Technique and Timing for Closed Reduction of Isolated Nasal Fractures: A Retrospective Study

Abstract

Isolat ed F ac tures of tile nasal pyramid are am ong tile 1II0St common facia l inju ries. Nevertheless, studies of therapeutic result s fo lio I ving closed reducti on of nasal Factures are rare. \Ve conducted a retrospective clinical relliew of 187 patients who were evaluated for nasal tra uma (including nond islocated [ ractures, dislocated fractures, and contusio ns) at our oto laryngo logy departtneut dur ing 1997 a1/l11998. Ofthis gro up, 96 fract ures lI'ere treated with closed reduction-either under local anesth esia (n = 68), under gen era l anesthesia (n = 21), or with concomitant sep top lasty under genera l an esth esia (u = 7). At fo llow-up, which ranged fro m I to 2 years, 91 of the 96 patients (94.8%) expressed satisfaction with their res ults. Pri or to decidin g 0 1/ a co urse of acti on, the surgeo n mu st conduct a caref ul ph ysical examination becau se the decision as to whether treatm ent is required, wliicli technique to use (op en vs closed redu ction), and which typ e ofanes thes ia is app ropriate (local vs ge ne ral) all depend on the clinical fi nding s, such as the degree of de viati on and airflow obstruction. We also suggest that all patient s receive both a \Vate rs ' lIiew and a lateral view x-ray. In our opinion, closed red uction is a safe p rocedure for isolated nasal fra ctures and can be perfo rmed with local anesthes ia in most ad ult patie nts. Morb idity is mi nimal in the hands of{Ill experienced ENT surgeon. f rom the Departm ent o f Otorhinolaryngology-Head and Nec k Surge ry, Uni versity of'Fre iburg. Germany

The role of septoplasty in the management of nasal septum fracture: a randomized quality of life study

“…Most surgeons consider septoplasty only if the initial results of closed reduction are unsatisfactory and the patient continues to complain of nasal obstruction. 7,8 However, closed reduction may not properly address the nasal obstruction caused by a septal fracture. Hung et al found that 18% of patients needed further surgery after closed reduction in their study.…”

Pediatric nasal bone fractures: Does delayed treatment really lead to adverse outcomes?

“…However, there are very few reports evaluating the long-term results of pediatric nasal bone fractures, and no reports on the link between time to surgery and surgical outcome in a pediatric population [17][18][19]. A pediatric nasal bone fracture is believed to require earlier reduction than in adults, typically within 3-7 days [6][7][8][9]. However, no relevant studies have been performed to show that a delayed reduction could bring unsuccessful surgical results based on long-term follow up.…”

“…Pediatric patients, however, have been known to need reduction sooner, typically 3-7 days after injury, because later reduction could be challenging [6][7][8][9]. In addition, in pediatric patients with a nasal bone fracture, the septoplasty should be carefully performed to avoid injury to the growth center at the nasal spine of the maxilla, which is very important for future facial growth and development [6].…”

“…Although some reports looked into the incidence, etiology, various treatment options, and outcomes in pediatric patients with nasal bone fractures [4][5][6][7][10][11][12][13][14], there have been very few recent reports investigating the time to reduction and subsequent long-term outcome in pediatric patients as a single group. We believe that an analysis of early and/or delayed treatment of nasal bone fractures in pediatric patients may help to predict long-term results and facilitate proper management of nasal bone fractures.…”

Role of intra-operative ultrasound-guided reduction of nasal bone fracture in patient satisfaction and patient nasal profile (a randomized clinical trial)

“…The standard treatment for a nasal fracture is a closed reduction conventionally within 7 days for children and 10 days for adults [6][7][8][9]. This method, although simple, fails to address the deformities of the cartilaginous framework and the nasal septum caused by the injury.…”