Thursday, September 24, 2009

Treatment of Nasal Fxs – an Article Review

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

Nasal fractures are extremely common.  Deciding which technique to use for a given nasal fracture can be challenging.  The recent article (full reference below) in the Arch Facial Plastic  Surgery does a very nice job of condensing down the treatment of nasal fractures into a logical approach.
They start with the classification of nasal fractures (photo credit)
  • Type I, “simple straight” --  unilateral or bilateral displaced fracture without resulting midline deviation.
  • Type II, “simple deviated” – unilateral or bilateral displaced fracture with resulting midline deviation.
  • Type III, “comminution of nasal bones”  -- bilateral nasal bone comminution and crooked septum with preservation of midline septal support; septum does not interfere with bony reduction
  • Type IV, “severely deviated nasal and septal fractures”  -- unilateral or bilateral nasal fractures with severe deviation or disruption of nasal midline, secondary to either severe septal fracture of septal dislocation.  May be associated with comminution of the nasal bones and septum, which interfere with reduction of fractures.
  • Type V, “complex nasal and septal fracture” – severe injuries including lacerations and soft tissue trauma, acute saddling of nose, open compound injuries, and avulsion of tissue.
The treatment of nasal fractures has classically been divided into open reduction (OR) and closed reduction (CR). 
Closed reduction involves manipulation of the nasal bones without incisions and has been the time-honored method of fracture reduction for thousands of years. It generally produces acceptable cosmetic and functional results, but its detractors point out that 14% to 50% of patients have deformities after CR.
Open reduction techniques for nasal fractures may include a range of techniques including septoplasty, osteotomies, and full septorhinoplasty.
Interesting, the study authors state,
There was no statistical difference between the results of an open repair and closed repair in terms of revision rate, patient satisfaction scores, or surgeon evaluation scores. Furthermore, our expert raters failed to find a difference in outcome based on the type of repair. Based on this data, it would seem that our patients did not perceive any difference in outcome, ie, patients were just as likely to be happy with the results of a closed repair as they were with open repair. These results contrast with those of many studies in which the surgeon's assessment shows a clear bias toward one technique or another.
The authors supplied this wonderful algorithm for treatment of nasal fractures (photo credit)

The Treatment of Nasal Fractures: A Changing Paradigm; Arch Facial Plast Surg. 2009;11(5):296-302; Michael P. Ondik; Lindsay Lipinski; Seper Dezfoli; Fred G. Fedok

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