Identification of Nasal Bone Fractures on Conventional Radiography and Facial CT: Comparison of the Diagnostic Accuracy in Different Imaging Modalities and Analysis of Interobserver Reliability

Baek, Hye Jin; Kim, Dong Wook Nathan; Ryu, Ji Hwa; Lee, Yoo Jin

doi:10.5812/iranjradiol.6353

Cited by 24 publications

(18 citation statements)

References 11 publications

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“…In total, there were three additional fractures detected by CT. Similar results were found in a study by Baek et al, [19] where unilateral and bilateral simple displaced fractures formed 69.3% of total cases (88). They showed that accuracy of nasal bone X-ray in detection of fracture ranged from 66% to 76%.…”

Section: Discussionsupporting

confidence: 91%

Diagnostic tools in maxillofacial fractures: Is there really a need of three-dimensional computed tomography?

Shah

Uppal

Mittal

et al. 2016

Indian J Plast Surg

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Introduction:Because of its functional and cosmetic importance, facial injuries, especially bony fractures are clinically very significant. Missed and maltreated fractures might result in malocclusion and disfigurement of the face, thus making accurate diagnosis of the fracture very essential. In earlier times, conventional radiography along with clinical examination played a major role in diagnosis of maxillofacial fractures. However, it was noted that the overlapping nature of bones and the inability to visualise soft tissue swelling and fracture displacement, especially in face, makes radiography less reliable and useful. Computed tomography (CT), also called as X-ray computed radiography, has helped in solving this problem. This clinical study is to compare three-dimensional (3D) CT reconstruction with conventional radiography in evaluating the maxillofacial fractures preoperatively and effecting the surgical management, accordingly.Materials and Methods:Fifty patients, with suspected maxillofacial fractures on clinical examination, were subjected to conventional radiography and CT face with 3D reconstruction. The number and site of fractures in zygoma, maxilla, mandible and nose, detected by both the methods, were enumerated and compared. The final bearing of these additional fractures, on the management protocol, was analysed.Results:CT proved superior to conventional radiography in diagnosing additional number of fractures in zygoma, maxilla, mandible (subcondylar) and nasal bone. Coronal and axial images were found to be significantly more diagnostic in fracture sites such as zygomaticomaxillary complex, orbital floor, arch, lateral maxillary wall and anterior maxillary wall.Conclusion:3D images gave an inside out picture of the actual sites of fractures. It acted as mind's eye for pre-operative planning and intra-operative execution of surgery. Better surgical treatment could be given to 33% of the cases because of better diagnostic ability of CT.

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Section: Discussionsupporting

confidence: 91%

Diagnostic tools in maxillofacial fractures: Is there really a need of three-dimensional computed tomography?

Shah

Uppal

Mittal

et al. 2016

Indian J Plast Surg

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“…Interestingly, nasal bone with mandible fractures was less associated with falls, (OR: 0.085, 95% CI: 0.01‐0.57, P = .0125), which may be due to a single, localized impact of relatively lower velocity that protects the midface. Most patients at the study institution underwent maxillofacial CT as part of their workup (85%), which is higher than other series . The rate of CT is likely higher in regional level 1 trauma centers, given the severity and scope of presenting injuries in this population.…”

Section: Discussionmentioning

confidence: 86%

“…Most patients at the study institution underwent maxillofacial CT as part of their workup (85%), which is higher than other series. 6,29 The rate of CT is likely higher in regional level 1 trauma centers, given the severity and scope of presenting injuries in this population.…”

Section: Epidemiologymentioning

confidence: 99%

Septal fractures predict poor outcomes after closed nasal reduction: Retrospective review and survey

2018

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Objectives/Hypothesis To determine outcomes of patients with displaced nasal bone fractures after closed nasal reduction (CNR). Study Design Retrospective patient review. Methods Review of all patients presenting to the emergency department of a tertiary‐care, level 1 trauma hospital with a nasal bone fracture over a 2‐year period, followed by telephone survey after CNR. Results Six hundred seven patients presented to the emergency department in 2015 and 2016 with a diagnosis of nasal bone fracture. Of these, 134 patients met inclusion criteria and underwent CNR without septal reduction. Those with sports‐related injuries and those with a septal fracture identified on computed tomography imaging were significantly more likely to undergo CNR. Ninety‐one patients completed the post‐CNR telephone survey. Over 90% of patients were satisfied with the procedure. However, patients with septal fractures reported worse outcomes, as 53.6% versus 24.1% (P = .0025) disagreed that CNR improved nasal breathing. Of all patients, 11 (2%) eventually underwent septorhinoplasty, with the presence of septal fracture on imaging a significant risk factor. Conclusions Nasal bone fractures are a common injury, often managed initially with CNR. Patients with septal fractures should be counseled on the high risk of posttraumatic nasal deformity and obstruction despite CNR. In addition, addressing a septal fracture found on imaging may be warranted with either closed septal reduction or early aggressive management given the poorer outcomes seen in the present study. Although these patients are more likely to have definitive treatment, many forego later intervention despite persistent symptoms, emphasizing the need for early intervention or close follow‐up. Level of Evidence 3Laryngoscope, 129:1784–1790, 2019

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“…These studies are further limited by their inability to detect cartilaginous injuries, which are more prevalent in pediatric cases. 4,6 For this reason, it is very important to have a radiologist with experience in nasal bone X-rays and to combine the lateral view with a frontal Waters view. In our country (Chile), X-rays have a legal importance, because as we show in this study, if they are informed correctly by a qualified specialist, they have an adequate diagnostic capability.…”

Section: Discussionmentioning

confidence: 99%

A Five-Year Retrospective Cohort Study Analyzing Factors Influencing Complications after Nasal Trauma

Andrades

Pereira

Rodriguez

et al. 2019

Craniomaxillofacial Trauma & Reconstruction

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The purpose of this study was to assess the outcomes of patients with nasal trauma during a long period of time and determine factors predisposing to complications after nasal trauma treatment. A retrospective cohort study was conducted that included all patients who were attended for a nasal trauma between January and December 2010. In 2015, the charts were retrospectively reviewed and the patients were prospectively followed up looking for outcomes after treatment of nasal trauma. A univariate analysis between complications and risk factors was performed and a logistic regression model was used to explore the prognostic role of the variables considered to have clinical relevance and to estimate the odds ratio for the occurrence of postoperative complications. A total of 220 consecutive patients with nasal trauma were included in the study. The mean follow-up was 44.3 ± 10.3 months (3–67) with 10% of lost patients. The most important factors determining complications after nasal trauma treatment were male gender, acute septal injury, chronic septal deviation, displaced or comminuted fractures in the radiologic study, and late nasal reduction surgery. A decision-making algorithm is proposed based on the fact that nasal bone fracture is not a minor problem and that closed nasal bone reduction is not the treatment of choice for all patients with nasal trauma.

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Identification of Nasal Bone Fractures on Conventional Radiography and Facial CT: Comparison of the Diagnostic Accuracy in Different Imaging Modalities and Analysis of Interobserver Reliability

Cited by 24 publications

References 11 publications

Diagnostic tools in maxillofacial fractures: Is there really a need of three-dimensional computed tomography?

Diagnostic tools in maxillofacial fractures: Is there really a need of three-dimensional computed tomography?

Septal fractures predict poor outcomes after closed nasal reduction: Retrospective review and survey

A Five-Year Retrospective Cohort Study Analyzing Factors Influencing Complications after Nasal Trauma

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