코뼈 골절의 임상적 진단과 전산단층촬영 판독간의 불일치

김동현,황건,Kim, Dong-Hyun,Hwang, Kun 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: The nasal bone is the most frequently fractured facial bone. Discordance between the CT reading by the radiologist and the diagnosis by the plastic surgeon is not uncommon. This study examined the discordance and proposes a method for reducing the rate of discordance. Methods: The CT readings by the radiologist were compared with the diagnosis by the plastic surgeon in 716 patients with a clinically suspected nasal bone fracture. The CT reading was classified as the following: a nasal bone fracture, suspicious nasal bone fracture, old nasal bone fracture, no nasal bone fracture. The sensitivity, specificity and positive predictive value of the CT reading were calculated. Results: A nasal bone fracture was diagnosed in 646 patients by the plastic surgeon and confirmed intraoperatively. The reading of a "nasal bone fracture", "suspicious nasal bone fracture", "old nasal bone fracture" and "no nasal bone fracture" was 85.8%, 4.6%, 0.6% and 9.1% respectively. The sensitivity and specificity of the CT reading were 95.0% and 92.9%, respectively. The positive predictive value of the CT reading was 99.3%. The reading of "nasal bone fracture" that was not a nasal bone fracture clinically was 17.1% (12 of 70), and the reading of "no nasal bone fracture" or "old nasal bone fracture" that was found to be a nasal bone fracture clinically was 3.3% (21 of 646). The discordance rate between the CT reading by the radiologist and the diagnosis by the plastic surgeon was 4.6%. Conclusions: To reduce the discordance rate, we propose to hold a meeting with the plastic surgery-radiology staff to communicate the information regarding a suspicious or old nasal bone fracture.

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.

The Usefulness of Nasal Packing with Vaseline Gauze and Airway Silicone Splint after Closed Reduction of Nasal Bone Fracture

Kim, Hyo Young,Kim, Sin Rak,Park, Jin Hyung,Han, Yea Sik Korean Society of Plastic and Reconstructive Surge 2012 Archives of Plastic Surgery Vol.39 No.6

Background Packing after closed reduction of a nasal bone fracture causes inconvenient nasal obstruction in patients. We packed the superior meatus with Vaseline gauze to support the nasal bone, and packed the middle nasal meatus with a Doyle Combo Splint consisting of an airway tube, a silastic sheet, and an expandable sponge to reduce the inconvenience. In addition, we aimed to objectively identify whether this method not only enables nasal respiration but also sufficiently supports the reduced nasal bone. Methods Nasal ventilation was measured via spirometry 1 day before surgery and compared to 1 day after surgery. To compare support of the reduced nasal bone by the 2 methods, 2 plastic surgeons assessed the displacementon X-rays taken after the surgery and after removing the packing. The extent of nasal obstruction, dry mouth, sleep disturbance, headache, and swallowing difficulty were compared with visual analog scales (VAS) on a pre-discharge survey. Results In the experimental group, the nasal respiration volume 1 day after surgery remained at $71.3%{\pm}6.84%$ on average compared to 1 day prior to surgery. Support of the reduced bone in the experimental group ($2.80{\pm}0.4$) was not significantly different from the control group ($2.88{\pm}0.33$). The VAS scores for all survey items were lower in the experimental group than in the control group, where a lower score indicated a lower level of inconvenience. Conclusions The nasal cavity packing described here maintained objective measures of nasal respiration and supported the reduced bone similar to conventional methods. Maintaining nasal respiration reduced the inconvenience to patients, which demonstrates that this packing method is useful.

Medial nasal bone trimming for managing the deviated and or wide bony vault in Asians

Chayakorn Phanniku(Chayakorn Phanniku ),Dong-Yun Lee(Dong-Yun Lee),Tae-Bin Won(Tae-Bin Won) 대한미용의학회 2023 대한미용의학회지 Vol.7 No.1

Background: Managing the bony vault in rhinoplasty is challenging despite the use of various techniques. High revision rates persist due to recurrent or residual deviations. In severe cases, intermediate osteotomy is difficult in Korean patients due to their shorter and thicker nasal bones. Objective: Managing the bony vault is challenging in rhinoplasty procedures. This study aimed to evaluate the results of medial nasal bone trimming to correct deviated and wide bony vaults. Methods: This retrospective study included patients who underwent rhinoplasty with medial nasal bone trimming at a single hospital between June 2010 and June 2013. Medical records including diagnoses, computerized preoperative tomography scans, operation records, intraoperative photographs, postoperative results, and complications were collected. Postoperative aesthetic improvement was evaluated using a 4 point-Likert scale. Results: Fifty patients were included, of which 31 patients were diagnosed with a deviated nasal dorsum, 12 with a deviated nasal dorsum, and seven with a wide nasal dorsum without deviation. Nasal bone trimming was performed bilaterally and unilaterally in 29 and 21 patients, respectively. Postoperative aesthetic score was 2.31±0.61, 2.57±0.45, and 2.7±0.56 for the patients in the deviated, deviated and wide, and wide without deviated groups, respectively. Conclusion: Medial nasal bone trimming can be a simple, safe, and effective procedure for achieving symmetry and narrowing of the bony vault in patients with a deviated or wide bony pyramid.

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

Kim, Hyo-Seong,Suh, Hyeun-Woo,Ha, Ki-Young,Kim, Boo-Yeong,Kim, Tae-Yeon Korean Society of Plastic and Reconstructive Surge 2012 Archives of Plastic Surgery Vol.39 No.3

Background : Among 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. Methods : A 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. Results : According 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. Conclusions : IOR 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.

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

Hyo Seong Kim,Hyeun Woo Suh,Ki Young Ha,Boo Yeong Kim,Tae Yeon Kim 대한성형외과학회 2012 Archives of Plastic Surgery Vol.39 No.3

Background Among 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. /Methods A 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. /Results According 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. /Conclusions IOR 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.

