Management Of Nasal Fractures Research Articles

Analysis of nasal fracture management and subsequent surgical outcomes across demographics.

Nasal bone fractures are the most common type of facial injury and can pose significant long-term challenges if not diagnosed and treated correctly at the time of presentation, including, but not limited to, septal hematoma, infection, epistaxis, persistent nasal deformity, nasolacrimal injury, deviated septum, and even mental health issues as serious as post-traumatic stress disorder as persistent complications (1-4). Optimal management remains controversial and subjective based on the clinician's judgment, with many factors playing a role in the provider's decision, including the timing of treatment, the choice between foregoing treatment or choosing to undergo a closed or open reduction, and how to manage subsequent revision surgeries if necessary.

Implementation of A Telephone Triage System for Management Of Acute Nasal Fracture in Response to The Coronavirus Disease 2019 Pandemic

Background: Acute nasal fracture is a common referral to ENT outpatient clinic. During the Covid-19 pandemic, NHS outpatient services were increasingly stretched and placed patients and staff at risk of Coronavirus. Virtual clinic appointments provided an effective method for reducing Covid-19 risk and improving the efficiency of outpatient services. We sought to implement a telephone triage system for the assessment of nasal fractures. Method A telephone triage pathway for nasal fracture was implemented in October 2021. Data on nasal fracture appointments and outcomes were retrospectively collected for 2 months prior to, and after, the introduction of the telephone triage pathway. All patients with suspected nasal fracture referred to ENT by the Emergency Department at Colchester Hospital were included. Results At baseline, 32 patients were referred for face-to-face (F2F) clinic, 20 (62%) attended and 12 (38%) did-not-attend (DNA). Of those who attended, 17 (85%) were managed conservatively and 3 (15%) had manipulation under anaesthetic (MUA). 24 patients were included in the telephone triage pathway, 13 (54%) attended and 11 (46%) DNA. Of those who attended, 11 (84%) were discharged and 2 (16%) were brought in for F2F assessment. One was managed conservatively and the other had a MUA (8%). The increase in DNA rate from the F2F pathway to the telephone triage pathway was not statistically significant. Conclusion Our data suggests that the telephone triage system for nasal fracture management results in fewer F2F appointments. This reduces COVID-19 transmission to the public and hospital staff but also improves utilisation of outpatient capacity.

1402 Impact of COVID-19 on Nasal Fracture Presentation and Epidemiology: A Retrospective Comparative Case-series Study

Abstract Aim Nasal fractures (NF) are the most common ENT presentation and commonly managed in the clinic or A&E. With the recent COVID pandemic, this study aims to assess the difference in demographics, incidence and aetiology in NF since the start of the first lockdown (16/03/2020) as well as management of nasal fractures. Method Retrospectively, data collection on demographics, history and management over 5 years (2015-2020) for all patients presenting with symptoms of nasal fracture. Data was collected on password-protected Excel spreadsheet and subsequent statistical analysis performed using IBM SPSS Statistics. Results A total of 346 patients were identified of which 36 were diagnosed during the lockdown. Seventy-one percent were ≤40 years old and common aetiology recorded was assault (n = 85), sports (n = 85) and falls (n = 77). Mechanical fall was the common aetiology in older patients. Across gender, falls was the most common aetiology in females (37/94) and assault for males (72/246). Epistaxis (57%) and nasal congestion (31.8%) were most commonly reported symptoms. Before lockdown, Fifty-six percent of the cohort underwent manipulation of NF under local anaesthetic and no intervention needed in 39% while 58% underwent no intervention during the lockdown. No patients were readmitted in 30 days who were treated conservatively or with local anaesthetic during the lockdown. Conclusions This study showed that the most common cause of NF was sports and assault while during the lockdown, falls was the leading cause. More patients were managed conservatively during the lockdown with no 30-readmission showing that conservative management was as effective as management under local anaesthetic.

