Nasal Fractures Research Articles

Management of Complications of Septoplasty; a Cross-sectional Comparative Study between Silicon Nasal Splints, Plastic Splints and without Splints for the Correction of the Deviated Nasal Septum

Introduction: In otorhinolaryngology practice deviated nasal septum is a very common issue. Multiple theories demonstrated that deviated nasal septum started from birth moulding to the trauma to the nose. Sometimes surgery is performed to the approach of paranasal sinuses but the most common indication for septoplasty is nasal obstruction. Aim/Objectives: To compare the management of complications after septoplasty in different groups by using nasal splints, plastic splints and without a splint. Methodology: One hundred and fifty patients were selected randomly having deviated nasal septum (DNS) for septoplasty. We divided all patients into three different groups i.e., Group I (without splints), Group II (silicon splints), and Group III (plastic splints). Fifty patients were enrolled on each group. We measured the severity of pain by using a visual analogue scale, postoperated bleeding, post-operated septal hematoma, post-operated nasal adhesion, saddle nose deformity, and septal perforations. Data was entered in SPSS software by using version 20. Results: Among 150 patients, ninety-five were male and 55 were female. Pain score (severe pain) in Group I was 0%, in Group II, it was 20% and in Group III, it was 30%, showing the severity of pain was less in Group I. Moderate pain was more (30%) in patients of Group III. Nasal bleeding was noted in 16% in Group I, 18% in Group II, and 80% in Group III. Nasal adhesions were more in Group I, i.e., 24 patients (48%), in Group II and in group III, it was 8%. The hematoma was more in Group III. Saddle nose deformity was seen in 2 patients in group III. Septal perforations were seen in 6 patients in Group I and 1 patient in group III. Conclusion: Silicon nasal splints are good and effective; patients were more comfortable and have fewer complications when compared to plastic splints and without splints.

The characteristics of assaulted victims presented to a university emergency department: Can head trauma in male patients be considered a clue for assaults?

Violence is a common issue without an exact number worldwide. The types are interpersonal, spousal, or domestic violence. We aim to reveal the demographic characteristics of cases involving violence, mechanisms of injury, and their relationship with head and face trauma. The files of patients presented to our University Hospital Adult Emergency Department (ED) between January 2018 and December 2020 after an assault were reviewed retrospectively. The data were analyzed with SPSS 20.0. The demographic findings, injury mechanisms, and affected areas were reported. The Chi-square test tested the differences between the groups, and p<0.05 was considered significant. Among the 1280 patients presented after an assault, 71% were male with a median age of 32 (IQR 25-43). In 84% of the cases, the perpetrators were unknown, while their spouses were the perpetrators in 9% of the cases. The place was most noted as home (11%). The methods used were struggling (43%) and punching (42%). The most common affected area was the head (70%) and diagnosis for nasal fracture (4%); two patients had epidural bleeding, and one had a pneumothorax. Males were more common in the 20-40 age groups (χ2, p=0.003). Most of the female victims were battered by their spouses (χ2, p<0.001). Head injury was found in 83% of patients with high blood alcohol levels (χ2, p<0.001) and 75% of male patients had head injuries (χ2, p<0.001). Assault is a common problem predominantly among young males. The most commonly affected body part was the head, and nasal fractures were the diagnosis. Most of the patients with high blood levels were among the male victims. The perpetrator of the female victims was their spouses. In the ED, male patients who presented with head trauma were considered as assault victims.

A Restrospective Evaluation of Otorhinolaryngology Consultations Requested from the Emergency Department

