CT Imaging Indications and Alternatives in Nasal Trauma

Indications for Maxillofacial CT

The American College of Radiology recommends CT maxillofacial without IV contrast when a patient has suspected complex injuries or associated facial fractures (e.g., naso‑orbital‑ethmoid, Le Fort, zygomaticomaxillary complex)【1】.

Plain radiographs demonstrate poor diagnostic accuracy (approximately 53‑82 %) and do not change clinical management in nasal trauma patients【1】.

CT provides high‑resolution detection of subtle, non‑displaced nasal bone fractures through thin‑section acquisitions【1】.
Multiplanar and three‑dimensional reconstructions from CT are essential for surgical planning in complex facial fractures【1】.
CT offers comprehensive characterization of injury extent and identifies additional facial fractures beyond the nasal bones【1】.
Compared with radiographs, CT has superior sensitivity for confirming nasal bone fractures【1】.

For isolated nasal bone fractures, point‑of‑care ultrasound can be used, showing 90‑100 % sensitivity and 98‑100 % specificity【1】【2】.
In some cases, ultrasound detects non‑displaced fractures and anterior septal cartilage deviation better than CT【1】.

Approximately 68 % of patients with maxillofacial trauma have concomitant head injuries; therefore, when signs of intracranial injury or additional facial fractures are present, a head CT is indicated【3】.
The American College of Radiology states that a head CT is not required for isolated nasal bone injury without other concerning findings【2】.

The American College of Radiology recommends imaging for nasal trauma when visible or palpable nasal deformity, tenderness to palpation of the nose, epistaxis, suspected complex injuries or associated facial fractures, or deep lacerations with exposed cartilage are present 4, 5
Imaging is indicated for patients with nasal trauma who have suspected complex injuries or associated facial fractures, according to the American College of Radiology 5, 6

The American College of Radiology recommends CT maxillofacial without IV contrast as the preferred imaging modality for nasal trauma, offering superior fracture detection and characterization compared to plain radiographs 4, 6
CT maxillofacial provides superior sensitivity for detecting nasal bone fractures, with higher detection rates compared to radiographs 7, 5
CT maxillofacial allows for high-resolution thin-section acquisitions to detect subtle nondisplaced fractures, and multiplanar and 3D reconstructions for better characterization of complex fractures 8, 7, 5
Ultrasound may be considered as an alternative for isolated nasal bone fractures, with very high accuracy, sensitivity of 90-100%, and specificity of 98-100% 7, 5, 6

CT head is not indicated for isolated nasal bone injury, but may be warranted if there are signs of intracranial injury or other associated facial fractures 8, 7, 9
Chest radiograph is only indicated if a tooth is absent to exclude aspiration 8, 7, 4