The nasal bones are a pair of small, oblong bones that sit side-by-side, forming the bony bridge of the nose. They are a component of the central facial skeleton, designed to protect the nasal cavity and provide attachment points for surrounding soft tissues. An X-ray is a common and rapid diagnostic tool used to assess the condition of these bones, allowing medical professionals to visualize the underlying bone structure based on density.
Why Doctors Order Nasal Bone X-Rays
A physician requests a nasal bone X-ray when a patient has experienced trauma to the face, such as from a fall or sports injury. The primary purpose is to quickly assess for structural damage, including fractures or dislocations of the nasal bones. Symptoms like persistent pain, visible deformity, significant swelling, or bruising around the nasal bridge often prompt this examination. While a physical examination is the initial step, the X-ray helps confirm or rule out underlying bony injury that may require specific medical intervention.
The Nasal Bone X-Ray Procedure
The procedure is quick, typically taking only a few minutes. Common views include the lateral projection, which captures a side profile of the nasal bones, and often a Water’s view, which helps visualize other facial structures like the sinuses. For the lateral view, the patient is positioned with the side of their head resting against the image detector, ensuring true lateral alignment. To prevent image artifacts that could obscure the view, patients are asked to remove any glasses or metallic items near the face, such as nose piercings. The imaging uses a very low dose of radiation tightly focused on the nasal area.
Identifying Normal Nasal Bone Anatomy
On a nasal bone X-ray, the paired nasal bones appear as two small, dense, oblong structures located at the top of the nose. They articulate superiorly with the frontal bone of the skull at the frontonasal suture. Laterally, they connect with the frontal process of the maxilla, which is the upper jaw bone. Because the nasal bones are denser than the surrounding soft tissue, they appear white on the X-ray image.
The X-ray must clearly demonstrate the bony outline and connecting sutures for proper interpretation. A normal finding may include subtle vertical lucent lines, which are anatomical grooves within the bone that accommodate small nerves and blood vessels. These grooves are a normal feature and must not be mistaken for a fracture line. The overall expected shape is a smooth, continuous contour, confirming the integrity of the bone structure.
Defining the “Normal” Result
A “normal” nasal bone X-ray indicates that the bony structure is intact, with no evidence of an acute fracture or significant displacement. The radiologist looks for a smooth and continuous cortical outline along the borders of both nasal bones. There should be no abrupt breaks or irregularities in the white line representing the bone’s dense outer layer.
Symmetry between the two nasal bones is an expected sign of a normal result, showing no deviation or angulation from their expected alignment. The bone density should be uniform, without areas of unexpected thinning or increased lucency. A key sign ruling out a fracture is the absence of any lucent lines—which appear black on the image—that run perpendicular to the long axis of the nasal bone. A normal X-ray will also show minimal or expected soft tissue swelling around the nose.