Do closed reduction and fracture patterns of the nasal bone affect nasal septum deviation?

Choi, Jun Ho,Oh, Hyun Myung,Hwang, Jae Ha,Kim, Kwang Seog,Lee, Sam Yong Korean Cleft Palate-Craniofacial Association 2022 Archives of Craniofacial Surgery Vol.23 No.3

Background: Many severe nasal bone fractures present with septal fractures, causing postoperative septal deviation and negatively affecting the patients' quality of life. However, when a septal fracture is absent, it is difficult to predict whether surgical correction can help minimize nasal septal deviation postoperatively. This study determined whether performing closed reduction on even mildly displaced nasal bone fracture could deter the outcome of septal deviation. Methods: We retrospectively reviewed the data of 116 patients aged 21-72 years who presented at the outpatient clinic and emergency room with fractures of nasal bones only without any involvement of the septum from January 2014 to December 2020. Patients were classified into three fracture type groups: A (unilateral), B (bilateral), and C (comminuted with depression). The degree of septal deviation was calculated by measuring the angle between the apex of the most prominent point and the crista galli in the coronal view on computed tomography images. The difference between the angles of the initial septal deviation and that of the follow-up was calculated and expressed as delta (Δ). Results: Closed reduction tended to decrease the postoperative septal deviation in all fracture types, but the values were significantly meaningful only in type A and B fractures. In the surgical group, with type A as the baseline, type B showed a significantly larger Δ value, but type C was not significantly different, although type C showed a smaller Δ value. In the conservative group, with type A as the baseline, the other fracture types presented significantly lower Δ values. Conclusion: For all fracture types, closed reduction significantly decreased the extent to which the nasal septum likely deviated. Therefore, when a patient is reluctant to undergo closed reduction, physicians should address the possible outcomes and prognosis of untreated nasal bone fractures.

A retrospective clinical investigation for the effectiveness of closed reduction on nasal bone fracture

Kang, Byung-Hun,Kang, Hyo-Sun,Han, Jeong Joon,Jung, Seunggon,Park, Hong-Ju,Oh, Hee-Kyun,Kook, Min-Suk Korean Association of Maxillofacial Plastic and Re 2019 Maxillofacial Plastic Reconstructive Surgery Vol.41 No.-

Background: The nasal bone is the most protruding bony structure of the facial bones. Nasal bone fracture is the most common facial bone fracture. The high rate of incidence of nasal bone fracture emphasizes the need for systematical investigation of epidemiology, surgical techniques, and complications after surgery. The objective of this study is to investigate the current trends in the treatment of nasal bone fractures and the effectiveness of closed reduction depending on the severity of the nasal bone fracture. Patients and methods: A total of 179 patients with a nasal bone fracture from 2009 to 2017 were enrolled. Their clinical examination, patient's records, and radiographic images of nasal bone fractures were evaluated. Results: Patients ranged from children to elderly. There were 156 (87.2%) males and 23 (12.8%) females. Traffic accident (36.9%) was the most common cause of nasal fracture. Orbit fracture (44 patients, 24.6%) was the most common fracture associated with a nasal bone fracture. Complications after surgery included postoperative deformity in 20 (11.2%) patients, nasal obstruction in 11 (6.1%) patients, and olfactory disturbances in 2 (1.1%) patients and patients with more severe nasal bone fractures had higher rates of these complications. Conclusion: Closed reduction could be performed successfully within 2 weeks after injury.

비골 골절에 대한 최근 5년간의 후향적 연구

오희균,박영준,김현섭,류재영,국민석,박홍주,유선열,Oh, Hee-Kyun,Park, Young-Jun,Kim, Hyun-Syeob,Ryu, Jae-Young,Kook, Min-Suk,Park, Hong-Ju,Ryu, Sun-Youl 대한구강악안면외과학회 2008 대한구강악안면외과학회지 Vol.34 No.2

