nose injury to child

My 4-year-old daughter suffered a bad fall recently - she was standing on a chair and fell face-first onto a concrete floor.  She had a terrible nose bleed and significant swelling around her nose, lips, eyes, and forehead.  We took her to the E.R., where they determined that she had not suffered a concussion, and she has had some follow-up visits to her pediatrician to address eye infections and an ear infection that arose in the few days after the fall.  

Now that the initial stress has passed, and we know that she didn't suffer a concussion or any more serious injury, I am starting to worry about whether there has been damage to her nose.  The swelling on the rest of her face has subsided almost completely, but her nose hasn't returned to its original shape.  It is wider and flatter than before, particularly across the bridge of the nose under the eye-line -- it now feels as if the cartilage has spread out and is much broader than before, almost like a boxer who's had his nose smashed in too many times.  (I had initially thought this was just swelling, but it actually feels very firm.)

She also seems to have difficulty breathing, as if she's constantly congested, particularly at night.  I'm hoping this is just residual swelling, but I was wondering if it could possibly be from damage to her nose.  (A few friends have had to get surgery to fix deviated septums caused by childhood injuries, and I'm wondering if this kind of damage is a possibility.

So my questions are (1) whether it's possible that the fall has permanently changed the shape of her nose, (2) whether it's likely that the fall has caused damage affecting her ability to breathe easily, and (3) if so, whether there's anything that can be done at this age to correct those things.  (And, I suppose, what kind of doctor you'd suggest we bring her to, if that's the case.)

Thank you.

[Howard Rosenberg, MD]

While I doubt that any surgeon would undertake any treatment of a four year old, it would be worthwhile to have her examined either by an otolaryngologist or a plastic surgeon. Time will tell (usually by puberty) whether there is a problem as growth of the nasal bones and septum result in either a cosmetic or a functional problem.  If so, treatment would be more appropriate at that time.  Any surgical treatment now might affect growth centers that could condemn her to more problems later.

[mani146]

A related discussion, Accidentally nose middle bone deviated in right side nose and turbinates surgery was started.