Nasal Fractures Research Articles

Comparative Analysis of Open and Closed Nasal Fractures in Trauma Settings: Mechanisms, Intent, Surgical Interventions, and Outcomes

Objectives: This study aimed to explore nasal fracture patterns, trauma mechanism and intent, treatment approaches, and mortality rates, offering insights for clinical practice and prevention in trauma settings. Design: This retrospective analysis was carried out using trauma data from the National Trauma Data Bank (NTDB) for the years 2013 to 2016. Main outcome measures: Trauma mechanism and mortality rates between closed and open fractures were conducted. Results: This study involved 122,574 closed and 9704 open nasal fractures to elucidate demographic, hospital, and clinical characteristics. Significant risk factors for open nasal fractures included a higher injury severity score, self-inflicted intent, unintentional causes, and firearm mechanism compared to assault injuries. Conclusions: Significant factors associated with open nasal fractures include injury severity, self-inflicted intent, trauma type, and firearm mechanisms, which notably increase the likelihood of open fractures. Findings highlight the need for targeted prevention, efficient resource allocation, and risk screening to enhance the management of complex facial traumas in the national trauma system.

Facial bone fracture repair using ultrasound‐aided pin fixation of resorbable plates in two horses

SummaryThis report describes the application of a resorbable implant (Resorb‐Vet) made of poly‐(DL) lactide (PDLLA) for the repair of a maxillary fracture in one horse and a nasal bone fracture in another. The horses were positioned in lateral recumbency and the fracture was reduced. An absorbable plate was moulded to the bone and fixed with PDLLA pins, which were attached to an ultrasonic device and inserted into predrilled holes by ultrasonic vibrations. Once the pins contacted the bone, the ultrasonic vibrations caused liquefication of the PDLLA, which infiltrated the bone and solidified after the ultrasonic vibrations ceased. Immediate primary stability was achieved with this technique. Both horses recovered well, were discharged without complications and returned to their previous level of activity.

Comparative Evaluation of L Plate Versus Z Plate for One Point Fixation in Zygomatic Fractures

The zygomatic bone’s lateral prominence and convexity make it the most important bone to provide aesthetic facial appearance and set the face width, but at the same time, this prominence and convexity make this bone more susceptible to injury. Among facial injuries, zygomatic-complex fractures or tripod fractures are the second most common fractures after nasal fractures. This study has performed a comparative assessment of fixation of zygomatic buttress by L and Z shaped plate. Fourteen zygomatic-complex fracture patients were selected and split into two groups, further divided into two subgroups (A, B). Group A patients were treated with a titanium Z shaped plate and Group B with L shape plate. One point fixation was performed and was observed in terms of stability, aesthetics and prevention of vertical or horizontal axis of rotation of the fracture segment. Z-shaped plates showed some advantage over L-shaped plates so there use can be preferred in complex fractures where comminuted bone pieces are scattered.

Iodoform in Surgical Practice: A Comprehensive Review of Its Historical Evolution, Clinical Applications, and Safety Profiles.

Iodoform, a halogenated organic compound, has been a cornerstone in surgical practice due to its potent antiseptic and antimicrobial properties. This comprehensive review examines the historical evolution, mechanism of action, clinical applications, and safety profile of iodoform across various surgical disciplines. Historically significant formulations like Whitehead's varnish and bismuth iodoform paraffin paste (BIPP) demonstrated remarkable efficacy in wound healing during the late 19th and early 20th centuries. BIPP, extensively used for cavity packing, combines bismuth subnitrate for its antibacterial and astringent effects with paraffin to minimize tissue trauma. The antimicrobial action of iodoform is attributed to the release of iodine upon activation by free radicals, leading to the denaturation of bacterial proteins and cytotoxic effects on inflammatory cells, thereby enhancing therapeutic efficacy. Clinically, iodoform has diverse applications in ear, nose, and throat surgery, neurosurgery, oral and maxillofacial surgery, and general dental practice. It is utilized for dressing wounds, packing surgical cavities, and managing conditions such as nasal fractures, epistaxis, cerebrospinal fluid leaks, and dry sockets. The radiopacity of BIPP, due to its bismuth content, aids in radiographic identification but necessitates clear communication with radiologists to prevent misinterpretation. Despite its benefits, iodoform use is associated with potential complications. Bismuth and iodoform toxicities, though rare, can lead to neurotoxicity and systemic symptoms, requiring prompt recognition and intervention. Allergic reactions, particularly in patients with prior exposure, and dermatological side effects like dermatitis herpetiformis flare-ups have been documented. Mechanical complications and considerations during pregnancy, owing to the potential transfer of iodine to the fetus, highlight the need for cautious application. This review underscores the enduring significance of iodoform in surgical settings while emphasizing the importance of awareness regarding its potential risks. Careful clinical judgment and ongoing research are imperative to optimize its therapeutic benefits and enhance patient safety.

