Nasal Fractures Research Articles

Electric Scooter-related Craniofacial Injuries.

Injuries associated with the use of electric scooters are a serious problem in modern society and traffic in relation to their increasing frequency of use. Although injuries involving all body parts are seen in such injuries, craniofacial ones are also very common. The aim of this study was to evaluate the craniofacial and other accompanying injuries in electric scooter-related accidents in Istanbul. Between January 2020 and December 2022, patients with electric scooter-related trauma among the patients admitted to the emergency unit for trauma were evaluated retrospectively. All electronic medical records, CT scans, other examinations, and treatments were retrospectively reviewed, and craniofacial fractures and other injuries seen in the patients were classified. A total of 20.358 patients were admitted to the trauma unit between January 2020 and December 2022. Two hundred ten patients (142 male, 68 female) had electric scooter-related trauma and 58.1 % of them had craniofacial injuries. Thirty patients (14.3 %) (23 male, 7 female) had craniofacial fractures, whereas 43.8 % of them had craniofacial soft tissue injuries. The nasal fracture was the most common craniofacial fracture (14 patients, 46.7%). Orbital wall and zygomaticomaxillary complex fractures were found to be the second most common fractures. The rate of electric scooter-related injuries among all trauma patients admitted to the emergency trauma unit during the mentioned period was 1.03%. The results of this study were found to be in accordance with the data in the literature. The craniofacial region is the most frequently injured body part in patients with electric scooter-related trauma, and patients should be comprehensively evaluated for possible soft tissue injuries, craniofacial fractures, and other accompanying system injuries.

Pattern and Outcome of Otolaryngological and Facial Injury in Road Traffic Accidents at a Tertiary Care Centre in Eastern Nepal

Introduction: Otolaryngological trauma is prevalent in road traffic accidents (RTA), with or without multiple organ injuries.
 Objective: The aim was to report the number and pattern of otolaryngological injuries in cases of road traffic accidents (RTA) and their outcome.
 Methodology: A prospective study over one year of cases of RTA was done. The pattern and outcome of the otolaryngological and facial injury was recorded.
 Result: Out of 90 cases, 69(76.66%) were male, 21 (23.33%) were female. The mean age was 32.33 ±13Yrs.The mean time of presentation to emergency was 16.24 ±19.61hrs. Motor vehicle accident was more common, 75 (83.33%). Multiple injury was found in 68(75.55%) cases. Among 89 cases with ear problem, common complaints were hearing loss, 20(22.47%), otalgia, 17(19.1%) and laceration of pinna 13(14.6%). Ear complications were seen in16 (17.97 %) cases . Among 55 cases of nose/face injury, common presentation were epistaxis, 20 (36.36%) and nasal bone fracture, 12 (21.81%). Nasal complications were found in 8 (14.54%) cases. In 32 cases of neck/throat trauma, laceration was found in 11 (34.37%) cases. 4(12.5%) cases had undergone tracheostomy. Complications (stenosis and hoarseness) were found in 6(18.75%) cases. Patients who required admission were 81(90%).
 Conclusion: Motor vehicle accidents were more common. It was commoner in male. Ear was most commonly affected by injury and complications. The complication of nose and neck/throat was associated with prolonged admission.

Does the type of craniomaxillofacial fracture (CMF) differ between patients with intracranial hemorrhage (ICH) and those with blunt cerebrovascular injury (BCVI)? A retrospective study

The purpose of the present study was to investigate and compare craniomaxillofacial fracture (CMF) type in patients with intracranial hemorrhage (ICH) versus blunt cerebrovascular injury (BCVI).A retrospective cohort study was performed. The predictor variables were the types of CMF. The primary outcomes variables were ICH and BCVI. Secondary outcomes were death and survival with or without neurological sequelae. Descriptive, bivariate, and multiple logistic regression statistics were computed, and the significance level was set at P ≤ 0.05.The sample was composed of 1440 patients with a mean age of 46.6 years ±24 years, and 71% were men. Pure orbital wall (odds ratio [OR]), 3.62; 95% confidence interval [CI], 1.32-12.69; P < 0.022), Le Fort III (OR, 16.08; 95% CI, 5.89-43.50; P < 0.001), cranial vault (OR, 9.74; 95% CI, 3.83.24.32; P < 0.001), skull base (OR, 9.42; 95% CI, 3.86-24.02; P < 0.001) and cervical fractures (OR, 5.50; 95% CI, 1.65-15.97; P = 0.003) were significantly associated with BCVI. All of the CMFs (P < 0.001), except for Le Fort I (OR, 0.79; 95% CI, 0.18-2.63; P = 0.731), nasal (OR, 1.05; 95% CI, 0.77-1.42; P = 0.758), and mandibular (OR, 0.68; 95% CI, 0.45-1.01; P = 0.066) fractures, were significantly associated with ICH. Secondary outcomes were negatively influenced by ICH and BCVI (P < 0.001).Within the limitations of the study it seems that Le Fort I and nasal fractures could be protective of cerebrovascular injuries, by cushioning impact forces. On the other hand it seems that patients with pure orbital wall, Le Fort III and cranio-cervical fractures are more prone to having concomitant life-threatening cerebrovascular injuries. This category of patients should have an immediate and comprehensive neurological assessment and CT angiography to rule out BCVI and to determine its severity.