686 Evaluating and Modernising the Management of Nasal Trauma in Emergency ENT Clinic

Abstract Aim 1. Optimise and compare management of nasal fractures at a single UK based centre with nationally excepted standards from ENT UK and published literature. 2. To measure the non-attendance (DNA) rate in the emergency ENT clinic for patients with nasal trauma. 3. To assess the ratio of face to face (F2F) appointments to patients listed for a manipulation under anaesthesia MUA. 4. To provide additional insight into the aetiology of nasal trauma Method Retrospective analysis of clinical notes for all nasal traumas reviewed in the ENT emergency clinic at a single centre from 1st July 2019 – 1st March 2020. Parameters investigated included – demographics, days from injury, F2F:MUA, DNA rate and aetiology of injury. Implementation of a video-based clinic and local anaesthetic MUA clinic. Results At total of 255 patients and 311 appointments notes were reviewed in this period. DNA rate was found to be 28%. F2F:MUA was found to be 4:1. Patients were reviewed on average 9 days post-injury. Most common causes of trauma were assault (39%), fall (31%), sport (13%), accidental hit (10%). Conclusions The DNA rate was found to be 20% higher than the national average for outpatient clinics and a F2F:MUA of 4:1 displays a high burden of unnecessary F2F contact. A video-based and local anaesthetic nasal fractures clinic has been implemented to combat these issues which will be re-audited.

Precisely Closed Reduction of Nasal Bone Fracture Assisted With Plain Film Measurements Under the Picture Archiving and Communication System.

To prevent aesthetic and functional deformities, precisely closed reduction is crucial in the management of nasal fractures. Plain film radiography (PF), ultrasonography (USG), and computed tomography can help confirm the diagnosis and classification of fractures and assist in performing closed reduction. However, no study in the literature reports on precisely closed reduction assisted with PF measurements under the picture archiving and communication system (PACS). We retrospectively evaluated 153 patients with nasal bone fracture between January 2013 and December 2017. Surgeons conducted precisely closed reduction assisted with PF measurement of the distance between the fracture site and nasal tip under PACS on 34 patients (group A). Another group on 119 patients were reduced under surgeon's experience (group B). No significant differences in age, gender, Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classification, and reduction outcome were observed between group A and group B (P > .05). The operative time of the group A was significantly lower (12.50 ± 4.64 minutes) compared to group B (23.78 ± 11.20 minutes; P < .001). After adjusted age, gender, and AO classification, patients in group A scored 10.46 minutes less on the operative time than those in group B (P < .001). In addition, the severity of nasal bone fracture (AO classification, β = 3.37, P = .002) was positive associated with the operative time. In this study, closed reduction in nasal bone fracture assisted with PF measurements under PACS was performed precisely, thereby effectively decreasing operative time and the occurrence of complications. This procedure requires neither the use of new instruments or C-arm nor USG or navigation experience. Moreover, reduction can be easily performed using this method, and it requires short operative time, helps achieve great reduction, less radiation exposures, and is cost-effective.

The Effect of COVID on Nasal Fracture Management in ENT Emergency Clinics.

Retrospective cohort study. Management of nasal fractures is usually in ENT emergency clinics, with our center aiming to assess patients within 10-days. During 2020, there have been numerous lockdowns and social distancing measures implemented in the UK as a result of the coronavirus pandemic (COVID). This study aimed to assess the effect of COVID on nasal fracture management in ENT emergency clinics in terms of number of patients seen, time to follow up and their management strategies. All patients with suspected or confirmed nasal bone fractures presenting to the emergency department (ED) between January 1, 2019 and December 31, 2020 at our major trauma center were analyzed in 2 groups depending on the year they were seen (2019 vs. 2020). There was a total of 104 patients analyzed, with 51.4% decrease in the number of patients seen in 2020 versus 2019. The mean days to follow up in 2019 was 8.09 days and 7.65 days in 2020 (P = .37). There was no statistically significant difference in the number of patients seen within the 10-day target between years (2019 = 65.7% vs. 2020 = 76.5%, P = .35). The majority of patients were managed with manipulation under anesthesia (MUA) in 2019 (n = 32, 45.7%) vs. discharge from clinic in 2020 (n = 21, 61.8%). Our study shows a drastic reduction in the number of patients seen in ENT emergency clinic from 2019 to 2020. This is in-keeping with other studies that have shown a reduction in ED attendances, trauma admissions and admissions across other specialties all around the world.