Comparison Of Surgical Techniques Used In Post-Traumatic And Non-Traumatic Rhinoseptoplasty

Introduction: The main goals of septorhinoplasty are to correct cosmetic and functional defects, which may occur in a patient with no history of previous trauma. As the most prominent facial feature, the nose has an increased risk of injury. Nasal fracture may eventually result in significant defects; posing challenges to the surgeon.Aim: The aim of the study is to compare the technique used in post-traumatic and non -traumatic cases of rhinoplasties.Materials and methods: The study group consisted of 227 patients, mean age 37.511.4 years, median 36 years, age range from 18 to 79 years. Statistical analysis was performed using the Statistica 13.3 package StatSoft, Dell Statistica. Categorical variables are presented as frequencies and percentages. The Chi2 or Fisher’s exact test - when the number in cells were less than 5, was respectively used to check whether there was a correlation between nasal injuries and surgical technique. The level of statistical significance was assumed to be equal to α=0.05.Results: Statistically significant differences were found in the use of five techniques. Septal filtration to the spine (44.1% vs 10.7%), septal extension graft (5.9% vs 1.3%), spreader graft (41.1% vs 21.1%) and osteotomy (85.3% vs 61.0%) were all performed more in patients with nasal trauma. On the other hand, LC steal was performed significantly more often in patients without nasal trauma (36.5% vs 22.1%).Conclusions: Nose injuries lead to cosmetic and functional complications pose a challenge to the rhinoplasty surgeon. Optimal management in the case of posttraumatic nose requires surgeon's experience and precise surgical planning.

Comparison of the Effects of Lidocaine Versus Magnesium Infusion on Quality of Recovery After Nasal Bone Fracture Surgery.

Background and Objectives: Postoperative recovery from general anesthesia is a multidimensional process, and patient-centered outcome assessment should be considered an important indicator of recovery quality. This study compared the effectiveness of intraoperative lidocaine and magnesium on postoperative recovery in nasal bone fracture surgery, using the quality of recovery-40 questionnaire (QoR-40) to assess recovery quality and pain intensity. Materials and Methods: A total of 74 patients scheduled for elective closed reduction surgery for isolated nasal bone fracture were assigned to the intraoperative infusions of lidocaine or magnesium. Immediately after anesthetic induction, 1.5 mg/kg lidocaine or 20 mg/kg magnesium was administered over 10 min, followed by a continuous infusion of 2 mg/kg/h lidocaine or 20 mg/kg/h magnesium until the end of the surgery. The primary outcome variable was the QoR-40 survey on postoperative day 1. The secondary outcome variables included postoperative pain intensity, sedation score, the incidence of postoperative nausea and vomiting, and other side effects. Results: The global QoR-40 score at postoperatively 24 h was comparable between the intraoperative lidocaine and magnesium groups. Postoperative pain 30 min after surgery was significantly lower in the lidocaine group than in the magnesium group (p = 0.01), along with lower rescue analgesic consumption (p = 0.003), but pain intensity was not different at other time points (2, 6, and 24 h). The incidence of nausea and vomiting and the sedation score in the post-anesthetic care unit were not significantly different between the two groups. Conclusions: Intraoperative lidocaine and magnesium had no difference in the scores of postoperative QoR-40, but lidocaine was associated with lower postoperative pain scores and analgesic requirement in comparison to magnesium in the closed reduction of nasal bone fractures.

Facial Fractures at the Armed Forces Capital Hospital of Korea: A 10-Year Study From 2013 to 2022.

