Nose (Nasal Bone) X-ray (complete)

What it is

The bridge of the nose is built from two small paired bones that sit edge-on to most x-ray beams, with cartilage below them that does not show on film at all. A single picture is nearly useless here, which is why the complete study is more than three exposures: side views of each side of the nose, a view angled up under the nose, and a view of the face. The point is to catch a crack or a shift in position that only lines up with the beam from one particular angle. A nose can be clearly broken to look at and still appear intact on the film, and it can show an old healed line that has nothing to do with today's injury.

Why it is done

• To look for a break in the nasal bones after a fall, a fight, a ball, or a collision
• To distinguish a fresh fracture from an old one in someone with a nose that has been injured before
• To document the bone before a procedure to straighten the nose
• To check whether the injury extends beyond the nasal bones themselves into the surrounding face

What to expect

There is no preparation and no injection. Glasses, earrings, and anything in the hair come off. The patient sits or lies with the head turned into each of several positions against a small imaging plate, holding still for each exposure. It takes a few minutes. A recently broken nose is tender and swollen, and the positioning can be uncomfortable even though the x-ray itself is not felt. Swelling also makes it hard to judge the final shape of the nose for several days, so a follow-up examination is common regardless of what the film shows. A collection of blood inside the nose after an injury is something a clinician looks for by examining it, not on the x-ray.

Questions worth asking

• Will the result actually change what is done? Ask whether the plan depends on the film or on the examination, before agreeing to the study.
• If I am sent to an ear, nose and throat specialist afterward, will they repeat imaging, and can these images go with me instead?
• Does this charge cover the whole multi-view series as one exam, or are individual views itemized?
• Was a broader facial bone or CT study ordered at the same time? If so, ask whether the nasal series adds anything the other one does not already show.