Head and Neck Imaging

Nasal fracture

The nose is easily injured due to its protruding anatomy. Isolated nasal fractures are very common and in fact do not require a radiographic examination, as they can usually be assessed by clinical means; radiography would be useful if some prediction could be made as to the function and the shape of the nose after treatment, but this is not possible. Films are usually taken for medicolegal reasons. The normal grooves in the nasal skeleton, in which the nasociliary nerves and vessels run, should not be misinterpreted as fractures; lucent lines are also produced by the sutures between the frontal process of the maxilla and the nasal bones. On a lateral X-ray, these normal lucent lines run parallel or slightly oblique to the nasal surface. Most fractures involve the thinner distal third of the nasal bones. More sophisticated imaging is of no use in the case of isolated nasal fractures.

An anteriorly placed nasal blow fractures both nasal bones at their lower end; the force is absorbed by the nasal septum, displacing and fracturing it. A septal haematoma will interfere with the vascular supply of the cartilage and can become infected: necrosis can occur, potentially resulting in a saddle nose deformity. A fracture of the anterior nasal spine can be associated with damage of the cartilaginous septum.

If a small object hits the nasal bridge with higher energy, a naso-orbital or nasoethmoidal fracture can result; see facial fracture.

RH