The aim of this study was to analyze facial bone fractures at the Armed Forces Capital Hospital of Korea (AFCH) from 2013 to 2022. This review included individuals who visited AFCH for treatment. The inclusion criteria for the study were fractures resulting from external trauma, specifically coded as S02.1-4 and S02.6-9. The exclusion criteria comprised fractures caused by factors other than external trauma. This retrospective study of 178 facial bone fractures included 176 males (98.9%) and 2 females (1.1%) (22.5±5.1 years). The most common causes of injury were bumps (72.5%), followed by slips (7.3%), assaults (5.6%), and falls (5.1%). The majority of facial bone fractures occurred during sports activities (33.7%), training (31.5%), or everyday activities (28.7%). Nasal bone fractures were the most prevalent (47.7%), followed by fractures of the maxilla (19.2%), orbit (18.7%), mandible (10.3%), and zygoma (3.3%). The interval between the injury and hospital arrival was 6.0±8.0 days. Among the 164 patients, 110 (67.1%) underwent surgery. The overall complication rate was 8.9%. The highest complication rate was mandibular fractures (22.7%), followed by nasal bone fractures (9.8%). Among the 208 recorded facial bone fractures, 145 patients (69.7%) received treatment at AFCH, whereas 63 (30.3%) were treated in a civilian hospital; 59 patients (28.4%) by their own choice and 4 patients (1.9%) on a consignment basis. The average follow-up period was 202.0±183.2 days. The relatively high rate (28.4%) of treatment at civilian hospitals is attributable to legislation allowing injured soldiers the option to choose between military and civilian medical facilities.

Management of Neglected Facial Fracture: A Case Report

Introduction: Neglected fracture occurs where there has been a delay of more than 30 days. The maxillofacial fracture complex is the most common fracture in traffic accidents. The most common maxillofacial fractures are Naso-Orbito-Etmoid (NOE), Lefort fracture, Zygomatic Complex (ZMC), Palate Fracture, and Parasymphysis Fracture. Neglected fractures lead to delayed treatment, worsening conditions, and even disability. Case: A 52-year-old male patient presents with complaints of facial bone fracture after being involved in a motor vehicle accident. CT scan examination showed: Multiple fractures of the bilateral nasal bones, interethmoidal septum, anterior walls of bilateral frontal sinuses, bilateral lamina papyracea of the ethmoid bone, anterior, medial, and lateral walls of bilateral maxillary bones all support Le Fort II. fracture, extending to bilateral dentoalveolar processes, bilateral zygomatic bones, and right mandibular parasymphysis. Case Management: The ORIF technique was used for the upper, middle, and lower face fractures in a preferred order. The palatal reduction and fixation step was frequently the first in this sequence. When proper occlusion was achieved, it was maintained by intermaxillary fixation. Conclusion: There was a significant result in correcting the functional, mastication, and aesthetic of the mid and lower face by using surgical management of facial fractures using ORIF. Keywords: Facial fracture, Neglected fracture, ORIF

Impact of COVID-19 on Maxillofacial Trauma Incidence at Vajira Hospital: A Retrospective Study (2018-2021)

Background: Maxillofacial injuries vary globally depending on social, cultural, and environmental factors. The coronavirus disease 2019 (COVID-19) pandemic has further contributed to global variations in maxillofacial injury incidence owing to precautionary restrictions. Objective: To investigate the impact of COVID-19 on maxillofacial fractures. Materials and Methods: The present study was a retrospective cohort study that analyzed the medical records of patients with maxillofacial fractures admitted to the Emergency Department, Vajira Hospital, Bangkok. The incidence, causes, and anatomical sites of fractures were compared between the pre-COVID-19, 2018 to 2019, and COVID-19 periods, in 2020 to 2021. Results: The present study included 749 patients with maxillofacial fractures. The analysis revealed a 15% decrease in the number of patients with maxillofacial fractures during the COVID-19 pandemic. Males were more affected than females in both periods. Traffic accidents remained the primary cause of injuries, while assault-related injuries decreased significantly. Nasal bone fractures were the most frequent, with a significant reduction in orbital fractures caused by assault (p=0.033) during the COVID-19 period. The incidence of isolated zygomatic arch and panfacial fractures caused by assault increased during the COVID-19 period (p=0.026 and 0.041, respectively). The incidence of mandibular fractures due to other causes was significantly higher (p=0.009). Conclusion: The COVID-19 pandemic had led to significant changes in daily life in Thailand. Understanding the characteristics of patients with maxillofacial trauma provides valuable insights into prevention and management strategies, particularly during prolonged infectious disease outbreaks such as COVID-19 and potential future incidents.

