is “How painful is your nose?” – if you still have a lot of pain or increased local tenderness of a particular area of the nose you may have a fracture and it is advisable to miss the rest of the game and only return to contact once that pain and tenderness has settled.

In the majority of noses that are broken but are not displaced the above management of the nose is acceptable. If you suspect a broken nose and you want to confirmation then a standard x-ray can be taken to have a look to see if there are any cracks or breaks in the nasal bones. This particular presentation of the injury often heals without any special intervention needed.
Severe Injury

In the case of a more severe injury to the nose the symptoms of bleeding, swelling and pain are all present but the nose will, in most circumstances, be crooked or have shifted out of position.  

What should you do if you have a nose injury like the one described above?

If you are fortunate enough to have a qualified doctor at the practice or match they may attempt to straighten the damaged nose. This can often be very uncomfortable and most doctors will advise that this procedure (that is having the nose straightened) is done a couple of days later. A very important point to remember is that if you have broken you nose and you had it straightened by the team doctor there may be underlying damage to the nasal septum (that is it may have deviated and not have been restored back to its optimal position). This may result in you having trouble breathing efficiently and in order to correct this you may need surgery.

Most of the time though, when a team doctor suspects a broken nose, he will remove you from the field of play and thoroughly examine the nose. If you do not have a doctor available at field side but you have the above described signs and symptoms it would be advisable to pay a visit to your local doctor so that he can assess the injured/damaged nose and advise you on the management and the way forward.

When examining the nose the doctor will do the following:
1. Look at its shape and symmetry,
2. Note the alignment of its bones,
3. Note the position of the nasal septum
4. Note any obvious areas of deformity or tenderness.

Using a bright light and an instrument (nasal speculum) that gently spreads open your nostril,  he will inspect the inside surface of each nostril and check your nasal septum for a bruise or blood clot. In many cases, no other tests are needed.
He may send you for an x-ray to confirm any bony damage.

If your nose is deformed, the air flow through your nose is obstructed, or you have other symptoms that require specialized care he may refer you to specialist (ear, nose and throat specialist) or a plastic surgeon. These doctors may order additional testing before treating your problem.
In many cases though the nose can be realigned within the first 10 days after injury in a nonsurgical procedure called a closed reduction. After that time, the realignment can be done surgically with a procedure called a rhinoplasty, which reshapes your nose to improve its appearance. (Usually done once you have decided to hang up your rugby boots) When the nasal septum needs to be repaired as well, the procedure is called a septorhinoplasty.

Conclusion

In most cases, the outlook is good, even when surgical treatment is necessary to realign or reconstruct the nose. Please remember though, if you are planning to return to rugby for the remainder of the season, the nose must have healed sufficiently and that all your symptoms have settled before you get involved in the contact aspects of the game.

 

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