The Usefulness of the Endonasal Incisional Approach for the Treatment of Nasal Bone Fracture

Abstract

BackgroundAmong all facial fractures, nasal bone fractures are the most common, and they have been reduced by closed reduction (CR) for a long time. But several authors have reported suboptimal results when using CR, and the best method of nasal bone reduction is still being debated. We have found that indirect open reduction (IOR) through an endonasal incisional approach is a useful method for more accurate reduction of the nasal bone.MethodsA retrospective chart review was performed of 356 patients who underwent reduction of a nasal bone fracture in our department from January, 2006, to July, 2011. We treated 263 patients with IOR. We assessed patients' and doctors' satisfaction with surgical outcomes after IOR or CR. We evaluated the frequency of nasal bleeding owing to mucosal injury, and followed the surgical outcomes of patients who had simultaneous dorsal augmentation rhinoplasty.ResultsAccording to the analysis of the satisfaction scores, both patients and doctors were significantly more satisfied in the IOR group than the CR group (P<0.05). Mucosal injury with nasal bleeding occurred much less in the IOR group (5.3%) than the CR group (12.9%). Dorsal augmentation rhinoplasty with IOR was performed simultaneously in 34 cases. Most of them (31/34) showed satisfaction with the outcomes.ConclusionsIOR enables surgeons to manipulate the bony fragment directly through the endonasal incisional approach. However, we propose that CR is the proper technique for patients under 16 and for those with comminuted nasal bone fractures because submucosal dissection in IOR can damage the growth or circulation of nasal bone.

Local anesthesia for Reduction of Nasal Bone Fracture: our experience

“…Results showed significant patients satisfaction and good efficacy of using the local anaesthesia for closed nasal bone fracture reduction in agreement with many other studies supporting the use of local anaesthesia to avoid the risks and complication of general anaesthesia [11][12][13], and to decrease the cost of the reduction procedure which was an important factor in avoidance of seeking medical help for such nasal injuries [14], while others had advocated the use of endonasal incision in some cases [15].…”

Nasal bone fractures are successfully managed under local anaesthesia – experience on 483 patients

“…Considering the low rate for the need for re‐operations, this seems feasible. Some authors claim that as more extensive procedures can be undertaken under general anaesthesia, it should be favoured . However, there is no evidence on the superiority of general anaesthesia in this patient group.…”

The Algorithm-Oriented Management of Nasal Bone Fracture according to Stranc&apos;s Classification System

“…Frontal plane 2 and lateral plane 1, 2 fracture were treated with OR through endonasal incision. In the case of comminuted fracture, the broken bone fragments that had been maintained by soft tissue can be scattered when conducting OR, and this may decrease the blood supply in the fractured bone segments [ 10 ]. For this reason, CR was conducted in this study.…”