Serial High-Resolution Ultrasound Findings of Acute Nasal Fracture: A Potential Implication to Predict the Time of Facial Injury

Abstract

Background: Despite the fact that physical examination is the gold standard for diagnosing nasal fractures, high-resolution ultrasonography can also be used as a noninvasive method to evaluate facial injuries especially in legal cases with old nasal trauma and also for medico-legal purposes to determine whether the findings are of recent onset. Objectives: The aim of this study was to investigate the ultrasound findings of nasal fracture over time. Patients and Methods: Thirty-six patients with the diagnosis of nasal fracture according to their physical examinations were enrolled in the current study. All patients underwent nasal bone ultrasound, and both longitudinal and transverse views were obtained and evaluated by an expert radiologist using a SonixOP system (Ultrasonix Medical Corporation, Richmond, Canada). The first ultrasound exam was performed within the first five days of nasal trauma, and the follow-up studies were done 3, 6, 12, and 24 weeks after the trauma. Any abnormality in the nasal bone, including subperiosteal hematoma, nasal bone stepping, and hypoechoic/anechoic fracture lines were searched for on ultrasound investigation. Results: We found that in the first sonographic investigation, the sensitivities of subperiosteal hematoma, lucency in the lateral nasal bone, and nasal bone stepping were 100%, 90.32%, and 77.42%, respectively for the diagnosis of recent fracture. During the first three weeks after nasal trauma, subperiosteal hematoma and lucency in the lateral nasal bone had the highest diagnostic values which were statistically significant (P < 0.0001). The predictive values of subperiosteal hematoma and lateral nasal bone lucency in sonographic investigation for estimating the time of nasal trauma were 86.3% and 67.7%, respectively. Furthermore, in the performed serial ultrasound exams, subperiosteal hematoma and lucency in the lateral nasal bone were persistent for 25 and 85 days, respectively. Conclusions: High-resolution ultrasound can be helpful to diagnose nasal fracture and to estimate the actual time of nasal bone fracture. The latter has potential implications in forensic medicine to predict the time of facial injury, e.g. a patient with a nasal fracture between 25 and 85 days ago may have lucency in the lateral nasal bone with no subperiosteal hematoma.