Have you ever got involved in a contact sports injury, a slip and fall accident, or any other trauma, leaving you with a nose fracture?
If you jog your memory a bit, you may remember rushing to ER with a bleeding nose, ice packs being applied, x-rays being ordered, and the doctor finally evaluating.
The moot point here is, was the broken nose detected on an x-ray?
Nose Fracture Imaging
In fracture treatments, the gold standard in patient management is the physical examination of the patient by an experienced physician or surgeon. On top of it, radiological studies are obtained to serve as a data point to rule in or rule out various possibilities.
Though nasal bone fractures account for 40% of facial fractures, they are missed when facial swelling is significant. Therefore, assessment is carried out based on radiographic studies.
Conventionally, x-rays or “plain films” of the nose and the adjoining paranasal sinuses (PNS) are ordered to evaluate nasal fractures irrespective of your nose shape.
This is done mainly:
- To assess the number of fractures – single, double, or multiple, as the case may be.
- To assess the fracture type – hairline, compound, oblique, comminuted, etc.
- To know the quality of bone to ascertain the reparation and restoration possibilities.
- To probe if a previous fracture exists.
- To explore injuries to other parts of the nose.
The studies could be either:
- A plain x-ray.
- Conventional pluri-directional tomographic study.
- Computerized Tomography (commonly known as CT).
- Magnetic Resonance Imaging (MRI).
CT and MRI studies are scanning methods.
For critical nasal fractures, the accepted best imaging study that can show any pathology in the PNS and nose is a combination of CT with GdMR using Gadolinium (Gd) as the paramagnetic contrast agent.
How Effective Is An X-ray For Broken Nose?
A few nasal bone fractures are obvious and less painful for the patient. Doctors do not call for x-rays to treat them.
For patients with profuse edema after an injury, a physical examination could be difficult and painful for patients. In such cases, x-rays serve as a handy mechanism to arrive at a diagnosis.
An x-ray image can identify abnormalities in bones and bony tissues. Usually, for identifying and fixing a broken nose, lateral view images are sought to check nasal anatomy, while for nasal arch assessment, Waters view is preferred. In addition, coronal and lateral views of both nasal bones are included.
The effectiveness of a broken nose x-ray – though limited in purpose – helps detect transverse fractures of the nasal bone.
Benefits: In terms of clinical infrastructure, an x-ray apparatus is easily available and accessible even in small clinics and less populous cities compared to CT scanning. Further, compared to other imaging techniques, radiation exposure is minimal.
Limitations: X-rays have their restrictions. These include x-ray exposure variation, positional restriction in trauma patients, the need for multiple views to detect a particular site, etc., which can render it troublesome for patients who are grieving in trauma.
Can Your Nose Cartilage Be Broken Even If Your X-rays Are Negative?
The nasal bone is small and thin, and the nasal septum is made up of the nasal bone and cartilage.
A “broken nose” could mean breakage to nasal bone or disruption of the cartilaginous structures.
An x-ray series is intended to look at the bony structures. Except in cases where there is calcification of the cartilage, x-rays can miss out on the cartilage component, leaving their quality and position undetected. For instance, an x-ray cannot pick up a cartilage dislocation. Cartilaginous malalignments cannot be checked through nose x-rays.
Therefore, you can have a “normal x-ray” and still have a severe breakage or off-positioning of a small or big cartilage which could be serious.
Experienced ENT physicians and surgeons arrive at a diagnosis based on other factors in patient management. They order only the relevant radiographic study after the initial history and physical.
Therefore, misdiagnosis is out of question.
How Much Does A Nose X-ray Cost?
The cost of broken nose treatment includes radiographic charges.
A nasal bone x-ray may cost you around $200, but some facilities could charge more in proportion to the cost of the city where they are. Additionally, more films and views ordered to identify the area of interest could add up the cost.
Currently, health insurance companies cover nasal bone fracture treatment. In some plans from some companies, a copay would be included. Even in such cases, the cost of the x-ray is merged with the overall treatment costs.
However, without a proper insurance plan, patients should be prepared to shell out upwards of $200.
Do Broken Noses Heal On Their Own?
A broken nose, if left untreated, in healthy individuals, can heal on its own if pain, swelling, and bleeding are well-controlled. This is natural in the absence of a severe injury.
However, the anatomical alignment, contour, and functionality may not be as good as before. The nose can also reset itself in an aesthetically displeasing position.