Nasal Bone Fracture (NBF): A Retrospective Study on Epidemiology and Treatment Outcomes in the Omani Population.

Purpose To investigate the epidemiology, etiology, treatment outcomes, and sequelae of nasal bone fractures (NBFs) in the Omani population, which may contribute to developing better treatment approaches and preventive strategies. Materials and methods A retrospective chart review was conducted at Al Nahdha Hospital from January 2012 to January 2017. Data on demographics, injury mechanisms, treatment modalities, and outcomes were collected for 453 patients with NBFs. All patients with fresh NBFs, children, or adults of both genders, were included. Of these, 171 patients underwent nasal bone reduction under general anesthesia (GA). The collected data included the patients' age, gender, cause of injury, treatment, and surgical outcome. SPSS was used for data collection and analysis. Results Sports-related injuries, particularly football, were the most common cause (35.97%), followed by accidental falls (32.92%), road traffic accidents (17.68%), and assaults (12.82%). Most cases (98.8%) were managed with closed reduction, with a satisfactory outcome in 85.81%. However, 14.18% experienced residual deformities requiring further surgery. The highest frequency of displaced NBF was in the 21-30 age group, with males being the predominant patients. Conclusion NBFs are particularly common among young males (21-30 years). Sports injuries, falls, and road traffic accidents are the primary causes. Timely and appropriate management is crucial to minimize long-term complications. Hence, an emphasis on health education and preventive measures for sport injuries among the young population is required.

Changes in peripheral blood IL-9, Th9, and BAFF levels in patients with allergic rhinitis and their clinical implications.

Allergic Rhinitis (AR), a prevalent condition in otorhinolaryngology, is mediated by Type 1 hypersensitivity through IgE, characterized by Type 2 inflammatory response and eosinophil infiltration in the nasal mucosa. Since AR disease exhibits significant heterogeneity in symptom severity, an objective assessment of AR severity may facilitate better individualized treatment. To explore the changes in peripheral blood IL-9, Th9, and BAFF levels of allergic rhinitis (AR) in patients and the clinical significance associated with it. A retrospective study selected 80 AR patients admitted from January 2022 to October 2022 as the case group, dividing them into mild and moderate-to-severe groups based on symptom scores. Concurrently, 50 patients without AR, who were treated for nasal bone fractures or underwent septoplasty, were selected as the group for comparison. Alterations in the expression levels of peripheral blood IL-9, Th9, and BAFF were analyzed and compared among the different groups. The diagnostic value of serum BAFF for the severity of AR was analyzed using the receiver operating characteristic (ROC) curve. Noticeable variations were observed in clinical variables among the three groups such as, total IgE levels, peripheral blood eosinophil count and proportion, TNSS, and VAS (P< 0.05), while no statistically significant differences were observed in other variables (P> 0.05). The comparison of IL-9, Th9, and BAFF among the three groups revealed statistically significant differences (P< 0.05). Analysis using multivariate logistic regression revealed that IL-9 (OR = 2.365), Th9 (OR = 2.186), BAFF (OR = 2.307) were influencing factors of moderate-to-severe AR (P< 0.05). The ROC curve indicated that the AUC for the diagnosis of moderate-to-severe AR by IL-9, Th9, BAFF were 0.770, 0.734, 0.761, respectively, and the combined detection AUC was 0.888, an area under the curve higher than individual testing. Changes in peripheral blood IL-9, Th9, and BAFF levels in AR patients may function as indicators to assess the level of severity in diagnostic procedures.

A retrospective epidemiological analysis of maxillofacial fractures at a tertiary referral hospital in istanbul: a seven-year study of 1,757 patients