Aim: In this study, it was aimed to examine the emergency service consultations requested from the otorhinolaryngology outpatient clinic and to discuss the results in the light of the literature. Material and Methods: In our study, 376 emergency department consultations requested from the otorhinolaryngology outpatient clinic of Kastamonu Training and Research Hospital between the dates 01.10.2019 and 01.10.2021 were examined retrospectively. Age and gender of patients, date of consultation, reasons for consultation, diagnoses made as a result of consultation and interventions were recorded. Results: 142 (37.8%) of the patients who requested consultations were female and 234 (62.2%) of them were male. The mean total age was 38.43. The most common reason for consultation was nasal fracture, infectious causes, foreign body in the ear and foreign body in the nose, respectively (n=77, 20.47%; n=51, 13.56%; n=39, 10.37%; n=36, 9.57%). The most frequently consultation requested months are July (n=62, 16.48%), August (n=45, 11.96%) and September (n=44, 11.70%), respectively. As a result of the consultations, the most common interventions were foreign body removal and nasal fracture repositioning (n=64, 17.02%; n=58, 15.42%). No otorhinolaryngology pathology was found in 79 patients (21.01%). Conclusion: The fact that emergency physicians have sufficient knowledge and experience in otorhinolaryngology emergencies will both reduce the mortality and morbidity of patients and prevent the loss of time and internal power by preventing unnecessary consultation requests

Comparison of the Efficacy of Ivalon® Nasal Pack and Ribbon Gauze Pack Following Nasal Surgeries- A Randomised Clinical Trial

Introduction: Nasal bleeding is one of the Ear, Nose and Throat (ENT) emergencies which are usually managed by the Hippocratic maneuver. Anterior nasal packing is unavoidable after nasal surgeries and refractory anterior nasal bleeding. There are wide variety of newer nasal packs available and easily acceptable by the patients. The most commonly used nasal packs in day to day practices are Ivalon® and vaseline soaked ribbon gauze pack. Aim: To compare the difference between Ivalon® nasal pack with a traditional ribbon gauze pack in terms of efficacy, feasibility, patient comfort, cost and need for repacking postremoval in patients undergoing nasal surgeries. Materials and Methods: This randomised clinical trial involved 144 patients who required nasal packing after nasal surgeries, like septoplasty, Functional Endoscopic Sinus Surgery (FESS) and nasal bone fracture reduction in the Department of ENT, Head and Neck surgery at a Tertiary Care Centre, Chennai, India. Patients were categorised into two groups- Ribbon gauze group and Ivalon® group. The patient’s comfort was quantified based on nasal discharge, pain on removing the pack, stuffiness of the nose, and irritability were compared. After pack removal, mucosal oedema, congestion, and synechiae formation were assessed by using a diagnostic nasal endoscopy after 1 week. Results: Out of 144 patients, in Ivalon® group, 37 (51.4%) were males and 35 (48.6%) were females. The incidence of nasal symptoms with nasal surgery i.e nasal discharge was significantly higher in the ribbon gauze packing group (68.1%) compared to Ivalon® pack (31.9%) (p-value=0.044). Pain on pack removal was also more in the former (76.4%) compared to Ivalon® group (23.6%) which were statistically significant (p-value=0.005). Pain on pack removal was significantly more in the former (76.4%) compared to Ivalon® group (23.6%). Other symptoms like anxiety, discomfort, stuffiness, local irritation, and congestion were lesser in the Ivalon® group. Mucosal oedema was higher in ribbon gauze group (59.7%) compared to Ivalon® pack (40.3%) which was statistically significant (p-value= 0.019). Conclusion: As a postnasal surgery pack, Ivalon® pack is a better option due to less pain, anxiety, stuffiness, local irritation, congestion, synechiae formation and gives better comfort when compared to the ribbon gauze packs.

Computer Aided Facial Bone Fracture Diagnosis (CA-FBFD) System Based on Object Detection Model

Facial bone fractures must be diagnosed and treated as early as possible to avoid complications and sequelae. CT images need to be analyzed to detect fractures, but the analysis is time-consuming, and enough specialists are not available to analyze them. Many classification and object detection studies are being conducted to address these issues. The ability of classification-based studies to pinpoint the exact location of fractures is limited. Object detection-based research, by contrast, is problematic because the shape of a fracture is ambiguous. We propose a computer-aided facial bone fracture diagnosis (CA-FBFD) system to address the aforementioned challenges. This system adopts the object detection model YoloX-S, which is trained using only IoU Loss for box prediction, along with CT image Mixup data augmentation. For training, we used only nasal bone fracture data, whereas for testing, we used several other facial fracture data. During evaluation, the CA-FBFD system achieved an average precision of 69.8% for facial fractures, which is better than the baseline YoloX-S model by a large margin of 10.2%. In addition, the CA-FBFD system achieved a sensitivity/person of 100% for facial fractures, which is considerably better than that exhibited by the baseline YoloX-S model by a margin of 66.7%. Therefore, the CA-FBFD system can effectively minimize the labor of doctors who need to determine facial bone fractures in facial CT.