Evaluation of Treatment Outcome Following Closed Reduction of Nasal Bone Fractures

The closed reduction of a displaced nasal fracture is a preferred method in oral and maxillofacial surgery. This prospective study was conducted to evaluate the treatment outcome following closed reduction of nasal bone fractures. A total of 20 patients with nasal bone fracture who underwent closed reduction were included in the study. The cases were operated under local or general anesthesia. The outcome of treatment was evaluated pre- and postoperatively through systematic follow-ups. Clinical assessment was done to evaluate functional (airway patency, nasal obstruction, crepitus) as well as esthetic parameters (facial symmetry, swelling, and nasal deviation). Functional and esthetic satisfaction of patients was assessed using visual analog scale (VAS) pre- and post-operatively. It was observed that there was significant improvement in both functional and esthetic parameters following closed reduction of nasal fractures. The present study suggested that closed reduction of nasal bone fracture is very effective in the management of nasal bone fractures. However, further studies with larger sample size in different clinical situations should be considered to confirm the efficacy of the same. Closed reduction can be a viable and more conservative alternative in management of nasal fractures.

Management of Nasal Fractures in Sports.

Nasal fractures represent approximately 60% of all maxillofacial injuries that occur in athletic activities; however, there are no current guidelines regarding immediate sideline management of these injuries. Therefore, the purpose of this article was to (1) summarize the anatomy, etiology, and incidence of nasal fractures, and (2) evaluate the current body of literature regarding immediate on-field and subsequent outpatient management. It is imperative to establish that the athlete's airway is not compromised and there are no other severe concomitant injuries, such as a concussion, ocular injury, or leakage of cerebrospinal fluid. Immediate closed reduction should not be attempted unless there is airway compromise or the practitioner has experience in performing it. The majority of athletes with these injuries in isolation may return to play; however, in our practice, we recommend they wear a face mask for 6weeks after their injury. Despite our recommendations, we know there is a paucity of clinical studies on immediate sideline and longer-term management. Future studies should focus on establishing therapeutic algorithms that will allow physicians to make treatment recommendations to patients with strong evidence to support their decision.

The Nasal Fracture Algorithm: A Case for Protocol‐Driven Management to Optimize Care and Resident Work Hours

Since the initiation of resident duty hour restrictions, significant controversy has arisen regarding its impact on surgical resident training. We reviewed a singular facet of the otolaryngology residency experience, nasal bone fracture management, to identify if treatment standardization would improve care and efficiency. For 1 year, otolaryngology consults for isolated nasal fractures were analyzed to assess consultation trends, rate of intervention, and resident work hour utilization. Following a review of the literature, an evidence-based algorithm for management of nasal fractures was developed. Analysis revealed a potential improvement in intervention rate from 20% to 100% with utilization of the algorithm, with an 84% decrease in overall emergency room and inpatient consultations. Sixty-three hours of otherwise lost resident time would be gained. In the setting of Accreditation for Graduate Medical Education duty hour restrictions, implementation of protocol-driven management may result in a decrease in work hours and serve as a model for more efficient otolaryngology care.

Improving Results in Closed Nasal Reduction: A Protocol for Reducing Secondary Deformity.

Nasal fractures are the most common facial fracture. Improper reduction is a common occurrence, resulting in a residual deformity that requires secondary surgery. A treatment protocol for nasal fracture management is presented with the aim of reducing secondary deformities requiring corrective surgery. After institutional review board approval, a retrospective review of all closed nasal reductions performed by a single surgeon between 2006 and 2015 was conducted. Patient age, sex, presence of secondary deformity, and need for a correctional operation were recorded. Clinical records were analyzed for evidence of postoperative deformity and need for subsequent manipulation or surgery. A total of 90 patients with nasal bone fractures who underwent closed nasal reduction were identified. The mean age of patients was 24.9 years. The male-to-female ratio was 2.2:1. Postoperative deformity was reported in 14 patients (15.6 percent). Four of the 90 patients (4.4 percent) were found to have avulsion of their upper lateral cartilage from the nasal bone. Nine of the 14 subjects (64.3 percent) presenting with secondary deformity were managed with external manipulation, avoiding a secondary operation. Five patients (5.5 percent) from the original cohort of 90 underwent revision surgery. By using the described protocol to treat nasal fractures, we have seen a low rate of postreduction deformity and a small percentage of need for secondary operation. The overall success rate of closed nasal reduction with postoperative manipulation (when necessary) was identified to be 94.5 percent. Using this protocol, surgeons may see a decrease in secondary deformities following closed nasal reduction procedures. Therapeutic, IV.