BackgroundThe aim of the study was to evaluate the etiology, incidence, demographics, and characteristics of maxillofacial fractures treated at a university hospital over a seven-year period.MethodsWe performed a retrospective analysis of 1,757 patients with maxillofacial fractures who were referred to our department between May 2012 and March 2019. The patients’ demographic and clinical characteristics were noted, as well as the fracture type, location, and etiology. The treatment modalities were also analyzed.ResultsA total of 2,173 maxillofacial fractures were seen in 1,757 patients. The male to female ratio was 3.9:1, and the mean patient age was 31.89 ± 17.70 years (range: 0–95 years). Maxillofacial injuries were most prevalent in the 19–28 years age group (23.9% of cases), with a general increase in injuries observed between 2013 and 2018 across all age groups. The most common etiological factor was assault (29.1%), followed by falls (26%). In male patients, assault was reported as the main cause, while in female patients, falls were identified as the main cause. The nasal bone was the most common site of fracture, followed by the maxilla. The average time from admission to surgery was 2.8 days, with local anesthesia being the most frequent surgical intervention. The average time from admission to surgery was 2.8 ± 2.5 days (range: 0–20 days), with surgeries performed under local anesthesia being more frequent than those carried out under general anesthesia. Among the surgical interventions, the most common general anesthesia technique for fracture reduction was open reduction and internal fixation with plates and screws. Plate exposure, wound-site infection, and temporomandibular joint ankylosis were the major complications encountered in the study population.ConclusionThe study reveals significant variability in maxillofacial fractures based on gender, age, and etiology. Assault emerged as the leading cause of these fractures, followed by falls and road traffic accidents. Men were affected by maxillofacial trauma four times more often than women, with the highest incidence occurring in the 19–28 years age group. Nasal fractures were the most frequently observed (78.7%), while condylar-subcondylar process fractures were the most common type of mandibular fracture. Given these findings, a targeted, lifelong prevention strategy focused on high-risk groups could significantly reduce the burden of maxillofacial trauma.

Clinical effects of two kinds of nasal bone reductors used for shortened and displaced overlapping external nasal fracture reduction under nasal endoscopy and the impact on ventilation function

Objective:To explore the clinical effects of two kinds of nasal bone reductors used for shortened and displaced overlapping external nasal fracture reduction under nasal endoscopy and the impact on ventilation function. Methods:From January 2020 to February 2022, 82 patients with shortened and displaced overlapping external nasal fractures diagnosed and treated in the Department of Otolaryngology, the Second People's Hospital of Hefei were collected as the study subjects. The patients were divided into control group（41 cases） and observation group（41 cases） by random number table method. Both groups underwent closed reduction under nasal endoscopy. The control group was treated with traditional straight nasal bone reductor, and the observation group was treated with gun-shaped hook type nasal bone reductor. The success rate of reduction, follow-up rate, clinical effect, and complications were compared between the two groups. The visual analogue scale（VAS） was used to evaluate the aesthetic effect and functional recovery. Rhinomanometry and acoustic rhinometry were used to evaluate nasal ventilation function. Results:The success rate of one-time reduction in the observation group was significantly higher than that in the control group, and the nasal reduction adaptation time was shorter than that in the control group（P<0.05）. There was no significant difference in the follow-up rate of 95.12% and 92.68% between the two groups. The success rate of one-time reduction in observation group was significantly higher than that in the control group, and the adaptation time for nasal reduction in observation group was shorter than that in the control group（P<0.05）. There was no significant difference in the follow-up rate of 95.12% and 92.68% between the two groups in six months after surgery. the total clinical effective rate in observation group was higher than that in the control group（94.87% vs 76.32%, P<0.05）. After surgery, the scores of nasal aesthetics, nasal congestion and olfactory function in both groups were significantly lower compared with the preoperative scores. All the scores in the observed group were lower than that in the control group（P<0.05）. After surgery, there were significant increases in the minimum cross-sectional area of nasal cavity, volume of nasal cavity and total nasal expiratory volume in both groups. Above indicators in observation group were significantly greater than that in control group. The nasal exhalation and inhalation resistance was significantly lower than that before operation, and the resistance in observation group was significantly lower than that in control group（P<0.05）. The total incidence of complications was lower than that in observation group（P<0.05）. Conclusion:The application of gun-shaped hook-type nasal bone reductor in patients with shortened and displaced overlapping external nasal fractures has better success rate of one-time reduction, adaptation time of nasal reduction and treatment outcome. Moreover, it has more advantages in aesthetic effect of nasal appearance, nasal ventilation function and reduction of complications.

Psychopathologic Evaluation in Patients With Nasal Bone Fractures.

