• Dom. Jul 14th, 2024

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Kylian Mbappe’s broken nose, the medical assessments and the pros and cons of protective masks

The Athletic


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“It looked pretty nasty and it’s not ideal — but it’s not a disaster, is it?” says the former England and Newcastle striker Alan Shearer. “Crack on. It’s a broken nose, not a broken leg.”

He is referring to the collision between Kylian Mbappe and Kevin Danso during France’s 1-0 win over Austria in Dusseldorf on Monday. As Mbappe attempted to head the ball, his face crashed into Danso’s shoulder. Scans later revealed he had broken his nose.

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Shearer would know. He broke his nose twice within the space of eight weeks. The most painful was when he and former team-mate Rob Lee “smashed into each other” during Newcastle’s 3-2 win at Derby County in April 2002.

“I had a big hole in my nose,” he says. “It was bleeding, sore, throbbing, a little bit wonky, but you soon get over it. It’s not as if you’ve snapped your cruciate or broken your ankle.”


Shearer receives treatment after clashing with Lee (Nick Potts – PA Images/PA Images via Getty Images)

This is true, though every situation is different. France manager Didier Deschamps was certainly not optimistic post-match, describing the injury as a “black mark” on France’s victory. At least Mbappe left a Dusseldorf hospital in the early hours of Tuesday morning reassured that he would not require surgery for the time being and a mask would be fitted to enable his return to play.

The French Football Federation has not confirmed whether he will be fit to play against the Netherlands on Friday in arguably France’s toughest group game at Euro 2024. But what are the chances of his involvement and what are the consequences for the rest of the tournament?

The Athletic has spoken to nasal experts to find out more about the injury and likely recovery process — they did not all agree — as well as mask-making, and consulted former England internationals Shearer and Faye White to glean their experiences of how the injury and wearing a protective mask affected them.


The damage?

“The nose is made up of several bony structures at the top of the nose,” explains Robin Youngs, a former consultant ear, nose and throat (ENT) surgeon at Gloucestershire Hospitals.

“Then there are other structures made out of cartilage — that’s the soft bit of the nose lower down — and then there is the nasal septum, a bit of cartilage and bone that separates the right from the left nostril that goes down the middle. All of those things can be damaged.”

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The nasal bones are attached to the bones of the face, called the maxilla. When the bones are fractured they are either ‘displaced’ or ‘undisplaced’. Fahmy-Fayez Fahmy, consultant ENT surgeon at Cambridge University Hospital, thinks Mbappe’s injury is a displaced fracture to one side — a very common sporting injury, particularly in rugby.

“The whole of the nasal pyramid, effectively his nasal bones, have shifted, almost like a wonky tent,” he explains. “It’s a lucky injury because you can sustain much more serious injuries with a frontal impact.”


Mbappe inadvertently heads Danso’s shoulder (Lars Baron/Getty Images)

Mbappe has not had surgery, which, according to Manuel Chamorro, head of maxillofacial surgery at the Quiron Ruber Juan Bravo hospital in Madrid, means the nose has been straightened. “It will not remain displaced,” he says. There have been reports in France that the nose was reset by the team’s medical staff in the changing room immediately after the final whistle on Monday.

The bones are reset to their normal position by manipulation, a procedure that does not require surgery and does not interfere with the integrity of the nasal framework. “The decision to operate is normally based on the cosmetic appearance of the nose,” says Youngs, who adds Mbappe may have opted against surgery to minimise any time on the sidelines.

Deschamps, the French head coach, has confirmed further examinations will take place in the next few days and has not ruled out Mbappe undergoing surgery in the future.

The swelling around Mbappe’s nose may last for about seven to 10 days, according to Fahmy. Crucially, the nose needs some form of protection for a couple of weeks.


The return to play?

“If he has to miss one game, I would understand,” says Shearer. “But I’d be amazed if he’s going to miss more than one.”

The player’s view is not shared by all on the medical side.

In Chamorro’s opinion, contact sport should be avoided. “After such a fracture, I would recommend at least a month’s recovery. In the acute phase, the bones have to be put in place and I would wait a while because the mucosal damage takes time (to heal). It’s difficult for him to play again in the European Championship, honestly.”

But it is a major tournament. Mbappe is not going to wait around. That said, the French have to be sensible. Risking their star player for one game, albeit a difficult one against the Netherlands, having already endured a scare would be shortsighted.


A bloodied Mbappe in Dusseldorf (Charlotte Wilson/Offside/Offside via Getty Images)

Fahmy holds a different view from Chamorro.

“He would need a few days’ rest,” Fahmy says. “It’s unlikely he’ll play the next game. Not only do you have a fractured nose but you have swelling around the nasal area and eyelids. It will be uncomfortable. I don’t think they would risk him (against the Dutch), but he should be fit enough to play the following game (against Poland next Tuesday).

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“He will have a blocked nose. It’s not disastrous. Rugby players break their nose and they play two days later. It’s definitely not something that will hamper his chances to go all the way.”

There have been many previous examples of footballers continuing to play with broken noses, but that does not stop it from weighing on their minds.

“There’s always a chance of getting an elbow or a flailing arm,” says Shearer. “Even if you mistime your header and it hits your face, you have to be aware of that.” The former striker notes that, although Mbappe sustained the injury by going up for a header, his aerial skill is not the strongest part of his game.

