Treatment Of Nasal Bone Fractures Research Articles

Management of nasal bone fractures

Management of nasal bone fractures is a complex and challenging task to maxillofacial surgeons. Incorrect and inappropriate treatment of nasal bone fractures will end with secondary deformity that is very difficult to correct. All patients with nasal bone fractures were seen at Maxillofacial Surgery Department at Ramadi Teaching Hospital and Maxillofacial Surgery Department at Karkh General Hospital during the period of December 2009 till October 2010. Age, sex, etiology, associated injuries, pattern of fractures and treatments were reviewed and a radiographic study has been achieved to analyze and diagnose nasal bone fractures clinically and radiographically.

Proposed Method for Closed Reduction of Impacted Nasal Bone Fractures Using a Kirschner Wire and a C-Arm

Closed reduction is commonly used for the treatment of nasal bone fractures. If the fracture is impacted, accurate reduction is difficult. Therefore open reduction is often required. Between January 2010 and December 2011, we used a Kirschner wire and a C-arm intraoperatively for accurate closed reduction of impacted nasal bone fractures. During the follow-up period of 4 weeks to 6 months, all patients had satisfactory cosmetic results. The effectiveness of open reduction was obtained without noticeable scarring with our method of closed reduction using a Kirschner wire and a C-arm.

The Usefulness of the Endonasal Incisional Approach for the Treatment of Nasal Bone Fracture

BackgroundAmong all facial fractures, nasal bone fractures are the most common, and they have been reduced by closed reduction (CR) for a long time. But several authors have reported suboptimal results when using CR, and the best method of nasal bone reduction is still being debated. We have found that indirect open reduction (IOR) through an endonasal incisional approach is a useful method for more accurate reduction of the nasal bone.MethodsA retrospective chart review was performed of 356 patients who underwent reduction of a nasal bone fracture in our department from January, 2006, to July, 2011. We treated 263 patients with IOR. We assessed patients' and doctors' satisfaction with surgical outcomes after IOR or CR. We evaluated the frequency of nasal bleeding owing to mucosal injury, and followed the surgical outcomes of patients who had simultaneous dorsal augmentation rhinoplasty.ResultsAccording to the analysis of the satisfaction scores, both patients and doctors were significantly more satisfied in the IOR group than the CR group (P<0.05). Mucosal injury with nasal bleeding occurred much less in the IOR group (5.3%) than the CR group (12.9%). Dorsal augmentation rhinoplasty with IOR was performed simultaneously in 34 cases. Most of them (31/34) showed satisfaction with the outcomes.ConclusionsIOR enables surgeons to manipulate the bony fragment directly through the endonasal incisional approach. However, we propose that CR is the proper technique for patients under 16 and for those with comminuted nasal bone fractures because submucosal dissection in IOR can damage the growth or circulation of nasal bone.

A new approach to the treatment of nasal bone fracture: The clinical usefulness of closed reduction using a C-arm

A new approach to the treatment of nasal bone fracture: The clinical usefulness of closed reduction using a C-arm

Clinical Utility of Three-Dimensional Facial Computed Tomography in the Treatment of Nasal Bone Fractures: A New Modality Involving an Air-Bone View with a Volume Rendering Technique

To evaluate the utility of three-dimensional (3D) reconstruction when planning the surgical treatment of nasal bone fractures. The axial scan of high-resolution facial bone CT was reconstructed in 3D using the program V-works 4.0 (CyberMed, Seoul, Korea) with a volume and surface rendering technique. For detailed stereoscopic examination of the nasal valve area, an air-bone view with the volume rendering technique was obtained using thresholds for air, cartilage, and bone. In most nasal bone fractures, 2D and 3D CT had similar detection rates. However, to determine the fracture angle and dimpled area, and identify multiple fractures, surgeons can get better information to help with the reduction of the fractured bone from 3D reconstruction images. Additionally, with a septal deformity, this view helps in deciding on the need for septal surgery during nasal reduction. The air view of the nasal passage provides clues to obstruction of the nasal cavity. We could identify the contour and location of the fracture site accurately from 3D CT images. The detection rate of fractures was similar to that of 2D CT. However, 3D CT enabled the accurate determination of the distance and direction of the fractured bony fragment from normal bone structure. Additionally, a stereoscopic image of the fracture site facilitated an understanding of the location and range of reduction. The air-bone view gave more information about the pathological obstruction of the nasal air passage.

New Maneuver for Fixation of Pediatric Nasal Bone Fracture

Surgical treatment of nasal bone fractures in children is a complex and challenging task not only to maxillofacial surgeons but exceeding to ears, nose, and throat and plastic surgeons. Twelve child patients including 9 boys (75%) and 3 girls (25%) with nasal bone fractures were seen at the Maxillofacial Surgery Department at Ramadi Teaching Hospital during the period of December 2009 to December 2010. Fractured nasal bone is reduced to its anatomic position with Walsham forceps, and the dislocated or disrupted nasal septum with Asch forceps. The most common cause of the injury was road traffic accident and motorcycle accident 5 (42%); nasal deviation was found in 9 cases (75%), and depression in 2 (17%). In 9 patients (75%), injuries were isolated, and 3 (25%) were associated with other facial bone fractures. Significant advances have been made in the management of these injuries, decreasing the incidence of secondary deformities.