Background: Nasal bone fractures are pretty common. The most common causes include interpersonal violence, traffic accidents, sports injuries, and falls. This study aimed to assess patients presenting with nasal bone fractures not only for nasal trauma but also for personality disorders, impulsivity, and attention-deficit/hyperactivity disorder (ADHD) using psychiatric questionnaires. Methods: The study included 41 patients, and the control group consisted of 43 volunteers without nasal bone fracture; neither the patients nor the volunteers had previously been diagnosed with or treated for psychiatric disorders. The psychiatric questionnaires administered were the Eysenck Personality Questionnaire Revised-Short Form (EPQR-S), the Barratt Impulsivity Scale-Short Form (BIS-11-SF), and Turgay's Adult ADD/ADHD DSM-IV-based Scale. Results: The most common cause of nasal bone fractures in our study was violence (41.5%), followed by traffic accidents (29.3%), falls (17%), and sports injuries (12.2%). In the EPQR-S assessment, the nasal bone fracture (NBF) group had significantly-higher total scores than the control group (CG) (P < .001). In the subscales of the questionnaire, extroversion, psychoticism, and lie subscale scores were higher in the NBF group than in the CG. In the BIS-11-SF assessment, the NBF group had higher total scores than the CG (P < .001). Assessment using Turgay's adult ADD/ADHD DSM IV-based diagnostic screening and rating scale revealed no statistically-significant difference between the NBF group and the CG in terms of attention deficit and hyperactivity. Conclusion: We found that psychoticism patterns and impulsivity were more prevalent in the patient group, whereas ADD/ADHD was not. The results of our study suggest that performing a psychiatric assessment may be the right decision in patients presenting with NBFs caused by violence, whether they are the aggressor or the victim.

Clinical application of submandibular endotracheal intubation in craniomaxillofacial fracture

ObjectiveTo explore the clinical application of submandibular endotracheal intubation in craniomaxillofacial fractures. MethodsThe submandibular endotracheal intubation was used to treat 10 patients with cranio-maxillofacial fractures and contraindications to nasal intubation.Ventilator monitoring data including SPO2(oxygen saturation of blood), Freq,VT,MV,PEEP, PLAT and PEAK were monitored before and after the operation of submandibular endotracheal intubation. The technique of submandibular intubation was assessed intraoperatively and in the postoperative period. The outcomes and complications are presented. ResultsThe study included 10 patients aged between 18 and 63 years(6 males and 4 females). All patients had mandibular fractures, with 6 midface fractures (60 %), 5 nasal bone fractures (50 %), 6 zygomatic bone fractures (60 %). The procedure time ranged from 6 to 10 min (mean, 7.9 min). NO delayed extubation was performed in 10 cases. The technique has proved to be straightforward and satisfactory. A postoperative superficial infection occurred in 1 patients, whereas hypertrophic scars occurred in another 1 patients. ConclusionSubmandibular endotracheal intubation is a safe procedure for intraoperative airway control in maxillofacial trauma patients who present contraindication to nasotracheal intubation.

Intranasal Outer Cortex Splinting With a Kirschner Wire to Immobilize Reduced Buckle-out Segments in Nasal Fractures.

High-velocity lateral impacts to the nose sometimes cause nasal buckle-out fractures with a trapdoor buckle-out segment displaced outwards. Prolonged immobilization of a reduced buckle-out segment at risk for outward redisplacement remains challenging. Here we introduce a novel method of intranasal outer cortex splinting with a Kirshner (K)-wire to reinforce the reduced state and prevent outward re-displacement of the buckle-out segment. Eighteen patients with nasal buckle-out fractures underwent outer cortex K-wire splinting to securely immobilize a reduced but unstable buckle-out segment after indirect open reduction through intercartilaginous incisions and inner cortex K-wire splinting. A thin K-wire (diameter 0.8mm) was inserted at the vestibule, passed above the upper lateral cartilage and the outer cortex of the reduced buckle-out segment, and extended to the cephalic non-fractured bone. The wire served as a crossbeam, effectively supporting the reduced buckle-out segment. All K-wires for inner and outer cortex splinting were removed 10 to 14 days postoperatively. Immediate postoperative computed tomography scans showed successful immobilization of buckle-out segments in 17 patients (94.5%). Postoperative 6-month scans of 7 patients showed excellent maintenance and bony alignment of buckle-out segments in all cases. Sixteen patients (88.9%) were satisfied with the overall external nasal contour at the last follow-up. There were no complications directly related to outer cortex K-wire splinting. One patient complained of a focal lateral protrusion resulting from the under-correction of a buckle-out segment. This technique may be a valuable option for immobilizing and maintaining reduced nasal buckle-out segments until a stable bony union is established.

