Manipulation of nasal fractures with local anaesthetic: A ‘How to do it’ with online video tutorial

Abstract

Nasal fractures are the most common facial fractures and displaced fractures may cause considerable cosmetic concern. Traditionally, displaced nasal fractures have been manipulated under general anaesthesia (GA) performed within 2 weeks of the injury. Despite evidence for the benefit of local anaesthesia (LA), nasal fractures are still most commonly reduced under GA. We have presented a method of reduction of simple nasal fractures under LA in an outpatient setting. This has the advantage of being painless, simple to attempt and cost-effective. If reduction is inadequate then a general anaesthetic reduction is still possible. A recent comprehensive systematic review of all the available evidence did not show any significant difference (in terms of cosmesis, pain or nasal obstruction) between using LA and GA methods and highlighted the evidence base to support LA. We describe our method of assessment and treatment of displaced nasal fractures and provide an online tutorial (http://sciencestage.com/v/22194/local-anaesthetic-nasal-fracture-reduction.html). It is important to keep in mind that any concerns should be referred to an otolaryngology specialist for further management and that practitioners attempting this technique should first receive training from an otolaryngologist.

Manipulation under anaesthesia of fractured nasal bones – a 10-year retrospective study

“…5 In recent years, manipulation under anaesthesia procedures have also been performed in an out-patient clinic setting using local anaesthesia (LA) techniques such as the nasociliary nerve block. 2 This involves the infiltration of LA bilaterally, between the medial canthus and glabella, down to the periosteum. Some providers also administer topical anaesthetic to each nostril.…”

“…Some providers also administer topical anaesthetic to each nostril. 2 The coronavirus disease 2019 (Covid-19) pandemic has forced surgical departments across the country to reduce the number of surgical procedures performed in order to minimise hospital contact, and to reconsider which emergency procedures can be conducted in an out-patient clinic setting. 6 This has led to the shift to performing manipulation under LA, to reduce the demand on elective operating theatres and limit the number of hospital interactions.…”

“…These fractures are traditionally managed with closed manipulation under general anaesthesia (GA) performed within two weeks of injury, with the aim of restoring nasal anatomy prior to the formation of fracture callus. 1,2 Nasal deformities associated with poor cosmesis or nasal obstruction can be assessed post-injury, and the need for septoplasty or septorhinoplasty can be determined. 1 Outcomes used to assess the success of manipulation under anaesthesia include patient satisfaction and the need for future surgery.…”

“…Nasal bone fractures are a common emergency presentation seen in Otorhinolaryngology departments and account for up to 50% of facial fractures. These fractures are traditionally managed with closed manipulation (MUA) under general anaesthetic (GA) within two weeks of injury, with the aim of restoring nasal anatomy prior to the formation of fracture callus 1,2 .…”

“…In recent years, MUAs have also been performed in an outpatient clinic setting using local anaesthetic (LA) techniques such as the nasociliary nerve block 2 . This involves infiltration of local anaesthetic bilaterally, between the medial canthus and glabella, down to periosteum.…”