Nasal fracture manipulation: a comparative study of general and local anaesthesia techniques

Abstract

Nasal injuries are common conditions treated in either Otolaryngology or Plastic Surgical departments. Manipulation for deformity can be conducted in various ways. The aim of this study is to determine if the anaesthetic technique used for manipulation influences outcomes. Five hundred and fifty-five patients had either local anaesthetic (LA) or general anaesthetic (GA) nasal fracture manipulations in our departments over a 6-year period. Three hundred and twenty-four of these could be contacted and questioned as to subsequent surgical treatments received. Rhinoplasty, septorhinoplasty or septoplasty had been subsequently performed in 3.2% of the GA group and in 17.2% of the LA group (P < 0.0001). We recommend considering this result when treating nasal fractures in conjunction with other important issues of patient preference, financial costs, associated risks, morbidity and facilities available.

Characteristics of Nasal Injuries Incurred during Sports Activities: Analysis of 91 Patients

“…17,18 Courtney et al conducted a follow-up study of 324 patients who had undergone CRNF and found that revision surgery was required in only 3.2% of those who had initially received general anesthesia, compared with 17.2% of those who had received local anesthesia (p < 0.0001). 19 Almost all of the patients in our series (92.3%) returned to their sport. Patients who experience only a nasal contusion can resume their activity immediately.…”

Relation between epistaxis, external nasal deformity, and septal deviation following nasal trauma

“…Hence, all patients with a suspected nasal fracture are referred to the ear, nose, and throat department (ENT) where they are seen one to two weeks after injury and reassessed. If there is nasal deformity then manipulation can be undertaken [3][4][5][6] to restore the appearance of the nose and function. 7 The nose is the central and most dominant feature of the face, and even millimetres of nasal deviation are easily evident even to the most casual of observers.…”

Acute nasal fracture management: A prospective study and literature review

“…Many studies have supported the treatment of simple nasal bone fractures involving the distal portion of quadrangular cartilage by manipulation (MNBS) under local anaesthesia, on presentation or up to 2 weeks after injury. The results have been comparable with manipulation under GA . In cases with nasal bone and septal cartilage fracture, performing only MNB without manipulation of nasal septal cartilage makes the reduced nasal bones heal in the direction of the deviated and fractured septum .…”

“…Various studies have employed different tools of satisfaction assessment, but no standardized system has been applied . Patient satisfaction rates following manipulation are variable, ranging between 68% and 87% for nasal cosmesis and 64% and 86% for nasal breathing . Objective tools pertaining to patient's cosmesis and nasal breathing are difficult to design.…”