What could be the cause of a tender nasal bone, runny nose, and pain when bending forward after a head butt injury to the nose, with no fever, bleeding, polyps, masses, or bruising?

Nasal Bone Contusion with Post-Traumatic Rhinorrhea

You most likely have a nasal bone contusion (bruise) from the head butt injury, and the runny nose that developed afterward is likely traumatic rhinitis—inflammation of the nasal mucosa triggered by the impact—rather than a sinus infection or fracture. 1

Understanding Your Symptoms

The combination of nasal tenderness, runny nose developing the same day as injury, and pain when bending forward (without fever, bleeding, or visible deformity) suggests:

• Nasal bone contusion: The tenderness indicates soft tissue injury or bone bruising without fracture 1
• Traumatic rhinitis: Direct trauma causes immediate nasal mucosal inflammation, leading to clear nasal discharge 1
• Sinus pressure: Pain when bending forward can occur from mucosal swelling blocking normal sinus drainage, even without infection 1

Key Reassuring Signs You Have

• No visible deformity: Suggests no displaced fracture 1
• No bruising: Orbital or periorbital bruising would raise concern for more significant injury 1
• No bleeding: Absence of epistaxis is reassuring 1
• No fever: Makes acute bacterial sinusitis unlikely 1

When Imaging Would Be Needed

You do NOT need imaging based on your current symptoms. 1 Imaging would only be indicated if you had:

• Obvious nasal deformity suggesting displaced fracture 1
• Signs of facial fracture (facial swelling, abnormal eye movements, vision changes) 1
• Persistent symptoms beyond 10-14 days suggesting bacterial sinusitis 1
• Clear fluid drainage (suggesting cerebrospinal fluid leak) 1

Recommended Management

Immediate care:

• Apply ice to the tender area for 15-20 minutes several times daily for the first 48 hours to reduce swelling 1
• Use saline nasal spray frequently to keep nasal passages moist and reduce inflammation 1, 2
• Take acetaminophen (Tylenol) for pain—avoid ibuprofen or aspirin initially as they can increase bleeding risk 1

For the runny nose:

• The clear discharge should resolve within 5-7 days as the traumatic inflammation subsides 1
• Continue saline nasal sprays to promote healing 2, 3
• A humidifier may help if your environment is dry 4

Warning Signs Requiring Medical Attention

Seek immediate evaluation if you develop: 1

• Vision changes or double vision
• Severe headache or neurological symptoms
• Clear watery drainage from nose (not just runny nose)
• Fever over 101°F
• Purulent (yellow-green) nasal discharge persisting beyond 10 days
• Worsening facial swelling or pain
• Symptoms that worsen rather than improve after 3-5 days

Expected Timeline

• Nasal tenderness: Should improve significantly within 5-7 days 1
• Runny nose: Should resolve within 5-7 days as inflammation subsides 1
• Pain with bending: Should improve as mucosal swelling decreases over 7-10 days 1

If purulent discharge develops or symptoms persist beyond 10-14 days without improvement, this would suggest secondary bacterial sinusitis requiring medical evaluation. 1