A New Approach to the Treatment of Nasal Bone Fracture: Radiologic Classification of Nasal Bone Fractures and Its Clinical Application

A radiologic examination is required in the treatment of nasal bone fracture to determine the fracture condition. Thus, there is an increasing need for radiologic classification of nasal bone fractures that can be applied to clinical practice. Computed tomography was performed in 125 patients with nasal bone fractures to determine which axial view best showed the entire nasal view. The obtained axial view was then used as a reference for classification. The length from the top to the base of the nasal bone was divided into upper, middle, and lower levels, after which the fracture location was determined. If the fracture spanned the boundaries of these levels, it was classified as the total level. Subsequently, the fracture was subclassified based on the fracture direction and pattern and the concurrent fracture. Radiologic examination of patients with nasal bone fracture showed that nasal bone fracture was frequently found at the total, middle, upper, and lower levels, in that order. Nasal bone fractures at the upper level showed lower frequencies of complication and reoperation than the fractures at the other levels, whereas nasal bone fractures at the total level showed the highest frequencies of complication and reoperation. Radiologic classification can be useful for preoperative and postoperative evaluations of nasal bone fractures and can be helpful in understanding such fractures because it can efficiently predict the prognosis of a fracture.

A new approach to the treatment of nasal bone fracture: The clinical usefulness of closed reduction using a C-arm

Closed reduction is commonly conducted for the treatment of a nasal bone fracture unless a concurrent fracture or a severe nasal septum fracture is observed. As the reduction, however, is not conducted through the direct gross observation of the fracture site, it is difficult to obtain a good result from it. Accordingly, a supplementary process is required. Closed reduction with a C-arm was conducted within the period from March 2009 to January 2010 on 50 patients with nasal bone fractures, to treat these fractures or to evaluate the postoperative conditions of such. The usefulness of the C-arm was evaluated by comparing the aforementioned closed reduction with a C-arm with the closed reduction without a C-arm that was conducted on 64 patients with nasal bone fractures within the period from January 2008 to February 2009. The complication morbidity and re-operation rate were significantly lower in the patient group with closed reduction with a C-arm, and the radiologic examination also showed a significant difference. If closed reduction is conducted on patients with nasal bone fractures using a C-arm, an accurate result can be obtained by observing the fractured bone indirectly with continuous imaging during the operation, and the operation result can be immediately assessed in the operating room, thereby reducing the frequencies of complications and re-operation.

Usefulness of Ultrasonography in the Treatment of Nasal Bone Fractures

Ultrasonography has recently been used in assessment and diagnosis of maxillofacial trauma because it is easy and quick to perform, inexpensive, portable, and noninvasive. The aim of this study was to estimate ultrasonography as an intraoperative repositioning control of nasal bone fractures. We studied 32 patients with suspected nasal bone fracture. We performed preoperative computed tomography (CT) for evaluation of the type and extent of nasal bone fractures. We also took external photographs for evaluation of external deviation of the nose and nasal deformity. During surgery, we performed real-time ultrasonography-guided closed reduction using a 10 MHz linear transducer. After 1 year, we performed postoperative evaluation with CT and external photography. We classified patients into three groups according to their CT score. Patients were 23 males and 9 females aged 8-39 years. Clinical symptoms were pain, nasal swelling, nasal bleeding, and localized depression at the trauma site. In almost all patients, postoperative external photographs showed a symmetrical nasal dorsum without external deformity, and postoperative CT showed stabilization of bony fragments and good alignment of the nasal bone. Postoperatively, the CT score was 3 (excellent) in 25 patients, 2 (good) in 5 patients, and 1 (fair) in 2 patients. We suggest that ultrasonography is very useful for evaluating intraoperative repositioning of nasal bone fractures.

Endoscopically assisted reduction of nasal bone fractures

The standard treatment for a nasal bone fracture is closed reduction within 10 days. After that time, callus and fibrous connective tissue will limit a precise reduction. This study evaluated endoscopically assisted reduction for the treatment of nasal bone fractures in patients who miss the optimal operating time. Fifteen patients underwent endoscopically assisted correction of nasal bone fractures. The surgery was performed with the patients under general anesthesia. An intercartilaginous incision was made. The depressed bony fragments were repositioned under endoscopic visualization. In all cases, good anatomic reduction was obtained, the postoperative course was uneventful, with no complications, and the patients were satisfied with the shape of their noses. Endoscopy appears to be the best tool for visualizing intraoperative repositioning control, enabling the surgeon to confirm a fracture site with callus and to perform an accurate reduction. Endoscopically assisted reduction provides an alternative option in the treatment of patients outside the optimal temporal window for surgery.

Influence of Nasal Bone Fracture and Its Reduction on the Airway

Studies regarding nasal bone fractures have mainly focused on esthetic aspects, but the nose also plays an important role as an airway. The purpose of this study was to evaluate the influence of nasal bone fractures and the treatment of nasal bone fractures on nasal obstruction. Nasal bone fractures were classified by fracture site and septal displacement. Nasal airways were investigated at 3 time points: before reduction (n = 84), 6 days postreduction (n = 84), and 1-year postreduction (n = 27). Airway changes were based on minimal cross-sectional area measurements. The severity of airway obstruction following fracture differed according to the fracture site and the presence of septal displacement. Bilateral fractures caused more profound airway obstruction than unilateral or tip fractures and septal displacement was the most important parameter in nasal obstruction. Airway obstruction improved immediately after reduction by 21% and deteriorated by 4% 1-year postreduction.

Fractures and Post-Traumatic Deformation of the Nose

There has been but little significant change made in the treatment of nasal-bone fractures throughout the years. Upon review of the medical literature of the past few decades which deals with this subject, one is impressed with the fact that not only has treatment been at a standstill but there has been no modification of the pathogenic conception of this condition. Nasal-bone fractures being among the commonest of traumatic conditions, it is wrong to ignore the importance of this topic. In illustration, it may be well to quote Oscar Becker, who found that, of 135 cases of nasal trauma, 100 presented fractures. The attention of the E. N. T. specialist would readily be called to this condition if he took time to consider the esthetic deformation, at times permanent, of the nasal pyramid and the respiratory difficulties so often associated with it. It is forthwith evident that only a qualified