Imaging in Simple Nasal Trauma. Is Current Practice Uniform Worldwide? –A Survey of Global Practices

Background: Currently in the UK, it is accepted that imaging is no longer routinely undertaken if nasal injuries are suspected clinically. The argument for this is that it does not affect management in a clinically obvious fracture. Occasionally, nasal and septal fractures may be an incidental finding following CT head or facial bones and this can opportunistically help plan treatment. Whilst this rationale for a relatively straight forward clinical problem is generally agreed within the UK, anecdotally it appeared that this is not always the case overseas. We therefore set out to see if there was indeed a significant diversity of opinion in the assessment of what is essentially a ‘simple’ injury. Methodology: A questionnaire was sent to surgeons across the globe. Questions included the role of imaging in the assessment of acute nasal fractures, experience of ORIF and imaging of secondary nasal deformity in their day-to-day clinical practice. Results: 343 responses were received from 95 countries from a range of specialties: A&E, plastic surgery, ENT, OMFS and general surgery. Interestingly, in many countries plain films are still undertaken in the assessment of simple acute nasal trauma. CT imaging is occasionally performed for secondary corrective procedures. Conclusion: Internationally, the practice and need for imaging in the assessment of nasal injuries vary greatly. Even in 2018, there still does not appear to be universally agreed diagnostic pathways for what most clinicians would consider to be a common and simple injury. Historic practice and personal opinion seem to still trump any evidence base.