Nasal Fractures in Children and Adolescents: Mechanisms of Injury and Efficacy of Closed Reduction

Abstract

Objectives: (1) Determine the most common causes of traumatic nasal deformities referred to pediatric otolaryngology. (2) Examine the efficacy of closed reduction of nasal fractures in children and adolescents based on the parents’ and surgeon’s ratings of post-reduction nasal symmetry. Methods: Case series and chart review within an urban pediatric otolaryngology practice. Results: One hundred cases of traumatic nasal deformity met inclusion criteria over a 3-year study period. The mean age at presentation was 13 years (4 weeks-18 years); 55% were male and 70% were over the age of 12 years. The most common mechanism of injury was sports-related trauma (28%), followed by accidental trauma (21%), interpersonal violence (10%), motor vehicle collision (6%), and alcohol-related (2%). Of these 100 cases, 21% underwent closed reduction within a 14-day period following injury. All patients achieved symmetry in the operating room immediately following reduction. At the postoperative visit (7-10 days following surgery), the operating surgeon was satisfied with nasal symmetry in 43% of cases and the parent(s) was satisfied in 81% of cases. Both parent and surgeon were satisfied with postreduction symmetry 33% of the time. Conclusions: The most common source of traumatic nasal deformity in children and adolescents differs from the most frequent mechanisms of nasal trauma in adults. In cases meriting operative intervention, parents appear to be satisfied with early postoperative results following closed reduction in approximately 80% of cases; however, a result in which both parent and surgeon agree with successful re-establishment of symmetry occurs in only 1/3 of cases.