Further, any complication that has set in due to the trauma that caused a broken nose could become permanent. This can critically affect respiration and speech.
Broken noses with minor fissures can heal on their own in around 3-4 weeks.
However, evaluation by an ENT or facial cosmetic specialist would prevent any of the above issues. In addition, they can assist and treat to expedite the natural healing process.
Is A Broken Nose An Emergency?
When broken nose symptoms alleviate on their own with home treatments like applying ice packs, taking paracetamol, sitting upright, etc., people consider it as an absence of any complication. However, this is not true and can prove to be risky.
There are cases where the symptoms could subside and return in a day or two. In this intervening period, patients may return to regular work duty, sports activity, nose piercing, or activities involving aggressive facial movements. This can aggravate the situation or even lead to a second injury.
Some issues could remain hidden without manifesting as a symptom. Hence, any suspicious or confirmed breakage of nasal bone should be evaluated by an ENT physician/surgeon on an emergency basis.
This is crucial because a cosmetologist or an ENT doctor can:
- Examine the nose and check whether a quick reduction is needed.
- Reset the bones in place immediately if required or after a few days to let the swelling subside.
- Analyze the need to order imaging studies and, if required, can guide the patient.
- Recommend broken nose x-ray images at regular intervals before and after fixation are obtained.
- Prescribe appropriate medications.
The golden rule of “when doubtful, consult a doctor” holds good in such situations.
As a standard treatment, in many cases, a closed reduction of the fracture under general anesthesia after two to 10 days of injury is required.
Failed treatments are addressed by rhinoplasty, septoplasty, or a combination of both.
Therefore, not treating a broken nose as an emergency could jeopardize the nasal anatomy and physiological function.
What Happens If A Broken Nose Is Untreated?
The nose, being centrally located, is the first part to take a hit. In altercations, sports injuries, slip and falls, MVAs, etc., the nose is more vulnerable to injuries.
A broken nose can impact three significant parameters:
Aesthetic: The cosmetic appearance can diminish. It may lead to crooked nose formation. In some cases, even the nose size can change. It can also lead to nonaesthetic but structural deformities internally, like a deviated septum, shifted septum, or perforated septum.
Functional: Primary function of inhalation, exhalation, and filtration of air entering the lungs are affected. It can compromise lung function. Speech can become dysphonic, and the voice may turn strained or breathy. Trouble breathing, a potentially dangerous condition, is one consequence. An unattended broken nose can result in permanent nasal obstruction.
Psychological: A cosmetically displeasing nose, even though well-functioning, can be psychologically depressing to patients. It has been noted to diminish the performance of individuals in competitive sport activities like hurling, rugby, Gaelic football, soccer, etc.
Barring the above, a nasal fracture, if left untreated, can:
- Precipitate sinusitis or any other infection, if already present.
- Affect sleeping. Excessive snoring, even though benign, could set in.
- Increase the sensitivity to allergies.
When Should You Consult Your Doctor?
A clear assessment of the nose condition after a trauma can be made only by your physician. Therefore, establishing contact with an ENT doctor after facial or nasal trauma is highly recommended.
In case of mild injuries, once the swelling goes down completely and pain is either nil, bearable, or controlled with pain medications, you can postpone visiting your doctor.
However, an otolaryngologist consultation is essential if:
- The pain is a) unbearable, b) recurrent, or c) unresponsive to pain medications.
- The swelling increases or displays on and off with or without medications.
- In the absence of pain or swelling, your nose looks crooked.
- You experience shortness of breath.
- You notice frequent nosebleeds.
- You spot sporadic fluid discharge from either nostril or both nostrils.
- Your temperature spikes with inexplicable fever.
- You suffer severe, continuous, or intermittent headaches.
- You throw up a lot after eating, drinking, or resting.
- You have difficulty swallowing.
- You suddenly black out or pass out.
Rather than serving as conclusive evidence of a fracture, a broken nose x-ray is more of a screening test to evaluate further.
However, from a medico-legal perspective, if the cause of the fracture is a suspected assault arising from verbal duels or altercations, a broken nose x-ray serves as additional legal evidence where the victim would like to press charges. From a forensic standpoint, a reliable diagnosis is critical to prevent injustice and validate the complaints.
Despite technological advancements in radiographic studies, an x-ray of a broken nose is still considered an adjuvant, along with CT in critical nose fractures.