However, researchers have investigated whether US might be useful in this scenario. Research using US has revealed a very high accuracy with sensitivity ranging from 90% to 100%, a specificity of 98% to 100%, and high predictive values [38,85,86]. This is particularly true of isolated nasal bone fractures [87,88]. According to two reports, US better detects nondepressed fractures of the nasal bridge and anterior septal cartilage deviation than CT [85,86]. A conductor- assisted nasal US technique detected nasal fractures, with 100% sensitivity and 89% specificity, 96% positive predictive value, and 100% negative predictive value [89]. Another study revealed that US is a reliable diagnostic tool for estimating the time of nasal bone fracture [90]. Radiography Paranasal Sinuses Nasal radiographs have limited diagnostic value in the evaluation of nasal trauma. According to several studies, the diagnostic accuracy for radiographs to detect nasal bone fractures ranges from 53% to 82% [91-93]. Radiographs do not considerably alter the diagnosis or management of nasal fractures [94]. CT Head There is no relevant literature to support the use of CT of the head in the initial imaging evaluation of suspected nasal bone injury. CT Maxillofacial MDCT is useful in diagnosing maxillofacial injuries [2,30,31,37-43]. MDCT offers superb delineation of osseous and soft-tissue structures. CT provides high image resolution with thin-section acquisitions allowing for the detection of subtle nondisplaced fractures of the facial skeleton. Also, CT offers multiplanar and 3-D image reconstructions, allowing for better characterization of complex fractures. In particular, many surgeons find the 3- D reformations afforded by CT to be critical in their preoperative planning [13,15,21,39,41,44-46]. In complex nasal injuries and other associated facial fractures, CT can fully characterize the extent of injuries and detect any additional facial injuries [30].
Imaging of Facial Trauma Following Primary Survey. However, researchers have investigated whether US might be useful in this scenario. Research using US has revealed a very high accuracy with sensitivity ranging from 90% to 100%, a specificity of 98% to 100%, and high predictive values [38,85,86]. This is particularly true of isolated nasal bone fractures [87,88]. According to two reports, US better detects nondepressed fractures of the nasal bridge and anterior septal cartilage deviation than CT [85,86]. A conductor- assisted nasal US technique detected nasal fractures, with 100% sensitivity and 89% specificity, 96% positive predictive value, and 100% negative predictive value [89]. Another study revealed that US is a reliable diagnostic tool for estimating the time of nasal bone fracture [90]. Radiography Paranasal Sinuses Nasal radiographs have limited diagnostic value in the evaluation of nasal trauma. According to several studies, the diagnostic accuracy for radiographs to detect nasal bone fractures ranges from 53% to 82% [91-93]. Radiographs do not considerably alter the diagnosis or management of nasal fractures [94]. CT Head There is no relevant literature to support the use of CT of the head in the initial imaging evaluation of suspected nasal bone injury. CT Maxillofacial MDCT is useful in diagnosing maxillofacial injuries [2,30,31,37-43]. MDCT offers superb delineation of osseous and soft-tissue structures. CT provides high image resolution with thin-section acquisitions allowing for the detection of subtle nondisplaced fractures of the facial skeleton. Also, CT offers multiplanar and 3-D image reconstructions, allowing for better characterization of complex fractures. In particular, many surgeons find the 3- D reformations afforded by CT to be critical in their preoperative planning [13,15,21,39,41,44-46]. In complex nasal injuries and other associated facial fractures, CT can fully characterize the extent of injuries and detect any additional facial injuries [30].