Imaging Studies
The use of radiography is controversial. Old fractures, vascular markings, and suture lines can lead to false-positive results. A Water's view can be used to evaluate the bony septum, dorsal pyramid, and lateral nasal walls. However, studies have shown that radiographs are not helpful in the diagnosis or management of nasal fractures. [11]
Computed tomography (CT) scanning is useful to assess for associated injuries, as well as the extent of nasal injury. Septal fractures may be more obviously depicted on these films. Because the nose occupies such a prominent and accessible position, careful examination is possible and may obviate any need for radiographic study.
Photographs are useful and necessary for documentation and for comparison with preinjury photos. Photographs should include the standard angles used in facial analysis: frontal, left and right lateral, left and right oblique, base view, and often a bird's eye or partial base view. A smiling lateral view can also be helpful to evaluate depressor septae nasalis function. While 35-mm film and cameras still allow a superior resolution, digital photography is quickly becoming more prevalent.
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Oblique view.
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Lateral view.
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Nasal septum.
