Septal fractures predict poor outcomes after closed nasal reduction: Retrospective review and survey

Abstract

Objectives/Hypothesis To determine outcomes of patients with displaced nasal bone fractures after closed nasal reduction (CNR). Study Design Retrospective patient review. Methods Review of all patients presenting to the emergency department of a tertiary‐care, level 1 trauma hospital with a nasal bone fracture over a 2‐year period, followed by telephone survey after CNR. Results Six hundred seven patients presented to the emergency department in 2015 and 2016 with a diagnosis of nasal bone fracture. Of these, 134 patients met inclusion criteria and underwent CNR without septal reduction. Those with sports‐related injuries and those with a septal fracture identified on computed tomography imaging were significantly more likely to undergo CNR. Ninety‐one patients completed the post‐CNR telephone survey. Over 90% of patients were satisfied with the procedure. However, patients with septal fractures reported worse outcomes, as 53.6% versus 24.1% (P = .0025) disagreed that CNR improved nasal breathing. Of all patients, 11 (2%) eventually underwent septorhinoplasty, with the presence of septal fracture on imaging a significant risk factor. Conclusions Nasal bone fractures are a common injury, often managed initially with CNR. Patients with septal fractures should be counseled on the high risk of posttraumatic nasal deformity and obstruction despite CNR. In addition, addressing a septal fracture found on imaging may be warranted with either closed septal reduction or early aggressive management given the poorer outcomes seen in the present study. Although these patients are more likely to have definitive treatment, many forego later intervention despite persistent symptoms, emphasizing the need for early intervention or close follow‐up. Level of Evidence 3Laryngoscope, 129:1784–1790, 2019

Surgery to relieve nasal obstruction: outcome for 366 patients operated on by one senior surgeon

“…Among the patients undergoing a septoplasty, there were more men and they were younger than patients undergoing a septoplasty + turbinoplasty and turbinoplasty alone. The predominance of men in septoplasty has been likened to more nasal trauma in this group related to sports activities, assault and motor vehicle accidents, among others [ 14 ]. Why isolated septal deviations underwent surgery at an earlier age is not clear, but it is important in the assessment, as surgery at a young age is associated with a risk of a poorer outcome [ 2 ].…”

Effectiveness of endoscopic intranasal incision reduction for nasal fractures

“…For patients who have missed the optimal time for the operation (within 2 weeks after trauma) [ 18 ], CR is complicated by the formation of the callus which affects the operation. A retrospective review of 607 patients with nasal fractures reported that although only 5% of patients were dissatisfied with CR, 35% had some degree of nasal obstruction and 9% had nasal deviation [ 5 ]. Studies noted that 11–50% of patients had persistent deformities after CR and needed subsequent septoplasty [ 6 , 19 ].…”

“…Although CR is a simple, fast and economical method, the procedure is performed blindly and is mainly guided by the experience of the surgeon. The outcomes of CR vary widely throughout the literature with patient satisfaction rates being reported between 30% [3,4] and 95% [5]. Some studies reported revision surgery rates after CR were between 5.5% and 11% [6][7][8][9][10][11].…”

Tratamento incruento de fraturas nasais isoladas em adultos: uma revisão integrativa

“…No que se refere à eficácia de reduções fechadas de fraturas nasais, María Dalbosco et al (2017) descreveram que a realização desse tratamento sob anestesia local se mostrou eficiente na melhora da aeração nasal, bem como na melhora da estética, em comparação com o estado pré-operatório, de acordo com dados informados pelos pacientes. Além disso, um estudo realizado por Arnold et al (2019) relatou que mais de 90% dos pacientes que foram submetidos ao tratamento de fratura nasal por redução fechada e responderam ao questionário da pesquisa, sentiram-se satisfeitos com o procedimento.…”

“…Observou-se que a existência de fratura septal associada à fratura óssea nasal é um indicativo de piores resultados na redução fechada das fraturas nasais, principalmente no que se refere à respiração nasal (Arnold et al, 2019), satisfação do paciente (Jeon & Kim, 2018) e risco de desenvolvimento de sinéquia pós-operatória ( Kim et al, 2015).…”