Fractures of the nasal bone are the most prevalent form of facial skeletal injuries, making up nearly 40% of all maxillofacial fractures. Due to their central and prominent location, nasal bones are prone to trauma from direct external forces [1]. Although most medical providers often consider nasal bone injuries to be a minor form of skeletal injury compared with other maxillofacial fractures, a nasal bone fracture can have significant clinical consequences. If not identified or properly treated, the patient can have functional sequelae, such as nasal airway obstruction, septal deviation, epistaxis, or chronic rhinosinusitis, and aesthetic consequences such as asymmetry and deviated nasal deformities. These long-lasting consequences can have a negative impact on a patient's physical, psychological, and social well-being [2]. In polytrauma patients, nasal fractures often go underdiagnosed in the acute care setting as attention is directed to the acute stabilization of life-threatening systemic injuries. A delay in diagnosis may result in missed opportunities for early intervention and preventable complications. Emphasis cannot be understated regarding the early recognition of nasal fractures within the polytrauma patient population as timely intervention can reduce both functional disability and aesthetic deformity [3]. A radiological work up is an integral part of the evaluation and management decision making of nasal bone fractures. Conventional plain films, such as lateral nasal and Waters’ view, have been commonly used within the clinical practice [4]. However, plain films may be unreliable with minimally displaced or complex fractures (especially in the case of spatial overlap with facial bones obstructing visualization). With increased resolution and the ability to perform multiplanar reconstructions, CT has become the gold standard in imaging modalities. CT provides the confirmation of a fracture with assessments of fracture positioning, comminution, septal injury, and potential associated maxillofacial or intracranial injury [5].

The approach to the management of nasal bone fractures is largely based on the extent of the fracture and the clinical presentation of the patient. Treatment strategies include conservative care for undisplaced fractures, closed reduction for a simple or moderately displaced fracture and open reduction and internal fixation (ORIF) for complex or comminuted fractures; especially if there is associated septal injury. The aims of management are mainly towards restoring the function, airway patency, and some preservation and or restoration of the aesthetic [6,7].

Although many studies have investigated isolated nasal bone fractures, there is relatively little information available in the literature about nasal bone fractures sustained in polytrauma patients. Care of these patients in the emergency setting is a challenge due to a number of factors, including the presence of multiple injuries, the delay in prioritizing surgery on facial injuries, and the need for multispecialty care of the patient. A systematic and detailed approach involving imaging radiology, especially with CT imaging, can provide the best diagnostic opportunity and improve outcomes [8,9].

The current clinical study was done to evaluate the radiological range of nasal fractures in polytrauma, and to compare the diagnostic power of CT imaging to standard x-rays, and to review the outcomes of different therapeutic approaches. The current study is unique in its consideration for functional and cosmetic outcomes for the two types of modalities at a single academic institution; the goal is to provide evidence-based recommendation(s) that may assist could help formalize clinical protocols for early recognition and/or improvements in the management of nasal bone fractures in a polytrauma patient.