Management of Acute Nasal Bone Fractures in Adults: Systematic Review and Meta-Analysis

Management of Acute Nasal Bone Fractures in Adults: Systematic Review and Meta-Analysis

Efficacy of Nasal Septal Complex in the Endoscopic Reconstruction of Medial Orbital Wall.

The aim of this study is to investigate the efficacy of nasal septal complex reconstructing the medial orbital wall under some specific circumstances. The authors performed a study that included 10 patients who underwent isolated medial orbital wall fracture (blow-out fracture). All the reconstruction surgery of the patient included in this study fixed defect of medial orbital wall using autologous nasal septal complex (composed of nasal septal cartilage and perpendicular plate of ethmoid). The authors observed postoperative improvements of diplopia or ocular motility disorders of the affected orbit. The surgeries had gained satisfactory results, and without severe postoperative complications. After long-term follow-up, postoperative CT indicated the implant-covered defect of medial orbital wall, and there's no incarceration of the medial rectus. Meanwhile, the authors found there is no crack in the implant, and the surgery using nasal septal complex achieved premorbid orbital form. Autologous nasal septal complex provides a better complement to endoscopic reconstruction of medial orbital wall; this strategy allows nasal septum to reconstruct isolated medial orbital wall defects of various degrees, such as nasal septum fracture and dysplasia of perpendicular plate of ethmoid.

Big Data Analysis of Facial Fracture Epidemiology in South Korea From 2015 to 2020: Impacts of Aging and Personal Mobility.

The epidemiology of facial fractures is continuously evolving due to various influencing factors, including social, economic, and technological advancements. Thus, an updated analysis of facial bone fractures is necessary. This study aimed to provide an updated epidemiological analysis of facial bone fractures and assess severity using multiple factors. We retrospectively reviewed patients who underwent facial bone fracture surgery at 3 teaching hospitals in South Korea between January 2015 and December 2020. Data collected included patient demographics (sex and age), trauma mechanism, alcohol intoxication status, and fracture types. Trauma mechanisms were categorized into 7 groups: assault, fall, sports, occupational injury, motor vehicle crash, bicycle, and personal mobility. Severity was assessed using the modified facial injury severity scale. A total of 5953 patients (4437 males and 1516 females) were included, with ages ranging from 1 to 92 years (mean age: 36.37±18.61y). A steady decline in the number of patients was observed from 2015 to 2020. Falls were the most common cause of facial fractures (2300 cases, 39%), and nasal bone fractures were the most frequent type (3683 cases, 46%). The number of elderly patients (> 60y) and injuries caused by personal mobility devices increased steadily. Male sex and alcohol intoxication were associated with higher severity scores. Motor vehicle crashes had the highest severity scores (2.246). While the incidence of facial bone fractures has decreased in recent years, the proportion of elderly patients and injuries caused by personal mobility devices is increasing, posing a significant burden on the health care system.

Primary Open Reduction and Internal Fixation of Isolated Compound Depressed Nasal Fractures.

The aim of this study was to assess the efficacy of primary open reduction and internal fixation (ORIF) utilizing the existing dorsal wound for the management of isolated nasal fractures characterized by significant depression and to determine its effectiveness in preventing the need for subsequent nasal revisions. A retrospective review was conducted on patients who underwent ORIF of nasal bone for isolated compound depressed nasal fractures from January 2018 to January 2024. The primary outcomes included the assessment of clinical and radiographic results postoperatively, focusing on nasal symmetry, projection, airway patency, and the incidence of secondary surgical interventions. The study included 15 patients, predominantly males (60%), with an average age of 39.33 years. The mechanisms of injury included motor vehicle accidents (40%), falls (26.7%), interpersonal violence (20%), and occupational injuries (13.3%). All patients were treated on the first (73.3%) or second day (26.7%) after the injury. All patients had satisfactory esthetic and functional outcomes and did not require secondary rhinoplasty. The hardware was removed in 4 patients (26.7%). Primary ORIF through an existing dorsal wound for significantly depressed isolated nasal fractures was effective in obviating the necessity for subsequent nasal revisions.