THE UTILITY OF NASAL BONE RADIOGRAPHS IN NASAL TRAUMA

A prospective study was performed to assess the value of nasal bone ra diographs taken in the accident and emergency department. The study po pulation consisted of 100 consecutive patients who had nasal bone radi ographs in our accident and emergency (A&E) department following traum a. We looked at the casualty officers', radiologists' and ENT surgeons ' assessment of the cases. Thirty months later we reviewed the patient s' notes to identify the number who sought medico-legal reports on the ir injury in that interval. We found sporting injuries to be the commo nest mechanism of injury, followed closely by accidental falls. The re maining third was made up predominantly of cases of personal assault a nd road traffic accidents. Only two patients had a naso-pharyngeal his tory recorded on their visit to A&E. Thirty-five patients were referre d to ENT out-patients, only 24 kept their appointment. Thirty-one of t he 35 ENT referrals were felt to have a fracture demonstrated on their radiographs. However, 19 of those discharged were also thought to hav e an X-ray-proven fracture. Thirty months later only two patients had requested a medico-legal report. We demonstrate that the decisions reg arding treatment of nasal trauma are based on clinical findings and th at nasal bone radiography has no place in the decision making process and should therefore be abandoned.