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. CT scan is more useful to assess for other associated injuries, as well as extent of nasal injury. 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 for documentation and for comparison with pre-injury photos.
Even in the presence of significant edema, a nasal deformity often may be obvious. Reassessment of the nose after the edema subsides, in a patient with no apparent abnormality at the initial visit, may reveal findings necessitating repair. Surgical intervention then may be undertaken. The potential for optimal results lies in the reduction of the fracture within the first several hours following the injury, before significant edema has appeared. If this window has passed, subsequent reassessment of the injury is advisable, with correction planned for approximately 7 days following the injury.