Nasal fractures, occurring after either intentional or accidental trauma, are fairly common in clinical practice. Displacement of the nasal bone, epistaxis, local ecchymoses, edema, and tenderness are the main clinical features. The diagnosis relies on details obtained during history taking, findings from physical examination, and if necessary, imaging studies.
Nasal fractures are one of the most common forms of facial trauma in medical practice, with certain reports suggesting that they comprise up to 40% of all skeletal fractures   . They arise from trauma in virtually all cases, the most common form being a blunt trauma during contact sports  . In children, sports-related activities are the events leading to fracture, whereas motor vehicle accidents, falls, and intentional injuries, in addition to sports, are common causes in adults  . Many reports have confirmed that the peak incidence of nasal fractures is seen in adolescents around 20 years of age and that males suffer from nasal fractures much more frequently than women  . Depending on the mode of injury, patients present with a variable appearance of the nasal bone. It may be displaced outwardly after a lateral blow or depressed posteriorly after a direct blow to the nose . In some patients, however, the deformity might not be apparent . In addition to anatomical changes (nasal shortening, widening of the nasal base and malposition are also seen) epistaxis is the prominent symptom, indicating a more pronounced fracture   In addition, ecchymoses, local tenderness, edema, and crepitus are frequently noted   . In severe fracture, leakage of the cerebrospinal fluid (CSF), termed CSF rhinorrhea, changes in mental state, and limited movement of the eyes might be observed, in which case injuries of other anatomical structures should be excluded  . In fact, it is not uncommon for nasal fractures to be accompanied by additional maxillofacial or cervical injuries, especially in severe trauma .
The diagnosis of a nasal fracture can be easily made with a proper clinical workup consisting of a detailed patient history and a physical examination. The exact mechanism of injury, including the direction, the intensity and circumstances under which it occurred, should be revealed during history taking, whereas a detailed inspection and palpation of the nose, but also the surrounding structures (the orbit, the mandible, the teeth, zygomatic arches and the cervical spine) are vital steps in recognizing the extent of trauma    . If an apparent displacement of the nose is evident during the exam, a definite diagnosis is made solely on clinical criteria, but in the setting of an apparently normal anatomical appearance, imaging studies are necessary to validate clinical suspicion   . Plain radiography is considered to be a useful initial method for the detection of nasal fractures, with very high rates of diagnoses . Certain reports, however, have established that ultrasonography (US), particularly high-resolution (HRUS), may be a superior method compared to X-rays in this particular setting   . Computed tomography (CT), a definite imaging procedure that can confirm the exact site of the fracture, but also identify additional head injuries, is not widely used due to its high radiation dose and exposure to the lens and the thyroid gland   . Despite the important role of imaging studies in the evaluation of nasal fractures, clinical awareness is pivotal in making an early diagnosis  .