A Simple and Minimal Invasive Method in Reduction of Depressed Nasal Bone Fracture by Using a Foley Catheter Ballooning Technique.

The nasal bone fracture is the most common type of facial bone fracture. Closed reduction with metal reduction instrument is commonly conducted for the treatment of a type II nasal bone fracture. The authors defined a new catheter dilation technique and used it in patients with type II depressed nasal bone fractures. Preoperative and postoperative nasal appearance and radiologic examination of the patients were compared. There was a statistically significant improvement in the nasal appearance of all patients. No recurrence or dorsal irregularity has been observed. This new, easily applicable catheter dilation method of closed reduction may be a simple and less invasive solution to treat type II nasal bone fractures.

Analysis of Nasal Bone Fractures: A 17-year Study of 3785 Patients.

In our previous study, we classified nasal bone fractures into 6 types based on computed tomography and the patterns of the nasal bone fractures (NBF) in 503 patients treated between 1998 and 2004. In the present study, we analyzed 3785 patients treated between 2005 and 2021. The age, sex, etiology, associated injuries, pattern of fractures, and treatments were reviewed, and radiographic studies were analyzed. The highest incidence was in the age group of 10 to 19 years (N=870, 23.0%), followed by 20 to 29 years (N=792, 20.9%) and 30 to 39 years (N=635, 16.8%). The most common causes of injury were slip or fall-down (42.3%), violence (24.3%), sports (19.2%), traffic accidents (8.9%), and work-related (5.3%). Most of the patients had tenderness (96.1%) and swelling (78.8%). Other findings were depression (27.1%) and nasal deviation (25.8%). Crepitus was heard in only 0.4% of the patients. The patterns of the NBFs classified by computed tomography findings were type IIA (unilateral simple fracture with displacement/without telescoping, 1283 cases, 33.9%), IIB (bilateral simple fracture with displacement/without telescoping, 786 cases, 20.8%), IIAs (unilateral simple fracture with septal fracture and displacement/without telescoping, 566 cases, 14.9%), IIBs (bilateral simple fracture with septal fracture and displacement/without telescoping 530 cases, 14.0%), I (simple fracture without displacement, 522 cases, 13.8%), and III (comminuted with telescoping or depression, 98 cases, 2.6%). In most of the cases (3,666, 96.9%), closed reduction was performed. The present analysis is one of the largest data sets on NBF in Korea, which could provide reference values for diagnosing and managing nasal bone fractures.

Incidence and Management of Tooth Root Fracture in Mandibular Fracture Line - A Retrospective Study.