Acute nasal fracture management: A prospective study and literature review.

Functional and cosmetic deformities are common after nasal injuries and at times necessitate advanced surgery to reverse the effects of trauma. This study was designed to study the factors related to nasal injury and patient parameters in influencing the acute management of nasal injuries and its outcome. Prospective study. Nasal injuries from County Waterford in Southeast Ireland were referred to a new Cost-Neutral Nasal Fracture Clinic. The first 400 patients from this prospective audit, referred to Waterford Regional Hospital from August 2009 through December 2010, were included in this study. Twenty-one variables, including satisfaction scores using Visual Analog Scale (VAS), were studied. Data was obtained at each stage of management, from initial assessment in ears, nose, and throat (ENT) casualty to being seen and further reviewed in consultant-based specialty clinic. Men outnumbered women 72: 28, and the mean age was 26.89 (0.4 years-87 years). Patients presenting time to the ENT casualty after the injury ranged between 1 and 90 days (mean 10.5 days). The interval between injury and intervention was on an average 6.1 days. Accident (41%) and soccer (46%), among the sports group, were predominantly related to nasal injury. The overall satisfaction rate was 77.5% for breathing and 85.6% for cosmesis. One hundred twenty-seven (31.8%) patients were referred to and managed from the septorhinoplasty clinic. Overall, 11% required septorhinoplasty. Patient satisfaction was seen in manipulation performed up to 5 weeks postinjury. Our databank is the largest prospectively studied series of nasal-fracture management from Ireland. The incidence of nasal fracture in the southeast of Ireland is 0.37%. Age, gender, mode of injury, and type of sport influenced the satisfaction rates in this study. This type of service may not be practical in all ENT departments, but a regional center may be an idea worth considering.

Management of Nasal Fractures

Management of Nasal Fractures

Management of nasal fractures in a rural district general hospital: A completed loop

Management of nasal fractures in a rural district general hospital: A completed loop

Local vs general anaesthetic for nasal fracture management: A comparative study

Local vs general anaesthetic for nasal fracture management: A comparative study

Immediate Functional and Cosmetic Open Rhinoplasty Following Acute Nasal Fractures

Closed reduction and splinting are generally recommended in the acute management of nasal fractures. Although open reduction is recommended for more severe nasal fractures, immediate functional and cosmetic open rhinoplasty following nasal fractures has not been described for Asian noses. The authors document their experiences with combining open reduction of acute nasal fractures with simultaneous cosmetic correction of preexisting aesthetic concerns in an Asian population. Twenty-five Asian patients underwent primary functional and cosmetic open rhinoplasty immediately following acute nasal fracture. Grafts consisted of autologous material, including septum, concha, rib, and deep temporal fascia. Prior to opening the nose, anatomical reduction of the bony vault fractures was performed. Spreader grafts were used to stabilize the fractured or dislocated dorsal septum as well as to straighten the nose. Aesthetic refinement of the nose included lengthening, refining the tip, and increasing tip projection and was performed according to the patients' aesthetic desires. Patient satisfaction was subjectively reported on a 1 to 10 scale. Mean follow-up was 17 months (range, 10-24 months). Twenty-three patients rated the results of their procedures as 7 or higher. Functionally, all patients were breathing as well or better postoperatively compared with their preinjury functional state. One patient (4%) underwent a secondary filler procedure for a slight dorsal irregularity. Immediate cosmetic and functional open rhinoplasty is safe, predictable, and effective in Asian patients. 4.