Purpose: This study was performed to investigate the incidence, types of fracture, treatment, associated fracture and complications in patients with nasal bone fracture. Materials and methods: Clinical examination, patient's records and radiographic images were evaluated in 230 cases of nasal bone fractures who were treated at the Department of Oral and Maxillofacial Surgery, Chonnam National University Hospital for recent 5 years; from January 2002 to December 2006. Results: 1. The age of patient was ranged from 4 to 77 years (mean age=36.6 years); Males was 75.7% (n=174), and females 24.3% (n=56). 2. The cause of the nasal bone fracture in this study was a fall or slip down (28.8%, n=66), sports accident (26.0%, n=60), fighting (21.3%, n=49), traffic accident (9.6%, n=22), industrial trauma (7.8%, n=18), and the others (6.6%, n=15). 3. For the patterns of fracture, simple fracture without displacement occured in 10.4% (n=24). Simple fracture with displacement without septal bone fracture was found in 49.5% (n=114). Simple fracture with displacement in company with septal bone fracture showed in 32.6% (n=75). Commiuted fracture with severe depression was presented in 7.4% (n=17). 4. The reduction the displaced nasal bone was carried out in 2 to 10 days (mean 6.8 days) after the injury. 5. Nasal bone fracture associated with Le Fort I fracture (6.5%, n=6.5), Le Fort II fracture (7.4%, n=17), Le Fort III fracture (1.3%, n=3), NOE fracture (13.9%, n=32), ZMC fracture (17.4%, 40), maxillary bone fracture (8.3%, n=19), orbital blow-out fracture (15.7%, n=36), frontal bone fracture (1.3%, n=3) and alveolar bone fracture (10.9%, n=25). 6. The major type of treatment method was closed reduction in 90% (n=207), open reduction in 3% (n=7), and observation in 7% (n=16). 7. There were some complications such as ecchymosis, hyposmia, hypo esthesia and residual nasal deformity which are compatible. Open rhino-plasty was conducted for 3 patients who had residual nasal deformity. Conclusions: These results suggest that most of nasal bone fractures are occurred physically active aged groups(age 10-49 years) and could be treated successfully with closed reduction at 7 days after the injury.

하악골절의 임시 고정을 위한 골정복 겸자 사용의 최신지견

서창호,이소영 東國大學校醫學硏究所 2004 東國醫學 Vol.11 No.1

금속판이나 흡수성판으로 하악골절부위의 안정된 3차원적인 고정을 얻으려면 최종적인 내고정전에 골편들을 정확하게 정복시키는 것이 중요하다. 또한 정확한 정복에 더해 골편들간에 예비압박력(precompression)이 가해진다면 골절부위의 안정도 증가와 함께 치유도 촉진될 것이다. 이렇게 최종적인 내고정전에 임시로 정복, 고정 및 예비 압박력을 담당하는 기계로서 골정복겸자(bone reduction forcep)가 효과적으로 사용될 수 있다. 이에 저자등은 하악의 치열부분인 중앙부와 골체부, 우각부 골절의 내고정시 임시 정복, 고정 장치로서 골정복 겸자를 사용할 때의 유용성 및 기계적인 특성 등을 고찰하였다. 하악 정중부(symphysis) 및 부정중부(parasymphysis)에서는 형태적인 특성상 골정복 겸자의 사용이 매우 효과적이며 이러한 사실은 하악골의 광탄성 모델을 사용한 실험에서도 확인할 수 있었다. 반면 골체부(body)의 경우 부정중부가 포함되도록 겸자가 위치된다면 어느정도 효과적일 수 있으나 단순히 편평한 골체부 내에만 국한되어 골정복 겸자가 사용될 경우에는 중앙부만큼 효과적이지 못하며 전통적인 임시 정복, 고정방법인 Arch-bar를 사용한 악간고정을 수술중에만 일시적으로 시행한 상태에서 보조적으로 겸자를 사용하는 것이 더 효율적일 수 있겠다. 한편 우각부(angle)의 경우 일반적인 골정복겸자를 사용할 수도 있겠으나 우각부의 형태적 특성에 맞게 개발된 겸자를 사용하는 것이 더 효과적일 수 있겠으며 이는 광탄성 모델 실험으로도 확인할 수 있었다. 이와 같이 하악골절의 내고정에 있어 골정복겸자의 사용은 악간고정이 필요없이 조기에 악골기능을 회복할 수 있도록 해주며 골절부위의 빠른 치유를 도와주는 장점이 있으나 하악골의 해부학적 특성과 각 증례에 맞춰 적절히 사용하는 것이 중요하다고 사료된다. In the management of mandibular fractures, it is important to achieve a correct reduction of fractured fragments for a stable three-dimensional fixation using a plate system In addition, the technique of pre-compressing fractures has been shown to aid stability and healing of the fracture site, as it leads to increased bony surface contact. In preparation for plating, bone reduction forceps are used for holding and compressing mandibular fractures. In the mandibular symphysis and parasymphysis areas, the reduction forceps could be used effectively due to the convex shape of these regions and the clinical advantage was confirmed by photoelastic stress analysis. In the mandibular body area, it is difficult to apply the reduction forceps, as it is nearly flat along its lateral aspect. Bone reduction forceps are not recommended for compressing fragments in the flat surface of mandibular body. Therefore, in body fractures, maxillomandibular furation for temporary reduction and fixation and adjunctive use of reduction forceps for plating should be considered. In the mandibular angle area, reduction forceps could be applied effectively around the external oblique ridge but the use of new reduction forceps which were designed for application in the mandibular angle area via a transoral approach is highly recommended. The effectiveness of this newly designed reduction forceps were also confirmed by photoelastic stress analysis. Correct method in using reduction forceps helps to provide a precise three-dimensional reduction of mandibular fractures.