Nasal deformity correction with nasal prosthesis

Nasal deformities can vary in the form of severity. Several different factors such as congenital, burn and traumatic nasal fractures or soft-tissue injury/loss, neoplastic: defects resulting from surgery for the treatment of cancers causing compromise the structural architecture and functional framework of the nose. This case report describes the prosthetic rehabilitation of two female patients, one who was reported with congenital arrhinia and another one who had accidental electrical burns of the face. The surgeon's team as well as the maxillofacial prosthetics team discussed the treatment options with the parents and decided to rehabilitate with a nasal prosthesis. This clinical report is imparting an accessible and economic method for prosthetic rehabilitation of a patient.

Diagnostic errors of nasal fractures in the emergency department: A monocentric retrospective study.

Diagnostic errors of nasal fractures in the emergency department: A monocentric retrospective study.

CUSTOM MADE INTERNAL AND EXTERNAL NASAL SPLINTS : A COST EFFECTIVE ALTERNATIVE

Objectives: To evaluate the usability and effectiveness of tailor made internal and external nasal splints after nasal surgery.&#x0D; Study Design: An observational study.&#x0D; Place and Duration of Study: Combined Military Hospital Kohat, from Nov 2015 to Aug 2017.&#x0D; Methodology: the study was carried out on 523 patients who underwent nasal surgery by the same team of surgeons. Custom made free of cost internal and external nasal splints were used as required. Complications pertaining to the use of nasal splints were recorded.&#x0D; Results: The custom made splints were found to be an excellent and cost effective alternative of commercially available expensive splints. The benefits and pitfalls were comparable.&#x0D; Conclusion: Where these free of cost splints does the job they as well save a lot of money and can be used as an effective alternative to commercially available splints.

Antibiotic use in nasal bone fracture: a single-center retrospective study.

BackgroundProphylactic antibiotics are used to prevent surgical wound infection; however, proper indications must be followed with careful consideration of the risks and benefits, especially in clean or clean-contaminated wounds. Nasal bone fractures are the most common type of facial bone fracture. The most common method for treating nasal bone fracture is closed reduction, which is performed inside the nasal cavity without an incision. The purpose of this study was to determine the need for antibiotic use in the closed reduction of nasal bone fractures.MethodsA retrospective study was conducted using data from the National Insurance Service Ilsan Hospital of the Republic of Korea between 2016 and 2018. The records of patients who underwent closed reduction of nasal bone fracture were reviewed and classified according to sex, age, comorbidities, perioperative antibiotic usage, postoperative complications, nasal packing, anesthesia type, surgeon’s specialty, and operation time.ResultsAmong the 373 patients studied, the antibiotic prescription rate was 67.3%. Just 0.8% of patients were prescribed preoperative antibiotics only, 44.0% were prescribed postoperative antibiotics only, and 22.5% were prescribed both preoperative and postoperative antibiotics. There were no cases that satisfied the definition of “surgical site infection.” Furthermore, 2.1% of infection-related complications (e.g., mucosal swelling, synechia, and anosmia) occurred only in the antibiotic usage group. The use of nasal packing, anesthesia type, and surgeon’s specialty did not show any difference in infection-related complication rates.ConclusionAccording to the study findings, the routine use of perioperative antibiotics is not recommended in uncomplicated nasal bone fracture surgery.

