Covid-19 pandemic: Impact of facemask wearing on nasal tissues healing after closed reduction of nasal bone fractures

Abstract

Dear Editor, Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2, identified in Wuhan (China) during an outbreak in late 2019 and, subsequently, spread around the world. The symptomatology is usually related to respiratory manifestations, and the transmission can be by closed contact and airborne. Considering the airways spread of the virus, the facemasks have represented a prevention and self-protection tool. During the Pandemic period, world population was forced to wear facemask; so, several authors discussed the long-term effects of chronic facemask wearing. Cotrin et al. reported feel discomfort in the ears due to the elastics, feel shortness of breath, dermatitis and aesthetic issues 1Cotrin P. Bahls A.C. da Silva D.O. et al.The use of facemasks during the COVID-19 pandemic by the Brazilian population.J Multidiscip Healthc. 2020; 13: 1169-1178Crossref PubMed Scopus (15) Google Scholar. Moreover, Bonavolontà et al., in their preliminary studies, already showed the correlation between chronic facemask wearing and delayed facial wounds healing 2Piombino P. Committeri U. Norino G. et al.Facing COVID-19 pandemic: development of custom-made face mask with rapid prototyping system.J Infect Dev Ctries. 2021; 15: 51-57Crossref PubMed Scopus (8) Google Scholar, 3Bonavolontà P. Troise S. Norino G. Iaquino V. Abbate V. Califano L. The effects of the face mask wearing on the surgical facial wounds healing during the COVID-19 pandemic.J Plast Reconstr Aesthet Surg. 2022; 75: 3877-3903Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar. The aim of the present study was to investigate the impact of facemask wearing on nasal tissues healing after closed reduction of nasal bone fractures. Nasal bone fractures are the most frequent type of facial bone fractures; after the closed reduction, residual nasal deformity can occur from 14 to 50% of cases, requiring a second aesthetic procedure 4Besmens I.S. Shahrdar C. Fontein D.B.Y. Knipper S. Giovanoli P. Lindenblatt N. Efficacy of closed reduction of nasal fractures-a retrospective analysis with focus on factors affecting functional and aesthetic outcomes.J Plast Reconstr Aesthet Surg. 2023; 77: 371-378Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar, 5Yoon T. Kim Y. Postoperative Satisfaction in Nasal Bone Fracture Patients Who Had Rhinoplasty.J Craniofac Surg. 2016; 27: 1707-1710Crossref PubMed Scopus (5) Google Scholar. In this study, the impact of facemask wearing on nasal tissues healing after closed reduction of nasal bone fractures was analysed, evaluating the patients’ appearance satisfaction, in terms of need of a secondary aesthetical procedure, such as rhinoplasty or rhinofiller. 203 patients, who underwent closed reduction of nasal bone fractures in Maxillofacial Surgery Unit of Federico II University of Naples, were enrolled. The inclusion criteria were: - age 18-60 years old; -no pre-traumatic rhinoplasty o rhinofiller; - no congenital or acquired (infective/tumoral) pre-traumatic nasal deformities. The sample was divided in two groups: - Group A) 126 patients surgically treated before the Covid -19 pandemic (February 2018-February 2020); - Group B) 67 patients surgically treated during the Covid-19 Pandemic (March 2020-March 2022). Telephonic calls were conducted on March 2023, after a minimum follow-up of 12 months, asking the patients about their post reduction aesthetic satisfaction; thus, the need to undergo to a second aesthetic procedure was questioned. The results of the analysis are showed in the Table 1. The patients who required secondary aesthetic practices were: 21.42% (n=27/126) in the Group A and 34.32% (n=23/67) in the Group B.Table 1Secondary procedures after nasal bone fractures reduction.Patients treated for Nasal bone fracturesNo Aesthetic ProceduresAesthetic ProceduresTOTALGroup A(No Covid 19)9927126Group B(Covid 19)442367Total14350193 Open table in a new tab A statistical analysis of the data was conducted using a Chi- square test (Microsoft excel 16.16.27 Version) and the recorded values were compared to the Chi-square standard distribution tables. Considering a p-value <0.05, the Chi-Square test value (x2 =3.72) resulted statistically significant; thus, we hypothesized a possible correlation between the prolonged use of facemask and an unsatisfactory nasal aesthetic appearance after tissues healing. Probably, the frictional trauma of the rigid nasal portion of the facemask on the nasal pyramid, may cause a suboptimal post-surgical tissues healing, such that secondary cosmetic treatment could be required to satisfy the patients. Our data seem to confirm a correlation between chronic use of facemask and nasal tissues deformities after closed reduction of nasal bone fractures, such that requiring a secondary aesthetic procedure. This is a preliminary investigation and other studies with specific tools (3D Surface Scanning) and detailed questionnaires, submitted to patients, are mandatory. Anyhow, to reduce the risk of post-reduction nasal tissues deformities, we recommend to patients the use of facemask without the rigid nasal portion. N/A