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

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.

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.

 

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

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.

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.

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.

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.

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.

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.

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