Three Important Considerations in Posttraumatic Rhinoplasty

Abstract

Introduction: Many factors must be considered when performing a posttraumatic rhinoplasty. Since nasal fractures are the most common fractures in the adult facial skeleton, many patients who suffer midface trauma also suffer from nasal deformity/deviation and nasal airflow impedance. There are three specific regions within the nose which may impede airflow: nasal septum, internal nasal valves, and inferior turbinates. Each component of functional and posttraumatic rhinoplasty has been studied independently. However, a review of posttraumatic rhinoplasty procedures in which multiple regions of the nasal anatomy were addressed, when indicated, has not been elucidated much in the literature. Materials and Methods: A retrospective review of the medical charts and operative reports of 42 consecutive patients who underwent a post-traumatic rhinoplasty from July 2002 to December 2006 by the same surgeon was undertaken to determine which specific regions of the nose required secondary repair. Postoperative results were then reviewed to determine objective complications and subjective complaints. The specific techniques employed in the each operative procedure were then analyzed and objective complications and subjective complaints were recorded. Results: The most common preoperative patient complaint included difficulty breathing and nasal complex deformity followed by difficulty breathing alone and isolated deviation/deformity. The most common preoperative objective findings included airflow obstruction and nasal deformity, followed by isolated airflow obstruction, and isolated deviation/deformity with no air flow disturbance. All patients underwent a secondary posttraumatic septorhinoplasty. Septoplasty was performed in 78.6% of the patients; spreader grafts were used in 74% of the patients, and inferior turbinate surgery was done in 62% of the patients. Postoperatively, subjective findings revealed no complaints in 38 patients (90.5%). Two patients had complaints of persistent nasal deformity and air flow obstruction; 1 patient had persistent nasal deformity, and another patient had persistent air flow obstruction. Objectively, 5 patients had persistent nasal deformity, 2 patients had persistent air flow obstruction, and two patients had persistent airflow obstruction and nasal deformity. Conclusion: When indicated, by appropriately addressing the key regions of the nasal complex, including the septum, internal nasal valves, and inferior turbinates, the majority of patients (90.5%) will have no subjective complaints of difficulty breathing or a nasal complex deformity.