Comparison of the Outcomes of Closed Reduction Nasal Bone Fractures With a Surgical Navigation System

Abstract

Background: The most prevalent form of facial bone fractures is nasal fractures. The surgical procedures used for these fractures are relatively simple, but complete correction is not easy because the nasal bone is small and identifying the fracture site by palpation is difficult. This study aimed to investigate the efficacy of intraoperative surgical navigation systems in nasal bone fracture surgery through a prospective analysis. Methods: Between February 2019 and July 2019, 25 navigation-assisted closed reductions of nasal fractures were performed. Preoperative computed tomography images were obtained at 1-mm intervals before surgery and the navigation was set by a simulation to have an error rate of less than 1. Then, the navigation system was used to identify the fracture site. Closed reduction was performed with Asch forceps and a Langenbeck elevator based on the previous markings made using the navigation system. Results: The degree of reduction was evaluated by plain X-rays and computed tomography scans, which were performed 1 month after surgery. In the navigation group, the average distance between the fragment and normal bony alignment was decreased from 2.38 to 0.49 mm and the modified Motomura score was an average of 2.40 points. The decrease in the mean distance was significantly different (P = 0.038) compared with the conventional group. Conclusions: Surgical navigation systems could be a useful tool for localizing fracture sites and guiding closed reductions. In particular, the system could be recommended for nasal bone fracture reductions in the tip or pyriform regions, which are difficult to correct. Level of Evidence: II

A Simple and Minimal Invasive Method in Reduction of Depressed Nasal Bone Fracture by Using a Foley Catheter Ballooning Technique

“…4 To achieve better anatomic reduction, some modifications, including intraoperative imaging, ultrasoundguided, the use of C-arm, and mobile fluoroscan, were performed with closed reduction. 6,7 Because of the tear of nasal mucosa in nasal bone fracture, it is easy to bleed in the process of reduction with metal nasal bone fracture reduction forceps. In addition, patients underwent pain and anxiety in the process of closed nasal bone fracture reductions under local anesthesia.…”

“…Kun Hwang carried out a retrospective study of 503 cases with diverse fracture of nasal bones and found that closed reduction was done in 93% of the fractured nasal bones, 4% in open reduction, and 3% in no surgical intervention 4 . To achieve better anatomic reduction, some modifications, including intraoperative imaging, ultrasound-guided, the use of C-arm, and mobile fluoroscan, were performed with closed reduction 6,7 …”

Accuracy of the Application of 3-Dimensional Printing Models in Orbital Blowout Fractures—A Preliminary Study

“…Although the application of intraoperative navigation systems is gradually becoming popular with its real-time confirmation of the bone position and safety in treating facial bone fractures, 15,16 this method has main shortcoming, which is the expensiveness of the navigation system device and its accessories 17 . The 3D printing model rebuilt by superimposing all layers of transverse CT images with bioplastic filaments has been widely applied in maxillofacial surgeries 4 .…”

Perfecting the Outcome of Nasal Bone Fracture in the Pediatric Population With a Navigation System

“…The trend of using navigation systems for treating facial bone fractures is increasing. [3][4][5][6][7][8][9][10][11][12] Many hospitals adopted this navigation system due to the high demand for otolaryngologists or neurosurgeons to get a better outcome in treating sinus diseases or brain tumors.…”

“…Although only a few articles suggest the usefulness of the navigation system in correcting nasal bone fractures, any detailed recommendation has never been discussed. [3][4][5] Some authors suggest that reduction should be performed 1 to 2 weeks after injury, warranting subsidization of posttraumatic soft tissue edema. 13 In the pediatric population, however, closed reduction is recommended as early as possible due to early bony union after trauma.…”