Prospective, blinded study of nasal injuries: comparison of doctor and nurse assessment

This study aimed to compare an experienced ENT treatment room nurse's ability to assess nasal injuries with that of junior doctors. One hundred consecutive patients with nasal injuries were assessed prospectively in two phases, followed by a telephone survey. Comparison of nasal injury assessment, advice, and outcomes regarding cosmesis, airway obstruction and patient satisfaction. In the first phase, there was almost perfect agreement between doctor and nurse assessments regarding the management of nasal fractures (p < 0.0001). There was no deterioration in outcomes in the nurse assessment only patient group with regards to cosmesis and airway obstruction. Ninety-four per cent of patients were satisfied with nurse-only assessment. Our study showed that an experienced treatment room nurse was as effective as experienced junior doctors in assessing and advising patients with nasal injuries. Following this study, the nurse involved began to independently assess patients with nasal injuries attending the unit.

The Treatment of Nasal Fractures

To compare the efficacy of closed vs open treatment of nasal fractures, and to suggest an algorithm for nasal fracture management that includes closed and open techniques. Retrospective study of 86 patients with nasal fractures who received either closed treatment (41 patients) or open treatment (45 patients) between January 1, 1997, and December 30, 2007. Fractures were classified as 1 of 5 types. Revision rates were calculated for each group. Preoperative and postoperative photographs were rated, if available, and patients were interviewed about aesthetic, functional, and quality of life issues related to surgical treatment. The revision rate for all fractures was 6%. The revision rate for closed vs open treatment was 2% vs 9%, respectively. Many closed treatment cases were classified as type II fractures, whereas most open treatment cases were classified as type IV fractures. There was no statistical difference in revision rate, patient satisfaction, or surgeon photographic evaluation scores between the closed and open treatment groups when fractures were treated in the recommended fashion. Patients who undergo open or closed treatment have similar outcomes if the surgical approach is well matched to the individual fracture. Our treatment algorithm provided consistent aesthetic and functional results while minimizing the need for revision procedures.

The Treatment of Nasal Fractures

To compare the efficacy of closed vs open treatment of nasal fractures, and to suggest an algorithm for nasal fracture management that includes closed and open techniques. Retrospective study of 86 patients with nasal fractures who received either closed treatment (41 patients) or open treatment (45 patients) between January 1, 1997, and December 30, 2007. Fractures were classified as 1 of 5 types. Revision rates were calculated for each group. Preoperative and postoperative photographs were rated, if available, and patients were interviewed about aesthetic, functional, and quality of life issues related to surgical treatment. The revision rate for all fractures was 6%. The revision rate for closed vs open treatment was 2% vs 9%, respectively. Many closed treatment cases were classified as type II fractures, whereas most open treatment cases were classified as type IV fractures. There was no statistical difference in revision rate, patient satisfaction, or surgeon photographic evaluation scores between the closed and open treatment groups when fractures were treated in the recommended fashion. Patients who undergo open or closed treatment have similar outcomes if the surgical approach is well matched to the individual fracture. Our treatment algorithm provided consistent aesthetic and functional results while minimizing the need for revision procedures.

Diagnosis and management of nasal fractures

The nasal bony–cartilaginous framework provides support to the nose and maintains airway patency. The cartilaginous and bony components are both susceptible to fracture. Nasal fractures are one of the most common facial injuries, occurring across a broad spectrum of age groups. Inadequate acute injury treatment can lead to persistent airway obstruction and nasal deformities that are subsequently more difficult to correct. Herein we discuss common presentations of nasal fractures, classifications, and options for treatment.

Treatment of nasal fractures by Paul of Aegina

The most exact description of the management of nasal fractures given by any physician of ancient times belongs to Paul of Aegina (AD 625-690). The goal of this article is to describe the therapeutic methods and surgical techniques used by Paul of Aegina in the treatment of nasal injuries. We studied the original Greek texts and the translation published in Venice, titled "The seven books of excellent doctor Paul of Aegina." The sixth book of his medical compendium is devoted to surgery. We identified the treatments and techniques applied to the restoration of injured noses. In this historical article we present the management of nasal fractures by Paul of Aegina. Paul of Aegina's conservative and surgical management for each form of injury was adopted by later physicians and influenced European medicine, a management surprisingly identical with the way nasal fractures are managed nowadays.