초음파를 이용한 비골 골절의 비관혈적 정복술

양형은,박은수,차장규,김철한,김준혁,김용배 대한성형외과학회 2007 Archives of Plastic Surgery Vol.34 No.4

Purpose: Nasal bone fracture may be the most common fracture among facial trauma. However, diagnosis and treatment tend to be overlooked while the reduction and maintenance of fragments remain complicated. Thus, the results are plagued with high rate of nasal deformity which leads cosmetic and functional discomfort. We took advantage of the fact that the nasal bone is one of the thinnest facial bone while at the same time being located close to the skin and utilized ultrasound in performing reduction of nasal bone.Methods:This method was performed on 25 patients with nasal bone fracture. The CL 15-7 linear array transducer (10-15MHz) ultrasound which provides a total of 7 views (3 axial views and 4 transverse views) of the elevator under the bony fragments was enough for the surgeon to accurately perform the reduction.Results: In our class, an accurate and precise reduction has been made possible by real time images before, during, and after the procedure with the help of ultrasound while reducing the exposure to radiation.Conclusion: Compared to previous methods, satisfaction of patients has increased in the nasal tip, minimal fracture of the side wall and secondary reduction cases. Therefore, the incorporation of ultrasound in the closed reduction of nasal bone may prove to be a useful method.

Finger reduction of nasal bone fracture under local anesthesia: outcomes and patient reported satisfaction

Lee, Young-Jae,Lee, Kyeong-Tae,Pyon, Jai-Kyong Korean Cleft Palate-Craniofacial Association 2019 Archives of Craniofacial Surgery Vol.20 No.1

Background: Closed reduction of the fracture under general or local anesthesia with elevators or forceps is widely used to treat nasal bone fractures. However, operating under general anesthesia increases the risk of morbidity and raises the cost of management. Furthermore, using forceps or elevators may cause undercorrection, new fractures, mucosal damage, and nasal hemorrhage. We therefore performed manual reduction under local anesthesia, using the little finger, to minimize the demerits of treatment under general anesthesia with forceps or elevators and aimed to assess functional and aesthetic outcomes, and patient satisfaction. Methods: Patients who visited the plastic and reconstructive surgery department between November 2016 and November 2017 with nasal bone fractures and treated by a single surgeon were prospectively followed up. Patients with simple unilateral or bilateral nasal bone fractures were treated with bedside finger reduction under local anesthesia and patients with comminuted nasal bone or septal fractures were scheduled for closed reduction under general anesthesia. Results: Of 84 patients, 28 met the inclusion criterion and underwent bedside finger reduction under local anesthesia. Twenty-seven patients (96.4%) were successfully contacted via telephone for survey. Twenty-three (85.2%) showed good and three (11.1%) showed fair results. All 27 patients (100%) were satisfied with their postoperative function and 25 (92.6%) were satisfied with their postoperative aesthetic result. Twenty-five patients (92.6%) preferred the finger reduction method under local anesthesia over closed reduction under general anesthesia. Conclusion: Finger reduction under local anesthesia in patients with mild unilateral or bilateral nasal bone fractures is an easy and efficient procedure with high patient satisfaction and favorable postoperative functional and aesthetic outcomes.