Life-Threatening Panfacial Wild Dog Bites in a Child

Infants and toddlers can sustain grievous craniofacial injuries after dog bites, some of which may be life-threatening. An 18-mo-old male child presented to our emergency department with complex panfacial wounds after being bitten by an unvaccinated wild dog 6 h earlier. Primary management, hemostasis, and rabies postexposure prophylaxis were performed near his home. Initially, he was resuscitated from severe hemorrhagic shock and anemia in a pediatric intensive care unit. After stabilization, early primary repair of all facial injuries was performed. Surgical exploration revealed multiple full-thickness avulsions, lacerations, nasal bone fractures, facial muscle injuries, and right ear necrosis. Gentle tissue-handling and meticulous reconstruction satisfactorily restored his facial soft-tissue contours about 64 h after the bite injury. Postoperatively, recovery was uneventful except for localized soft-tissue infection caused by multidrug-resistant Pseudomonas, which resolved with appropriate antibiotics. Nine months later, his face and ear appeared almost symmetrical with well-settled scars. Psychological recovery progressed smoothly, excepting few incidences of panic attacks that were triggered by loud noises. Here, we observed that early primary reconstruction of severely mauled soft tissues after wild dog bites, performed within 72 h with adequate precautions, safely produced satisfying long-term outcomes.

Use of Bedside Ultrasonography for Diagnosis of Nasal Fractures in Emergency Service

Use of Bedside Ultrasonography for Diagnosis of Nasal Fractures in Emergency Service

Effects of the COVID-19 Pandemic on Pediatric Nasal Fractures.

ObjectivesNasal bone fracture is a frequent entity consulted to the otolaryngologists, approximately accounting for 39% of all facial bone fractures. The most frequent mechanisms of injury consist of assault, sport-related injuries, falls, and motor vehicle accidents. In this study, we examined the effects of the COVID-19 pandemic on pediatric nasal fractures.MethodsChildren with nasal fracture who applied to Malatya Training and Research Hospital during the year before the first case and the following year were included in this study. Data of 172 patients for the pre-pandemic period and 79 patients for pandemic were available and included in the study. Demographic information, clinical features, nasal fracture etiology, nasal fracture type, type and time of intervention, and other accompanying pathologies were recorded.ResultsWhile falls was the leading cause of fracture etiology before the pandemic (64 patients [37.21%]), assault seems to be the leading cause during the pandemic period (27 children [34.18%]). In the pre-pandemic period, the intervention for patients with nasal fractures was performed on an average of 5 days, while this period was calculated as an average of 6 days during the pandemic period. When the 2 groups are compared in terms of nasal fracture intervention time, it was seen that the intervention time was statistically significantly later in the pandemic period (P < .001). According to the results of the analysis, the most cases in the pandemic period were seen in the fourth month, which indicated a-month period between 11 June and 11 July.ConclusionsIn conclusion, our number of nasal fracture cases was decreased during the pandemic period compared to the 1-year period before the pandemic. We observed the most common type IIA nasal fracture. We gave outpatient treatment to most of the patients. Our most common cause of fracture was assault. We intervened in our cases in an average of 6 days and preferred closed reduction most frequently. We could not find any study on the same subject in the literature, and we aimed to contribute to the literature with this study.

Epidemiology of professional bare-knuckle fighting injuries

ABSTRACT Background Professional bare-knuckle fighting (BKF) is a variation of boxing which held its first modern legal event in 2018 in Wyoming. Since then, the sport has expanded with state-sanctioned events held in Florida, Missouri, Mississippi, Kansas, and Alabama. The purpose of this study was to evaluate the epidemiology of injuries in bare-knuckle fighting bouts and to discern any trends which may distinguish it from traditional boxing with padded gloves. Methods Observational data collection for all state-sanctioned professional bare-knuckle fighting bouts was conducted sequentially over a two-year period from June of 2018 through November of 2020. Information related to fight outcome, injury diagnosis, and injury location was documented. This data was then analyzed and the incidence rates by injury type and location were calculated. Results There were 141 bouts conducted during the study period. Out of the 282 individual combatants, 105 (36.6%) sustained at least one injury during the event and 123 total injuries were recorded. In total, 98 (34.8%) lacerations were recorded; on average, 6.2 +- 4.5 sutures were required per laceration. There were 5 superficial hand lacerations and 80 facial lacerations. Seventeen (6.0%) fractures occurred, with 8 hand fractures, 6 nasal fractures, 2 orbital fractures, and 2 dental fractures. There were 8 (2.8%) periorbital hematomas sustained by fighters. Transfer to the hospital was required on 5 (1.8%) separate occasions, twice for orbital fractures and 3 times for traumatic brain injuries. In all, there were 8 (2.8%) concussions with symptoms. Conclusion The most frequent injuries in BKF include lacerations and hand fractures. Concussions are relatively uncommon compared to other injuries.

