Comparison of ultrasonography with computed tomography in the diagnosis of nasal bone fractures

Abstract

Objectives: The aim of this study is to compare ultrasonography with CT in the diagnosis of nasal bone fractures. Methods: 40 patients (9 female and 31 male) with mid-facial fractures, which were suspected nasal bone fractures, were included. All of the patients had mid-facial CT images. Ultrasonography with a 7.5 MHz transducer (Aloka 3500, Tokyo, Japan) was used to evaluate the nasal bone fractures. All of the sonograms were compared with CT findings for sensitivity, specificity and predictive values. A x 2 test was applied to the data to assess statistical significance. Results: CT diagnosed nasal bone fractures in 24 of the 40 patients (9 unilateral fractures and 15 bilateral fractures) while ultrasonography diagnosed the fractured bones in 23 patients (9 unilateral fractures and 14 bilateral fractures). Ultrasonography missed one fractured bone in a bilateral fractured case and a unilateral fracture was also missed (two false-negative results). The sensitivity and specificity of ultrasonography in assessing nasal bone fracture in comparison with CT were 94.9% and 100%, respectively. The positive predictive value (PPV) and the negative predictive value (NPV) of ultrasonographic evaluation of the nasal bone fractures were 100% and 95.3%, respectively. The x 2 test did not show any significant difference between CT and ultrasonography in diagnosis of nasal bone fractures (P 5 0.819). Conclusion: Ultrasonography can be used as a first line of diagnostic imaging for evaluating nasal bone fractures, especially in children and pregnant women.

Ultrasonography in the diagnosis of nasal bone fractures: a comparison with conventional radiography and computed tomography

“…Recently, US has been introduced as an alternative technique for the evaluation of maxillofacial fractures because it is easy and quick to perform, inexpensive, portable, noninvasive, and does not involve the use of radiation [7,10,13]. The diagnostic merits of HRUS for the diagnosis of nasal bone fractures compared with conventional radiography have been demonstrated, especially in pregnant women and child [4,10,13,18,19]. Furthermore, HRUS was reported to be a reliable diagnostic tool for estimating the time of nasal bone fracture [20] and higher frequency probes provided higher resolution of the nasal pyramid, especially of the nasal dorsum [14].…”

“…Early and accurate recognition and treatment of nasal trauma are important, because incorrect diagnosis and treatment can lead to later deformity [3]. Although clinical examinations are considered standard for diagnosing nasal fractures, hematoma and edema of adjacent tissues make it difficult to diagnose them [4]. Conventional radiography remains the standard imaging procedure, but water's view targeting the lateral nasal walls is prone to misinterpretation [5,6].…”

“…Computed tomography (CT) is considered a gold standard for diagnosing complex facial fractures, especially mid-facial fractures [7][8][9]. However, CT is expensive, not readily available, and exposes the patient to high doses of penetrating radiation [4]. Furthermore, CT images are not always good enough to diagnose nasal fractures.…”

Role of Ultrasonography in Oral and Maxillofacial Surgery: A Review of Literature

“…It is contraindicated in pregnant women and in patients with cervical spine injuries. It has traditionally been used in the diagnosis of orbital and ocular lesions, but its role in maxillofacial trauma was not well recognized till the 20th century [36][37][38][39]. McCann et al used ultrasound with 85 % accuracy in diagnosing fractures of the zygomatico-orbital complex (ZMC).…”

“…12) and the anterior wall of the frontal sinus [36]. It can be an alternative primary technique in the diagnosis of nasal bone fractures, especially in pregnant women and children along with intraoperative evaluation of repositioning of the nasal bone [37]. The discontinuity is seen on the outer table of the bone if examined under it.…”