“His game is all about balance, technique and running with the ball. It’ll be different for him. But I don’t see it being a huge problem. Once you’re out there, it’s normal, you just forget about it and get on with it.”


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There are risks to consider, though.

“It will almost certainly cause swelling and respiratory insufficiency,” says Chamorro. “I wouldn’t play in a competition no matter how many masks he wears. He’s going to spend three months afterwards (attempting) to avoid problems.”

Mbappe will have what Fahmy describes as a “blocked stuffy nose” for at least the next two weeks. “It will affect fitness levels, nasal breathing, the ability to deliver air to his lungs through the nose, but he’s not going to be short of breath,” he says. “If you play sport when you have a cold, you can breathe through your mouth. It’s not going to be detrimental to your competitive level.”

Another concern with a recent broken nose is bleeding.

“If he played again soon afterwards he might get a nosebleed during the game,” says Youngs. “Bleeding from a broken nose can be quite severe and potentially a serious condition.”

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Loss of blood is never good. To stop the flow, surgery would be required to insert dressings into the nose — but Fahmy suggests bleeding happens in the first 24 hours and then is “extremely unlikely” to reoccur.

Shearer recalls his nose bleeding and taking a couple of days to settle down. “I just remember having to shove the odd bit of cotton wool up there to stop it,” he says. He did not have any problems with his breathing.


Shearer with stitches in his nose back in 2002 (John Walton/EMPICS via Getty Images)


The masked striker?

There is a good track record of players successfully playing in masks. Mbappe will have one custom-made to protect the nose from further injury and hold the external part of the nose — the bit you can see — firmly in place.

“It’s like a broken bone; you push it back to the correct position, but it’s still not healed,” says Fahmy. “You have a hairline fracture running across the nasal bones and this will be weak. A minor impact can potentially displace it again.

“If I have a fracture and I’m just going to work, I don’t need protection. But if I’m going to go and play contact sports, I will need protection for the next two weeks.”

The mask will be moulded to the shape of his face, so it fits snugly. Nowadays, facial construction experts are more likely to use scans and 3D imaging to make the protective face-wear.

Manchester City’s Josko Gvardiol, who broke his nose playing for former club RB Leipzig, wore a mask at the 2022 World Cup. The German club contacted Leipzig’s university hospital, whose specialists designed the device especially for him.


Gvardiol sporting his mask with Croatia at the 2022 World Cup (Simon Bruty/Anychance/Getty Images)

The masks are usually made of a strong, light, thin material such as carbon fibre or thermoplastic and fit around the mid-face. For the first two to three days, Gvardiol initially had problems wearing the mask because it limited his vision and he had to adjust his breathing, but gradually he got used to it.

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Shearer wore a small metal protective splint over his nose instead because he found a mask “uncomfortable”. White, another former England captain, has broken her nose three times and had to adjust to wearing a mask to protect a fractured cheekbone in the final of Euro 2009 against Germany.

She had flown back to London from Finland, where the women’s European Championship was being staged, to have her face scanned after undergoing surgery. While White’s and Mbappe’s masks may vary in design, the concept remains the same.

“It was a little bit too tight-fitting around my nose so I had to shave the mask the night before so it wouldn’t dig in so much,” the former Arsenal defender tells The Athletic.

“I got to train in it, but your peripheral vision is affected slightly. Every now and then, I had to tilt my head down unnaturally to double-check the ball was where I thought it was. When you play without a mask, you don’t have to do that, you know exactly where the ball is.”

Tottenham’s Son Heung-min, who wore a mask having suffered a fracture around his eye socket in 2022, also expressed difficulty seeing the ball. Mbappe may not encounter this issue given his is a nasal injury, but it depends on how big the eye hole is in his mask.


A masked White takes on Germany’s Birgit Prinz during the final of the women’s European Championship in 2009 (Lars Baron/Bongarts/Getty Images)

The other consideration is the discomfort of wearing the mask simply because of the pain and swelling.

A mask would be a “solution” but is not “optimal”, according to Chamorro.

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“To put a mask on and go out to play on Friday… I don’t see it. It is a very acute phase of the injury. The player is going to be very uncomfortable. I would wait a week, do a scan and see how the nose is. Let’s not rule out having to check it in the operating theatre. I see it as very difficult to play in the short term.”

From a player’s perspective, however, there will be impatience to return.

“You have your mindset,” says White. “You play through the pain because of how big the games are.”

Of course, there is also the risk that, if Mbappe returns to play, he could break his nose again.

“In competitive sport, it’s very complicated,” adds Chamorro. “Any elbow or blow can multiply the problem. It looks like he was lucky and I wouldn’t gamble with it.”

Fahmy, however, has a different opinion. “It can be fixed again. Rugby players do it all the time. Once it has healed, the bone is not weaker. For the first two weeks, you need protection but you can fracture it again. When someone has rhinoplasty, or a nose job, where you have actually interfered with the nasal framework and lose part of it, that makes your nose more vulnerable to injuries.

“But a fractured nose, you fix it, it heals. You can fracture it again without anything disastrous happening.”

That sounds more promising for the French. Mbappe has yet to score in a European Championship. Even if he is not risked in Leipzig later this week, the World Cup winner will be desperate to return and make a positive impression.

Real Madrid’s new striker, whether clad in a mask or not, remains a man on a mission in Germany.

(Top photo: Robbie Jay Barratt – AMA/Getty Images)