The Effect of Orthognathic Surgery on Changes in Masticatory Muscle Volume in Patients With Facial Asymmetry.

The masseter muscle changes remarkably with orthognathic surgery and has a marked influence on the contours of the lower face. If the postoperative volume change of masticatory muscles, including the masseter muscles, can be predicted, it will facilitate preoperative planning and outcome prediction. This study investigated the association of masticatory muscle volume according to the presence or absence of facial asymmetry, and evaluated whether the volume of masticatory muscles, including that of the masseter muscle, changes after orthognathic surgery in facial asymmetry patients.Twenty patients who underwent LeFort I osteotomy and bilateral sagittal segmentation ramus osteotomy (BSSRO) with facial asymmetry between 2011 and 2017 were assigned to the asymmetric group. Additionally, 207 patients with a simple nasal fracture between 2016 and 2019 were included as the common group. Threedimensional computed tomography images were retrospectively analyzed and compared between the asymmetric group and common group.The volume of both temporal and masseter muscles differed according to facial asymmetry, with the asymmetry in the muscle volume increasing in proportion to the degree of facial asymmetry. The difference in masseter volume on the shortened and lengthened sides was significantly reduced after orthognathic surgery, but a difference of about 1 cm 3 remained. Additionally, the masticatory muscle volume on the lengthened side tended to be decreased more than that on the shortened side.Consideration of the postoperative change in the volume of the masticatory muscles may be helpful in planning orthognathic surgery in facial asymmetry patients.

Etiology, pattern, and treatment of nose fractures: A 10-year cross-sectional cohort retrospective study.

Determining the etiology, epidemiology, pattern, and treatment of nasal bone fractures and the associated soft tissue injuries in a population will be beneficial for the prevention, rapid and correct diagnosis, and adequate management of this pathology in order to minimize postoperative complications. This study retrospectively evaluated the patients admitted and treated for nasal bone fractures in a university clinic of oral and maxillofacial surgery in Romania over a 10-year period. Following statistical analysis, evaluation and correlation of the monitored variables, a P value < 0.05 was considered statistically significant. Nasal bone fractures had the highest incidence among men (88.30%), aged 20-29 years (33.33%), with no education (33.33%), interpersonal violence being the main cause in this category of patients (P = 0.004; P = 0.005; P = 0.005). In urban environment (55.9%), nasal bone fractures through aggression and road traffic accidents were predominant, while in rural areas (44.10%), those caused by domestic accidents and animal attacks prevailed (P = 0.551). Nondisplaced (81.10%), closed (85.60%) and involving the nasal septum fractures (51.35%) were preponderant. Hematoma was the most frequent associated soft tissue injury (86.49%), its incidence being increased in the case of displaced (P = 1.000) and open fractures (P = 0.692). The most frequent treatment method was close nasal reduction (CNR) + closed septoplasty (51.35%). The most frequent complication was malunion (7.2%), secondary to CNR without septoplasty (P = 0.037). The main etiology of nasal bone fractures was interpersonal violence, which mainly affected men, aged 20-39 years, with a low level of education, living in urban areas. Implementing laws to fight interpersonal aggression and increase the education level of the population would lead to a considerable reduction in the incidence of this pathology. Patients treated by CNR + closed septoplasty and ORIF had the best postoperative evolution. Immediate septoplasty in the case of associated septal fractures significantly decreased the rate of postoperative complications.