The clinical usefulness of closed reduction of nasal bone using only a periosteal elevator with a rubber band

Park, Young Ji,Ryu, Woo Sang,Kwon, Gyu Hyeon,Lee, Kyung Suk Korean Cleft Palate-Craniofacial Association 2019 Archives of Craniofacial Surgery Vol.20 No.5

Background: Closed reduction of nasal fracture with various instrument is performed to treat nasal fracture. Depending on the type of nasal fracture and the situation in which it is being operated, the surgeon will determine the surgical tool. The objective of this study was to investigate whether a periosteal elevator (PE) was a proper device to perform closed reduction for patients with simple nasal fractures. Methods: From March 2018 to December 2018, 50 cases of simple nasal bone fracture underwent closed reduction performed by a single surgeon. These patients were divided into two groups randomly: nasal bone reduction was performed using only PE (freer) and nasal bone reduction was performed using Walsham, Asch forcep, and Boies elevator (non-freer, non-PE). Results: The paranasal sinus computed tomography was performed on patients before and after operation to carry out an accurate measurement of reduction distance at the same level. According to the results, the interaction between instruments and fracture types had a significant influence on reduction distance (p = 0.021). To be specific, reduction distance was significantly (p= 0.004) increased by 2.157 mm when PE was used to treat patients with partial displacement compared to that when non-PEs were used. Conclusion: Closed reduction using PE and other elevator is generally an effective treatment for nasal fracture. In partial-displacement type of simple nasal fracture, closed reduction using PE can have considerable success in comparison with using classic instruments.

Comparison of the outcomes of nasal bone reduction using serial imaging

Lee, Cho Long,Yang, Ho Jik,Hwang, Young Joong Korean Cleft Palate-Craniofacial Association 2021 Archives of Craniofacial Surgery Vol.22 No.4

Background: Nasal bone fractures are frequently encountered in clinical practice. Although fracture reduction is simple and correction requires a short operative time, low patient satisfaction and relatively high complication rates remain issues for many surgeons. These challenges may result from inaccuracies in fracture recognition and assessment or inappropriate surgical planning. Findings from immediate postoperative computed tomography (CT) scans and those performed at 4 to 6 weeks postoperatively were compared to evaluate the accuracy and outcomes of nasal fracture reduction. Methods: This retrospective study included patients diagnosed with nasal bone fractures at our department who underwent closed reduction surgery. Patients who did not undergo additional CT scans were excluded from the study. Clinical examinations, patient records, and radiographic images were evaluated in 20 patients with nasal bone fractures. Results: CT findings from immediately after surgery and a 1month follow-up were compared in 20 patients. Satisfactory nasal projection and aesthetically acceptable results were observed in patients with accurate correction or mild overcorrection, while undercorrection was associated with unfavorable results. Conclusion: Closed reduction surgery for correcting nasal bone fractures usually provides acceptable outcomes with relatively few complications. If available, immediate postoperative CT scans are recommended to guide surgeons in the choice of whether to perform secondary adjustments if the initial results are unsatisfactory. Based on photogrammetric data, nasal bone reduction with accurate correction or mild overcorrection achieved acceptable and stable outcomes at 1 month postoperatively. Therefore, when upward dislocation is observed on postoperative CT, one can simply observe without a subsequent intervention.