In cases of trauma, the most common fractures of the facial region are the nasal bone fractures followed by mandibular fractures. About 60% of mandible fractures are associated with teeth in the fracture line; however conversely, the dentulous mandible has a higher susceptibility of fracture in any impact. Whenever a tooth is involved in the fracture line, it is not unlikely that the tooth root fracture will be associated with it. The prognosis and treatment of such a tooth persistent in a fracture line depends upon the level of tooth root fracture. This retrospective study was conducted in the Department of Oral and Maxillofacial Surgery in a Meerut hospital. The eligibility criteria were based on the cases involving fracture line passing through the teeth bearing area of mandible. Total of 56 cases of mandibular fracture treated from January 2021 till December 2022 by open reduction and fixation were included in the study. A total of 56 patients (66 fracture lines) with mandibular fractures were selected, out of which 18 (32%) patients had fracture of the root of the tooth in the fracture line. Third molar root fracture were present in 12 cases (66.6%), first premolars in 4 cases (22.2%), and first molars in 2 cases (11.1%). There were 14 multi rooted teeth (77.7%) and 4 single rooted teeth (22.2%) involvement. All the multi rooted teeth fracture were treated by extraction during open reduction and fracture fixation. The single rooted teeth were successfully treated by endodontic treatment postoperatively. The fracture line passing through the dentate segment may fracture the tooth crown and/or root or propagate through the socket without any injury to the root. Root fracture at cervical and middle third is constantly exposed to oral fluids. The affected tooth may be mobile and lose vitality. Teeth in the line of fracture must be removed when they preclude the correct reduction of the segments or if they represent a risk for infection. If the tooth or root does not cause any hindrance during reduction or it is not infected, the tooth can be salvaged by endodontic therapy. The incidence of root fracture was seen in 32% of cases. Fracture of the third molar roots was the single largest group (66.6%). No root fracture was observed in the anterior segment.

Open Reduction of an Isolated Anterior Nasal Spine Fracture: A Case Report and Review of the Literature.

A 14-year-old girl had a midfacial trauma event caused by hitting against an opening door and experienced discomfort and swelling of the columella and upper lip. Physical examination revealed mild tenderness on light palpation without any discomfort with upper lip movement. A computed tomography scan of the maxillofacial bones with three-dimensional reconstruction showed a fracture of the anterior nasal spine with obvious leftward displacement, mild-deviation of the caudal aspect of the nasal septum, and no sign of nasal bone fracture. Open reduction and internal fixation was performed with regard to aesthetic and functional concerns, including nasal septum deviation. The postoperative course was uneventful, and healing proceeded normally without complications. Herein, we emphasize the importance of differential diagnosis of isolated anterior nasal spine fractures in patients with midfacial trauma and clinicians' strategic decision-making in treatment modalities.

Complications in the Treatment of Mandibular Condylar Fracture, Surgical Versus Non-Surgical Treatment

Background: The facial fractures include Condylar fractures are most common in mandibular fractures, which have the highest fracture incidence after nasal bone fractures. Three different traumatic forces can result in condylar injury: the first is energy imparted to a static person by a moving object, such as a blow to the face from a cricket bat; the second is a moving person striking a static object, such as a child falling and striking the ground; and the third is a combination of the first two forces, such as when a person is moving and an automobile is moving and is hit by an automobile. This kind of force typically has the biggest impact and causes the most severe injury patterns. Objective: To compare frequency of Complications of two procedures for the treatment of mandibular condylar fracture surgical versus conservative treatment. Methodology: This Randomized control trial was held in the Tertiary Care Hospital Karachi for 6 months from 12 Jul, 2019 to 12 Jan, 2020. ERC were taken before data collection. Patients suffering from mandibular condylar fracture and fulfilling exclusion and inclusion criteria and who were ready to give informed consent after explaining study protocol, risk benefit ratio and data usage for research were included in our study. The first group labelled as "A" was treated by closed reduction and immobilization and second group labelled as group "B" was undergone internal fixation and open reduction. Results: The mean age and standard deviation of the 72 patients was determined to be 40.85 ± 12.93 years, respectively, with the 18 years was the minimum age and the 65 years being maximum. Frequency of gender was shown in Graph 1.The minimum duration of fracture was 1 day, and maximum were 7 days. The minimum mouth opening was 15mm and maximum was 35mm (Table 1). Trismus was present in 5/72 (6.9%) patients while it was absent in 67/72 (93.1%) patients (Table 2). Malocclusion was present in 20/72 (27.8%) patients while it was absent in 52/72 (72.2%) patients. Unilateral Side of fracture was present in 40/72 (55.6%) patients while Bilateral was present in 32/72 (44.4%) patients (Table 3) Conclusions: In conclusion, closed reduction had clinically satisfactory results, although open reduction and internal fixation produced more accurate to reduce the complications. Keywords: Closed reduction, Internal fixation, Open reduction,complications

When is the Optimal Time to Reduce Pediatric Nasal Bone Fractures?

When is the Optimal Time to Reduce Pediatric Nasal Bone Fractures?

Evaluating the Outcomes of Closed Reduction of Different Types of Nasal Bone Fractures.