Cranial Traumas in a Sample from the Pucará de Tilcara Fortress (Jujuy Province, Argentina)

We analyze injuries in the cranial sample from the Pucará de Tilcara fortress, dating to the time of the Inca conquest. Analysis of violence markers, carried out by visual examination and computed tomography, and the comparison of results with those relating to samples from the Regional Development Period of the Quebrada de Humahuaca valley, suggest that although the violence level remained high, its nature could have changed after the arrival of the Inca. The female sample reveals just two perimortal injuries, no trophy skulls were found, and the frequency of nasal bone fractures is higher than in earlier samples. This may indicate lower level of between-group fi ghting for control over resources, and higher risk of interpersonal violence. The observed pattern suggests that having arrived in the Quebrada de Humahuaca region, the Inca eased political tension by establishing control over trade routes and the distribution of arable land areas, which had previously been the main cause of local armed clashes. The infl uence of artifi cial cranial modifi cations on the pathological and traumatic status of individuals was also analyzed. Two types of modifi cation were recorded in the sample—fronto-occipital tabular oblique and fronto-occipital tabular straight. None of them caused pathological changes or a decrease in the thickness of cranial bones.

An Epidemiological Analysis of Maxillofacial Fractures in the Inner Aegean Region: A Retrospective Evaluation of 343 Cases

Objective: The focus of this study was the sociocultural, economic, educational, and geographical factors that influence the incidence and types of fractures in maxillofacial trauma (MFT). The aim of this study was to identify the etiology and demographic characteristics of MFT cases in the inner (eastern) Aegean region. Materials and Methods: The records of patients treated at the Kütahya Health Sciences University Evliya Çelebi Education and Research Hospital for MFT from January 1, 2017 to March 1, 2020 were analyzed retrospectively. Results: A total of 476 bone fractures in 343 patients were analyzed. The sample comprised 239 male patients and 104 female patients. The average age was 35.19±17.79 years. Traffic accidents were found to be the most common cause (42%) of MFT. Of the isolated non-nasal bone fractures, 19 were in the maxilla, 17 in the zygoma, 14 in the mandible, and 7 in the frontal sinus. Nasal fractures (42.6%) were found to be the most frequently occurring breakages. Surgery was performed in 35.27% of the patients who agreed to have surgery for MFT. Conclusion: The etiology and incidence of MFT can vary not only by country but also by geographical region within countries. The results of this study support this view. A review of the literature indicated that MFT in the inner (eastern) Aegean region in Turkey has not yet been studied. Societal differences must be considered in the recommendation of measures to reduce the incidence of MFT and thus morbidity and mortality.

Pattern of maxillofacial fractures in a Tertiary Referral Centre in Central Kerala - A comparison between the Pre-COVID and COVID periods

Our aim was to observe if there was any appreciable difference in the etiology and pattern of maxillofacial fractures during the pre-COVID-19 and COVID-19 periods in Central Kerala, South India. This retrospective study was conducted with data over a period of two years from the central database registry of our hospital. Age, sex, etiology, date of injury, and site of facial fractures were recorded and compared between both the time periods. Increase in facial fractures due to fall at home (p value < 0.01) and decrease in mass casualty cases (p value < 0.01) were observed during the COVID-19 period. Pedestrians involved were significantly more in the pre-COVID-19 period (p value < 0.01) and heavy vehicle accidents producing facial fractures were significantly more in the COVID-19 period (p value < 0.01). Frontal bone (p value = 0.008), nasal bone (p value < 0.001) and zygomatico-maxillary complex fractures (p value < 0.001) occurred significantly more in the COVID-19 time period whereas naso-orbito-ethmoidal (p value = 0.003), mandibular (p value = 0.011) and dentoalveolar fractures (p value < 0.001) were seen significantly more in the pre-COVID-19 period. There was decrease in the total number of maxillofacial cases during the COVID-19 period. However, this was not significant when only the number of facial fractures were compared between the two periods. This study provided an insight on the differences in etiology and pattern of maxillofacial fractures during the pre-COVID-19 and COVID-19 periods. Road traffic accidents involving two wheelers predominate during the COVID-19 period also, prompting further critical exploration of the reasons behind this finding.

