The Role of Radiological Imaging in Pediatric Nasal Fractures: Too Much, Too Often?

Nasal fractures are the most common facial fractures in the pediatric population. Imaging is usually not necessary for isolated nasal trauma, but nasal X-ray and facial computed tomography (CT) are still frequently performed.

The aim of this study is to evaluate the appropriateness of radiological imaging in the management of nasal fractures.

We collected data on patients with a history of nasal trauma who underwent radiological imaging (X-ray or facial CT) from the electronic medical records of our hospital over a 3-year period.

We analyzed data from 534 patients who were admitted to our Emergency Department for nasal trauma and underwent radiological imaging (38% female, 62% male, median age 8.5 years, range 1-17 years). 293 patients (55%) underwent nasal X-ray, and 344 patients underwent facial CT (64%). For 302 patients (56%) a nasal fracture was identified on X-ray or CT and 18% of patients underwent surgery. For all patients who required nasal surgery, a facial CT was performed. Facial CT scans detected a nasal fracture more frequently than a nasal X-ray (74% vs. 43% p-value 0.00001). Patients who underwent surgery were more often male and more frequently presented with epistaxis at onset.

Our data confirmed that nasal X-rays may be of limited use after facial trauma. Furthermore, we highlighted that radiological imaging for nasal trauma could potentially be reduced given that a substantial number of patients underwent nasal X-ray or facial CT without presenting a nasal fracture or requiring surgical intervention.