This study was conducted to evaluate the outcomes of closed reduction of different types of nasal bone fractures depending on time between onset of injury and reduction and comparing the outcomes of early closed reduction (within 6h) of nasal bone fracture with late closed reduction (after 2weeks). A hospital based Prospective cohort type of study was conducted among cases of nasal bone fracture attending the outpatient department of Otorhinolaryngology at Chettinad Hospital and Research Institute, Chennai during the months of August 2021 to January 2022. A total of 54 participants were included in the study. Primary outcome was to assess the effectiveness of closed reduction of different types of nasal bone fractures postoperatively. The second objective was to compare the outcomes of early closed reduction (within 6h) of nasal bone fracture with late closed reduction (after 2weeks). Using chi square test, the association of factors such as age, sex, mode of injury, external framework deformity, type of fracture and treatment was analyzed with outcome measures such as post op degree of deviation, arch irregularity, malalignment, bony irregularity, bony displacement, olfactory disturbances and result. We analyzed the sample data statistically and measured the outcomes which showed that post operatively after undergoing closed reduction, some degree of deviation was present in 17(31.48./.), arch irregularity present in 12(22.2./.), malalignment in 11(20.37./.), bony irregularity in 24(44.44./.), bony displacement in 19(35.19./.), olfactory disturbances in 2(3.70./.). Comparing the outcome factors between early and late reduction, we found that the outcome was better in early closed reduction when compared with late closed reduction. Among the 54 patients studied, the results of closed reduction were found to be excellent in 27(50./.), Fair in 16(29.63./.), Good in 10(18.52./.) and poor in 1(1.85./.) We could thus conclude from this study that early closed reduction of nasal bone fracture gave better results than a late closed reduction in terms of post operative deformity, arch irregularity, malalignment, bony irregularity, bony displacement and olfactory disturbances.

A Novel Balloon Catheter Dilation Apparatus for the Treatment of Depressed Nasal Bone Fracture

The nasal bone fracture is the most common type of facial bone fracture. Closed reduction with metal reduction instrument is commonly conducted for the treatment of a depressed nasal bone fracture which often leads to iatrogenic injury. In this article, a new balloon catheter dilation apparatus for nasal bone fracture is hypothesized by the authors. This device aims to repair nasal bone fracture via dilated balloons under fractured nasal bone and used as nasal internal packing system after operation. Compared with the conventional approach, it is proposed that this balloon dilation apparatus could be a potential powerful, less invasive approach to treat depressed nasal bone fractures.

Efficacy of Nostril Supportive Splint Treatment for Nasal Septum Deformities after Le Fort I Osteotomy.

This retrospective study aimed to evaluate the efficacy of support splint treatment for deformities and deviations of the nasal septum after Le Fort I osteotomy (LFI). Patients were divided into two groups: the retainer group wore a nasal support splint immediately after LFI for 7 days, and the no retainer group did not wear a nasal support splint. Evaluation was performed by measuring the ratio of the difference between the left and right sides of the nasal cavity area (ratio of nasal cavity) and the angle of the nasal septum using three computed tomography frontal images (anterior, middle, and posterior) before and one year postoperatively. Sixty patients were included and divided into two groups, the retainer and no retainer group (n=30 each). Regarding the ratio of nasal cavity on middle images at one year postoperatively, the retainer and no retainer groups differed significantly (0.79±0.13 and 0.67±0.24, respectively; P =0.012). The angle of the nasal septum on anterior images at one year postoperatively was 164.8±11.7° in the retainer group and 156.9±13.5° in the no retainer group, showing a significant difference ( P =0.019). This study suggests that support splint treatment after LFI is effective in preventing post-LFI nasal septal deformation or deviation.

35. The Role of Antibiotics in Nasal Fractures following Closed Reduction

35. The Role of Antibiotics in Nasal Fractures following Closed Reduction

A biocultural study of nasal fracture, violence, and gender using 19th–20th century skeletal remains from Portugal

