The utility of nasal bone radiographs in nasal trauma.

A prospective study was performed to assess the value of nasal bone radiographs taken in the accident and emergency department. The study population consisted of 100 consecutive patients who had nasal bone radiographs in our accident and emergency (A&E) department following trauma. We looked at the casualty officers', radiologists' and ENT surgeons' assessment of the cases. Thirty months later we reviewed the patients' notes to identify the number who sought medico-legal reports on their injury in that interval. We found sporting injuries to be the commonest mechanism of injury, followed closely by accidental falls. The remaining third was made up predominantly of cases of personal assault and road traffic accidents. Only two patients had a naso-pharyngeal history recorded on their visit to A&E. Thirty-five patients were referred to ENT out-patients, only 24 kept their appointment. Thirty-one of the 35 ENT referrals were felt to have a fracture demonstrated on their radiographs. However, 19 of those discharged were also thought to have an X-ray-proven fracture. Thirty months later only two patients had requested a medico-legal report. We demonstrate that the decisions regarding treatment of nasal trauma are based on clinical findings and that nasal bone radiography has no place in the decision making process and should therefore be abandoned.