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.

L-형 장골이식을 이용한 구순열 비변형의 수정

유선열,박홍주,손영휘,윤천주,박충열,송종운,이용욱 대한악안면성형재건외과학회 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.6

Patients with a cleft lip nasal deformities hope for a pleasing nasal profile, a well-defined angular nasal tip, and symmetry of the nose. The main objective of the correction of cleft lip nasal deformity is to achieve nasal symmetry and an improved nasolabial relationship. The present study was carried out to assess the effect and prognosis of correction of cleft lip nasal deformity with L-shaped iliac bone graft. We performed correction surgery of the severe cleft lip nasal deformity with the autogenous L-shaped iliac bone graft in five patients and described the technique of correction. The columella portion of the L-shaped graft provided stabilization, eliminating the see-saw effect of the bridge on the bony fulcrum of the bony bridge, The disadvantage of this technique was stiffening of the nasal tip, which included the distal end of the grafted bone. However, the nasal tip gradually becomes softer, probably due to resorption of the bony edge several months after the operation. We obtained stable and symmetric reconstruction of the supporting elements of the nose. These results suggest that L-shaped iliac bone graft is stable and esthetic reconstruction method for correction of the severe cleft lip nasal deformity

한국인 코의 Keystone 영역에 대한 해부학 및 방사선학적 분석

김인상(In-Sang Kim),정영준(Young-Jun Chung),이영일(Young-Il Lee) 대한체질인류학회 2008 해부·생물인류학 (Anat Biol Anthropol) Vol.21 No.1

코의 Keystone 영역은 콧등에서 뼈와 연골이 만나는 곳으로 콧등의 구조적 안정성을 유지하는 중요한 연결 구조이다. 하지만 동양인에서 이 부위의 구체적인 형태 및 계측치들에 대한 연구가 부족하여, 코 수술에 있어이 부위의 안전한 절제 범위 및 수술 위험성에 대한 이해가 부족하였다. 대상으로는 12구의 사체를 사용하였으며, 콧등의 물렁조직을 제거한 다음 코뼈의 형태, 위가쪽연골과 코뼈의 중첩 형태와 길이 및 폭을 측정하였다. 방사선학적 분석을 위해서는 단국대학교병원에서 뇌자기공명영상 (brain MRI)을 촬영한 환자 중 코중격과 코곁굴이 정상이며 정중선에서 전체 코뼈와 코중격이 잘 보이는 380명의 필름을 분석하였다. 코뼈와 코중격연골과의 중첩 길이는 정중선에서 4~9 ㎜ (평균 6.5 ㎜)였으며, 정중곁선 부위에서는 0~4.5㎜(평균 2.7 ㎜)였다. 또한 중첩 부위의 좌우 폭은 8~14㎜ (평균 9.7 ㎜)였다. 또한 코뼈와 위가쪽연골의 중첩된 모양과 코뼈의 꼬리쪽 끝의 형태는 다양하게 나타났으며, 각각의 형태와 이의 조합에 따라 Keystone 부위의 안정성에 많은 변화가 나타날 것으로 예상되었다. Keystone 부위에서 코뼈와 위가쪽코연골, 코뼈와 코중격연골의 연결은 다양한 형태와 길이, 폭으로 나타났으며, 따라서 이러한 형태를 충분히 인지하고, 약한 형태의 연결인 경우에는 코의 수술적 처치시 매우 조심스러운 접근방법이 필요할 것으로 판단된다. The keystone area of nose is a clinically important structure for maintaining the stability of dorsum of nose. However, anthropometric data for individual structure constituting the keystone area were less studied. Dissections of external nose were performed in 12 cadavers for measuring the length and width of structural components of keystone area. Shape of nasal bones and the overlap area between upper lateral cartilage and nasal bone were classified. Measurements of the keystone area were also performed in 380 MRI and PACS images. Types of the caudal margin of nasal bone were classified as follows; type A: flat margin, type B: M shape, type C: extended midline, type D: retracted midline. Types of overlapped portion between upper lateral cartilage and nasal bone were categorized as follows; type Ao: flat midline, type Bo: short elongated midline, type Co: long elongated midline. Overlap length of upper lateral cartilage with nasal bone was 4~9 ㎜ (mean 6.5 ㎜)in the midline, 0~4.5 ㎜ (mean 2.7 ㎜)in the paramedian area of nasal bone. Overlapped width of upper lateral cartilage with nasal bone was 8~14 ㎜(mean 9.7 ㎜). Individual component of the keystone area has various shape and overlapped length. Therefore, cautious preoperative and intraoperative evaluation of each component is necessary for a safe nasal surgery.

비골 골절 교정술 후 "Tubed Merocel"과 골무를 이용한 비충전

조동환,김경목,이영섭 大韓成形外科學會 1997 Archives of Plastic Surgery Vol.24 No.5

Post-operative nasal packing is used almost universally following routine closed reduction of fractured nasal bone. But it is often considered by the patient to be one of the most unpleasant aspects of their operation. It is difficult for the patients to continue keeping nasal pack for more than a week especially for their breathing problem. In addition, nasal packing can precipitate hypoxia and obstructive sleep apnea, particularly in older patients, headache, foul odor and other problems. The Merocel which contains airway is thought to avoid some of these hazards. These packs or tampons with airway are constructed from a foam polymer of hydroxylated polyvinyl acetate and central tube. When the packs are moistened with secretioris or aqueous solutions they swell up to about 4.8 times of their original size, secure nasal patency and optimal pressure for hemostasis and stability of the reduced nasal bone. Nasal packing by using tubed Merocel and finger stall is comfortable to the patients after nasal bone reduction.