Complications After Inadequate Treatment of Nasal Bone Fracture Combined With Septal Fracture: A Case Report

양승구,홍승노 대한비과학회 2021 Journal of rhinology Vol.28 No.3

In treating a nasal bone, an incomplete nasal bone reduction can result in nasal deformity, both aesthetic and functional, requiring a secondary operation. A 60-year-old female with a traumatic comminuted nasal bone fracture with septal fracture was initially treated with closed reduction, which later resulted in a saddle nose and a completely occluded nasal cavity. Later, the patient underwent a revision operation of extracorporeal septorhinoplasty with rib cartilage graft, and the postoperative course was uneventful. Herein, we present a case of complications occurring after inadequate treatment of septal fracture. Physicians should thoroughly evaluate the extent of the nasal bone fracture, including the integrity of the nasal septum, and manage accordingly In treating a nasal bone, an incomplete nasal bone reduction can result in nasal deformity, both aesthetic and functional, requiring a secondary operation. A 60-year-old female with a traumatic comminuted nasal bone fracture with septal fracture was initially treated with closed reduction, which later resulted in a saddle nose and a completely occluded nasal cavity. Later, the patient underwent a revision operation of extracorporeal septorhinoplasty with rib cartilage graft, and the postoperative course was uneventful. Herein, we present a case of complications occurring after inadequate treatment of septal fracture. Physicians should thoroughly evaluate the extent of the nasal bone fracture, including the integrity of the nasal septum, and manage accordingly.

관혈적 정복 및 내고정을 이용한 관절 내 종골 골절의 치료 시 골이식 유무에 대한 비교 연구

손홍문 ( Hong Moon Sohn ),하상호 ( Sang Ho Ha ),이준영 ( Jun Young Lee ),조승환 ( Sung Hwan Jo ),양훈 ( Hoon Yang ) 대한골절학회 2010 대한골절학회지 Vol.23 No.2

목적: 종골의 관절 내 분쇄 골절에 대하여 관혈적 정복 및 금속판을 이용한 내고정을 시행한 환자에서 골이식의 시행여부에 따른 임상적 결과 차이를 비교하고자 하였다. 대상 및 방법: 관혈적 정복술 및 금속판을 이용하여 내고정술을 시행한 종골의 관절 내 골절 환자 중 최소 1년 이상 추시가 가능한 25예를 대상으로 하였으며 이중 골이식을 시행한 경우가 15예였다. 골이식 여부에 따른 골유합 기간 및 기능적 평가를 분석하였으며 합병증을 조사하였다. 결과: 전례에서 골유합을 얻었으며, 평균 골유합 기간은 골이식 군에서 11.6주, 골이식하지 않은 군에서 12.8주였고, Creighton-Nebraska Health Foundation (CNHF) 종골 골절 평가 점수는 골이식 군에서 평균 86.5점, 골이식 하지 않은 군에서는 평균 80.3점이었다. 골이식 여부에 따른 골유합 기간과 CNHF 점수의 통계학적 의의는 없었다. 골이식을 하지 않은 군에서는 4예, 골이식 군에서는 5에에서 합병증이 관찰되었다. 결론: 종골의 관절 내 분쇄 골절 치료에 있어 관혈적 정복술 및 금속판을 이용한 내고정을 시행하는 경우, 골이식 여부는 골유합기간 및 기능적 평가에서 큰 차이를 보이지 않는 것으로 생각된다. Purpose: This study compares the clinical results of open reduction and internal fixation with and without bone graft for the treatment of intra-articular calcaneal fractures. Materials and Methods: Twenty-five patients who had open reduction and internal fixation for intra-articular calcaneal fractures and available for at least 1 year of follow-up were included in this study. Fifteen cases were operated with bone graft. Period to bone union and functional evaluation score were compared between both groups with analysis of complications. Results: Bone union was achieved in all cases with average bone union time of 11.6 weeks and 12.8 weeks in group with and without bone graft respectively. Creighton-Nebraska Health Foundation (CNHF) functional score was 86.5 points and 80.3 points respectively. The period to bone union and the CNHF score in the comparison of two groups were statistically insignificant. Complications were observed in four cases of group without bone graft and 5 cases of group with bone graft. Conclusion: This study indicates that bone graft does not play a significant role in bone union and functional outcome when intra-articular calcaneal fractures are treated with open reduction and internal fixation.