Diagnostic value of ultrasound for identification of nasal fracture

Background: Nasal fracture is a common fracture due to trauma. Gold standard method in diagnosis of nasal fracture is clinical examination and radiography is used in legal situation. Recently, ultrasound is recommended as a noninvasive and simple method in diagnosis of nasal fracture. This study investigates the role of ultrasound in diagnosis of nasal fracture.

Methods: 126 cases with suspected nasal fracture were evaluated using both ultrasound and nasal radiography in compare with clinical examination as a gold standard and the results were evaluated statistically. Sensitivity, specificity, negative predictive value and positive predictive value, negative likelihood ratio and positive likelihood ratio were calculated with confidence interval 95%.  Accuracy of both methods was also evaluated.

Results: In clinical examination 111 cases (88.1%) out of 126 cases, were diagnosed fractured and 15cases (11.9%) were unfractured. From these 111 fracture cases, 108 cases in ultrasound and 92 in radiography evaluation were also diagnosed fractured. Ultrasound sensitivity, specificity and   accuracy in diagnosis of nasal fracture were; 96.4% (91.1-98.6), 93.3% (70.2-98.8) and 96% respectively. Radiography report showed sensitivity   81.1% (72.8-87.3%), specificity 86.7% (62.1-96.3%) and accuracy of 82%. Most sensitivity of both methods was in diagnosis of nasal dorsum fracture (100% in ultrasound and 92.6% in radiography). Most specificity of ultrasound was in diagnosis of lateral wall (100%) and in radiography was in diagnosis of nasal dorsum fractures (50%).

Conclusion: According to this findings ultrasound can used as a noninvasive method with high sensitivity and specificity to diagnosis of nasal fracture.