AbstractNasal fracture is usually described as the most common type of fracture of the facial bones, either alone or associated with other fractures. This work aims to study the nasal fracture among Portuguese individuals from the 19th and 20th centuries. The focus is on patterning in trauma in relation to gender and in the attempt to distinguish violent from accidental injury. The sample comprises 2023 (52.6% males, 47.4% females) individuals from three Portuguese identified skeletal collections who were born between 1804 and 1951 and died between 1895 and 1969. Age at death ranges between 1 and 109 years old. Nasal and other facial fractures were studied, and violent versus accidental trauma were distinguished following Magalhães et al. (2020). Nasal fracture was more frequent in males (10.4%, 101/969) than in females (5.9%, 47/800). This was true both for fracture inferred due to violence (laterally deviated fracture) and due to accident. Sixty‐one point five percent (91/148) of the individuals show a lateral impact force deviation. Comminutions correspond to 18.4% (26/141) of the total, and 12.8% (19/148) have other facial fractures. There is no association between nasal fracture and risk of death for both sexes, but the males seem to show a higher tendency for nasal fracture earlier in life than the females. The differences of nasal fracture between sexes are in accordance with the historical data showing that men had more social and cultural opportunities to engage in violent encounters. Although the percentage in women is lower, the majority of laterally deviated noses and isolated, non‐comminuted nasal fractures in both sexes show that interpersonal violence may have played an important role in the results.

Assessment of artificial intelligence-aided reading in the detection of nasal bone fractures.

Artificial intelligence (AI) technology is a promising diagnostic adjunct in fracture detection. However, few studies describe the improvement of clinicians' diagnostic accuracy for nasal bone fractures with the aid of AI technology. This study aims to determine the value of the AI model in improving the diagnostic accuracy for nasal bone fractures compared with manual reading. A total of 252 consecutive patients who had undergone facial computed tomography (CT) between January 2020 and January 2021 were enrolled in this study. The presence or absence of a nasal bone fracture was determined by two experienced radiologists. An AI algorithm based on the deep-learning algorithm was engineered, trained and validated to detect fractures on CT images. Twenty readers with various experience were invited to read CT images with or without AI. The accuracy, sensitivity and specificity with the aid of the AI model were calculated by the readers. The deep-learning AI model had 84.78% sensitivity, 86.67% specificity, 0.857 area under the curve (AUC) and a 0.714 Youden index in identifying nasal bone fractures. For all readers, regardless of experience, AI-aided reading had higher sensitivity ([94.00 ± 3.17]% vs [83.52 ± 10.16]%, P< 0.001), specificity ([89.75 ± 6.15]% vs [77.55 ± 11.38]%, P< 0.001) and AUC (0.92 ± 0.04 vs 0.81 ± 0.10, P< 0.001) compared with reading without AI. With the aid of AI, the sensitivity, specificity and AUC were significantly improved in readers with 1-5 years or 6-10 years of experience (all P< 0.05, Table4). For readers with 11-15 years of experience, no evidence suggested that AI could improve sensitivity and AUC (P= 0.124 and 0.152, respectively). The AI model might aid less experienced physicians and radiologists in improving their diagnostic performance for the localisation of nasal bone fractures on CT images.

AB094. SOH23ABS_067. Revisiting the role of submental intubation in maxillofacial trauma cases

Background: Airway management in maxillofacial trauma cases can prove particularly challenging as often the conventional methods of intubation are unsuitable. Standard orotracheal intubation may be a hinderance to the surgeon who may need to perform intra-operative maxillomandibular fixation. Nasotracheal intubation, a commonly used alternative is often not appropriate either particularly if there is a nasal fracture or base of skull fracture present. Clear communication between the anaesthetist and surgeon is paramount for successful intubation as both parties are forced to share the same working space. In these types of trauma cases Submental Intubation provides an excellent choice for airway securement. The Submental Intubation technique as an alternative method of airway management was first described in 1986 by Hernandez Altemir. It is a safe and effective method of intubation with a low risk of morbidity. It provides access to maxillofacial fractures without interference from an anaesthetic tube enabling maxillomandibular fixation and access to naso-orbito-ethmoid fractures. It avoids the need for tracheostomy which has many reported complications including post-op bleeding, surgical emphysema, tracheostomy site infections, nerve injury, tracheal stenosis, poor scar aesthetics, tracheoarterial fistula and death. Submental intubation has no associated major complications when compared to tracheostomy.

