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How is it Possible that Xray Would Show No Fracture When Another Doctor Told Me There Was One?

I was in a car accident on vacation and i banged my face really bad. My nose had a contusion and i was taken the the ER. The xray showed a old nasal fracture and a new one. The doctor told me to see a ENT when i got home and most likley i will need rhino. I get home and the ENT does a ct scan and xray and says there is NO fracture at all?! how is this possible? i have a big bump on my nose which was not there before and my nose is more runny, when i wipe it i hear a crackling sound.

Doctor Answers (10)

Nasal fracture imaging

+2

There are several explanations, but as others have said here, xrays are not the best way to diagnose a nasal fracture. However, if the radiologist report and the surgeon both don't see a fracture on a dedicated fine cut axial maxillofacial CT scan, there isn't likely a significant fracture that requires surgical treatment. One thing less commonly noted is you can have a fracture of the cartilage, which makes up the lower 2/3 of your nose. This will usually manifest as a deviated nasal septum with new breathing difficulties. If you have a new nasal deformity after trauma, I would recommend a second opinion with another surgeon. High quality photos of your nose prior to the injury would be most helpful to the surgeon and for getting the surgery covered by insurance.


Bakersfield Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

X ray and nasal fracture

+2

Plain x rays are typically of little value in diagnosing nasal fractures. CT scans are not much better unless there is significant displacement or comminution. History of trauma, nasal bleeding, visible displacement  and clinical exam are more accurate for diagnosis.

Michael L. Schwartz, MD
West Palm Beach Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Fracure of the nose

+2

xrays of the nose are notorious for not demonstrating the actual nasal injury.  physical exam is the gold standard for diagnosing nasal deformities and pathology.

All the best,

Talmage J. Raine MD FACS

Talmage J. Raine, MD
Chicago Plastic Surgeon
4.5 out of 5 stars 8 reviews

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How is it Possible that Xray Would Show No Fracture When Another Doctor Told Me There Was One?

+1

The nose is comprised of bone and cartilage.  While both can be fractured, due to trauma, only bone shows up on XRAY.  Cartilage is clear on XRAY and would not show cracks or fractures.  Palpation and examination, of the nose, would reveal deflections and deviations that point to fractures suitable for Rhinoplasty correction.

Francis R. Palmer, III, MD
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Nasal Fracture is a Clinical Diagnosis

+1

Based on the history described, it sounds as if you fractured your nasal bones.  X rays of the nasal bones are almost worthless and a waste of money; the only reason they are ordered is that many insurance companies will require them in order to confirm the diagnosis.  If you have a new finding of a hump on the top of your nose after the incident, this is likely due to periosteal remodeling, a frequent reaction to a nasal fracture.

Stephen Prendiville, MD
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X rays for nasal fractures

+1

Plain radiographs are not very diagnostic for nasal fractures.  A CT scan is better.  But you do not treat the x ray and the surgeon should address the physical findings even if there are not radiographic changes.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Donald Nunn, MD
Atlanta Plastic Surgeon
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Callous (bump) on the nose after nasal trauma

+1

Dear Sunny day

  • The changes that can occur after a nose is traumatized can include a  bump on the nose  (due to your own body reacting and healing the injury).
  • The xray and CT findings really don't change the situation because you feel like the nose is changed.
  •  Give yourself a few months to let all swelling go down, then grab some photographs from before the accident and compare them with your surgeon.
  • The clicking you are feeling is also not uncommon and can be completely normal,
  • Please discuss the "runny "nose with your doctor, so that he/she can rule out any serious problems.

Best Wishes

Travis T. Tollefson, MD, MPH
Sacramento Facial Plastic Surgeon
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Nasal Fractures Not Easily Detected y Plain X-rays

+1

The diagnosis of fractures of the nasal bones by x-ray is highly unreliable. Nasal fractures are frequently misdiagnosed by plain x-ray films. CT scans are much more accurate and this explains why no actual bone fracture has been detected. At this early point after the injury, the apparent bump and runny nose are all reactions to the injury and should go away in a few weeks. What counts after any nasal injury is how it looks and not what an x-rays says. I would wait a full 6 to 8 weeks after the injury to see how it looks then. It is possible that you have sustained some cartilage damage/misalignment and whether that exists will become apparent when all the swelling has subsided.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
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Xrays of Nasal Fractures

+1

Xrays of the nose are notoriously unreliable after nasal trauma. I rely on physical diagnosis - if there is no change in nasal appearance or breathing function, no treatment is necessary regardless of xray findings. Conversely, I will treat a patient with negative xrays.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
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Nasal fractures and xrays

+1

xrays are really not important    this has been answered in other questions and review.

either the nose is crooked and there are breathing problems or not..  it doesnt matter what the xray shows

the surgeon will treat the patient and not the xray.

 

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 16 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.