Trends in Medicare Reimbursement for the Top 20 Surgical Procedures in Craniofacial Trauma

PURPOSE: Research regarding financial trends in craniofacial trauma surgery is limited. Understanding these trends is important to the evolvement of suitable reimbursement models in craniofacial plastic surgery. The purpose of this study was to evaluate the trends in Medicare reimbursement rates for the top 20 most commonly utilized surgical procedures for facial trauma from 2000 to 2021. METHODS: The 20 most commonly utilized Current Procedural Terminology codes for facial trauma repairs from 2000 to 2021 were queried from The National Summary Data File from the Centers for Medicare & Medicaid Services. Reimbursement data for each procedure were then extracted from The Physician Fee Schedule Lookup Tool. Changes to the United States consumer price index were used to adjust all gathered data for inflation to 2021 US dollars. The average annual and the total percent change in reimbursement were calculated for the included procedures based on the adjusted trends. RESULTS: From 2000 to 2021, the average reimbursement for all procedures decreased by 16.6% after adjusting for inflation. Closed treatment of TMJ dislocation and closed treatment of nasal bone fractures without manipulation demonstrated the greatest decrease in mean adjusted reimbursement at −48.7% and −48.3%, respectively, whereas closed treatment of nasal bone fractures without stabilization demonstrated the smallest mean decrease at −1.4% during the study period. Open treatment of nasal septal fractures with or without stabilization demonstrated the greatest increase in mean adjusted reimbursement at 18.9%, while closed treatment of nasal septal fractures with or without stabilization demonstrated the smallest increase at 1.2%. The average reimbursement for all closed procedures in the top 20 decreased by 19.3%, while that for all open procedures decreased by 15.5%. The adjusted reimbursement rate for all top 20 procedures decreased by an average of 0.8% each year. CONCLUSIONS: To the best of our knowledge, this is the first study to comprehensively evaluate trends in Medicare reimbursement for facial trauma surgical repairs. Adjusting for inflation, Medicare reimbursement for the top 20 most commonly utilized procedures has largely decreased from 2000 to 2021. Consideration of these trends by surgeons, hospital systems, and policymakers will be important to assure continued access to meaningful surgical facial trauma care in the United States.

Antibiotic use in nasal bone fracture: a nationwide population-based cohort study in Korea.

BackgroundProphylactic antibiotics are commonly used in craniofacial surgeries. Despite the low risk of surgical site infection after nasal surgery, a lack of consensus regarding the use of antibiotic prophylaxis in the closed reduction of nasal bone fractures has led to inappropriate prescribing patterns. Through this study, we aimed to investigate the status of prophylactic antibiotic use in closed reductions of nasal bone fractures in Korea.MethodsThis retrospective cohort study was conducted using data from the National Health Insurance Service-National Sample Cohort of Korea from 2005 to 2015. We analyzed the medical records of patients who underwent closed reduction of nasal bone fractures. The sex, age, region of residence, comorbidities, and socioeconomic variables of the patients were collected from the database. Factors that affect the prescription of perioperative antibiotics were evaluated using multivariate logistic regression analysis.ResultsA total of 3,678 patients (mean± standard deviation of age, 28.7± 14.9 years; 2,850 men [77.5%]; 828 women [22.5%]) were included in this study. The rate of antibiotic prescription during the perioperative period was 51.4%. Approximately 68.8% of prescriptions were written for patients who had received general anesthesia. The odds of perioperative prophylactic antibiotic use were significantly higher in patients who received general anesthesia than who received local anesthesia (odds ratio, 1.59). No difference was found in terms of patient age and physician specialty. Second-generation cephalosporins were the most commonly prescribed antibiotic (45.3%), followed by third- and first-generation cephalosporins (20.3% and 18.8%, respectively). In contrast, lincomycin derivatives and aminoglycosides were not prescribed.ConclusionThe findings of this study showed that there was a wide variety of perioperative antibiotic prescription patterns used in nasal bone surgeries. Evidence-based guidance regarding the prescribing of antimicrobial agents for the closed reduction of nasal bone fractures should be considered in future research.