The Role of Antibiotics in Nasal Fractures after Closed Reduction: Erratum

The Role of Antibiotics in Nasal Fractures after Closed Reduction: Erratum

D116. The Role of Antibiotics in Nasal Fractures following Closed Reduction

PURPOSE: Nasal fractures represent the most common fracture in facial trauma. The role of prophylactic antibiotics in these injuries is debated, given low infection rates and demonstrated risks of antibiotic therapy. We studied the effect of prophylactic antibiotics on infection rate in patients with nasal fracture following closed reduction. METHODS: Retrospective analysis was performed of a prospectively maintained plastic surgery facial trauma database at a Level I trauma center. Demographics, comorbidities, fracture classifications, and management of patients who received antibiotics at the time of closed nasal reduction were compared against those who did not receive antibiotics. Infection rates between groups were analyzed. Multivariate analysis was conducted to control for confounding variables. Qualitative analysis was performed for patients who experienced infection. RESULTS: 282 patients met inclusion criteria (n=144, antibiotic; n=138, non-antibiotic). Six patients experienced infection (1 abscess, 5 sinus infections). There was no difference in local infection rate (2.0% vs 2.2%, p=0.90), upper respiratory infection (0% vs 0%), or pneumonia (0.3% vs 0%, p=0.52) between antibiotic and non-antibiotic groups. On multivariate regression, antibiotics did not significantly decrease odds of infection (OR 1.7, [0.17-13.6], p=0.64). Moreover, patients with open nasal fractures did not have significantly higher odds of infection (OR 1.9, [0.08-20.8], p=0.64). Similarly, increasing severity of injury based on Rohrich Classification did not significantly impact odds of infection (OR 0.68, [0.23-1.9], p=0.46). Qualitative analysis demonstrated all six infections were managed non-operatively. CONCLUSION: Prophylactic antibiotics do not decrease infection rates following nasal fractures managed by closed reduction, including in open fracture cases.

D155. Demographics, Injury Patterns and Associated Injuries in 3,334 Pediatric Facial Fracture Patients Treated at a Single Institution

PURPOSE: Pediatric craniofacial fractures are fundamentally distinct from their adult counterparts due to unique injury patterns and effect on future growth. Understanding patterns and injury context informs management and risk mitigation. Previous studies include only inpatients, operative patients, or are specialty-specific; in contrast, our study presents a comprehensive descriptive report of all pediatric facial fracture patients seen at a single institution. METHODS: Patients under 18 years old who were evaluated for facial fractures at a Level I pediatric trauma center between 2006 and 2021 were reviewed. Sub-analysis was performed for groups defined by age. Variables studied included demographics, etiology, fracture pattern, associated injuries, management and outcomes. RESULTS: 3,334 patients were included. Mean age at presentation was 11.5 years. The majority were Caucasian (82.6%) and male (68.4%). Sports were the leading cause of injury in older patients (42.2% of patients over 12 years), compared to activities of daily living in patients under 6 years (45.5%). Thirty-two percent of patients were hospitalized, 6.0% required ICU care, and 48.4% required surgery. Frequency of ICU admission decreased with age (p<0.001), while operative intervention increased with age (p<0.001). Zygomaticomaxillary complex (p=0.002) and nasal fractures (p<0.001) were common in older patients, while younger patients experienced more skull (p<0.001) and orbital fractures (p<0.001). The most common associated injuries were soft tissue (55.7%) and neurologic (23.6%). CONCLUSION: This large-scale study provides updated characterization of craniofacial fractures in the pediatric population, providing a necessary framework for future studies on outcomes assessments and preventative care.

Closed reduction of nasoseptal fractures: key concepts for predictable results

Nasal complex injuries are the most common facial fracture encountered in the trauma population. Multiple surgical techniques for treatment of these fractures have been described with varying results. The goal of this study was to review the efficacy of closed reduction of nasal and septal fractures using a technique based upon several key concepts. We reviewed the records of patients who had undergone isolated nasal and/or septal fractures with closed reduction at our institution between January 2013 and November 2021. Inclusion criteria consisted of preoperative CT imaging, surgical treatment within fourteen days of initial injury, and follow up of at least one year. All patients were treated under general or deep sedation. The same surgical technique was applied with closed reduction of the septum and nasal bones with internal and external postoperative splints. Of the 232 records initially reviewed, 103 met inclusion criteria. Four patients had undergone revision septorhinoplasty (3.9%). Mean (range) follow up was 2.7 (1–8.2) years. Three patients had undergone revision nasal repair due to persistent airflow obstruction with complete resolution of symptoms after revision. The other patient received multiple revisions at another institution as a result of their dissatisfaction with cosmesis without improvement. Closed reduction of nasal and septal fractures can be a highly successful procedure and yield predictable results, limiting the need for post-traumatic open septorhinoplastic surgery. Five critical concepts of nasal fracture repair can help surgeons achieve predictable functional and cosmetic results: selection, timing, anaesthesia, reduction, and support.