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Nasal fractures are commonly treated using nasal packing as an internal splint after performing closed reduction. Although gauze and polyvinyl alcohol sponge (PVAS) are both commonly used for packing, few reports have compared their efficacy and safety in nasal fracture treatment. Therefore, in this study, the authors, aimed to retrospectively compare the efficacy and safety of gauze packing in 208 patients and PVAS packing in 225 patients who underwent closed reduction at our hospital. The proportions of patients requiring revision surgery did not differ significantly between the PVAS and gauze groups ( P =0.627). However, in comparison to the gauze group, the PVAS group displayed significantly fewer instances of uncontrolled epistaxis following packing removal, as well as fewer occurrences of dropout and loss of packing ( P =0.023, P =0.007, and P <0.001, respectively). The results of logistic regression analysis adjusted for confounding factors also showed that compared with the gauze group, the PVAS group was significantly less likely to experience packing dropout (odds ratio=0.13; 95% confidence interval, 0.06-0.29, P <0.001) for which younger and older age and allergic rhinitis were independent risk factors. In conclusion, both gauze and PVAS are effective packing materials as internal splints after closed reduction of nasal bone fractures. Specifically, PVAS utilization warrants consideration in pediatric and geriatric populations, individuals with allergic rhinitis, and those at elevated risk of bleeding., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 by Mutaz B. Habal, MD.)

Importance: Although nasal bones are the most common type of facial fracture given their natural projection and vulnerability to trauma, there is a paucity of data on its trends. Objective: To report on the trends and costs associated with open and closed nasal bone fractures across the United States. Methods: A retrospective analysis from 2006 to 2014 was conducted of the Nationwide Emergency Department Sample by using the International Classification of Disease, Ninth Revision codes for closed and open nasal bone fractures (802.0 and 802.1) presenting to emergency departments (ED). Trend analysis of total number and rate of visits, discharges, admissions, and associated costs were conducted. Results: Data from 1,253,399.741 records were collected. The total number of ED visits decreased by 2.05% for both open and closed nasal fractures from 2006 to 2014 whereas their associated costs increased ( p  < 0.001 and p  < 0.05 for closed and open nasal fractures). Notably, open fractures were consistently costlier whereas closed fractures had a greater percent-increase in costs (76.65%). Conclusions and Relevance: This study identified a significant rise in nasal fracture costs, which can be reduced via use of cheaper diagnostic modalities and cost-effective endoscopic procedures.

Purpose: Nasal bone fracture reduction surgery is normally followed by nasal packing to control bleeding. Yet, patients suffer from pain and require further analgesic treatments following nasal packing and removal. This study aimed to evaluate the effect of fentanyl-soaked packing as a method of controlling pain after nasal surgeries in a prospective, randomized, double-blind controlled trial., Methods: Sixty-five patients that have undergone closed nasal bone fracture reduction surgery were included in this study. Thirty-two patients were treated postoperatively with 50 mcg fentanyl-soaked Merocel ® , a biodegradable synthetic polyurethane foams packing, and the other 33 patients were treated with saline-soaked packings. To analyze the relative nasal pain control effect of fentanyl, Numeric Rating Scale, patient satisfaction and Ramsay Sedation Scale were used. Patients were closely monitored to record relevant cardiopulmonary indicators and degree of adverse symptoms such as headache or sore throat., Results: Fentanyl group had a significantly lower Numeric Rating Scale and higher patient satisfaction for most of the time periods after operation (p < .05). Symptoms of headache and sore throat were also significantly reduced. Ramsay Sedation Scale scores improved compared to the control group (p < .05). No significant differences in cardiopulmonary relevant indicators between the two experimental groups were observed (p > .05)., Conclusion: Fentanyl-soaked packing significantly decreased postoperative pain with no observable adverse effects. Our results demonstrate that topical fentanyl application to nasal packing is an effective method of postoperative pain control after closed nasal bone fracture reduction surgery.

This is a review discussing evaluation and management of paediatric nasal fractures, which have been reported as one of the three most common facial bone fractures. Nasal fractures in children are usually treated with closed reduction after 3-5 days, while other injuries like septal haematoma must be treated at the initial presentation. It is important to pay careful attention to the nasal anatomy during the surgical management of paediatric nasal injuries, as disturbing the nasal growth zones can have an impact on future nasal development.

Background: It has been advocated that reduction of nasal bone fractures should be followed by internal packing and/or external splinting. Despite the ample literature concerning the advantages and limitations of various splint types, the necessity and effectiveness of external splinting has not been well documented., Objective: To present the authors' experience and review the literature on treatment of nasal bone fractures, focusing on the indications and effectiveness of external splinting following closed reduction., Study Design: Retrospective analysis and literature review., Patients and Methods: Medical records of all patients, treated at the Department of Oral and Maxillofacial Surgery of the "KAT" General Hospital of Attica between January 2010 and December 2016 for facial trauma including nasal bone fractures, were retrospectively reviewed. Patient demographic data, fracture type, applied treatment, complications, and final outcome were registered., Results: A total of 77 patients (58 males; 19 females) were included in the study. The age range was 18 to 65 years (mean, 37.8). Closed reduction without external splinting was performed in 63 patients and open reduction with internal fixation in 6; 8 severely comminuted fractures were treated with closed reduction and external splinting. The mean follow-up was 4.8 months. All severely comminuted fractures presented complications., Conclusions: External splinting following closed reduction of nasal bone fractures should not be used routinely but only in selected patients with severe comminution. Since the pertinent literature is inconclusive on the indications and effectiveness of external splinting, randomized controlled studies are warranted to fully elucidate the issue.

Background: Nasal fractures are the most common facial fracture. Improper reduction is a common occurrence, resulting in a residual deformity that requires secondary surgery. A treatment protocol for nasal fracture management is presented with the aim of reducing secondary deformities requiring corrective surgery., Methods: After institutional review board approval, a retrospective review of all closed nasal reductions performed by a single surgeon between 2006 and 2015 was conducted. Patient age, sex, presence of secondary deformity, and need for a correctional operation were recorded. Clinical records were analyzed for evidence of postoperative deformity and need for subsequent manipulation or surgery., Results: A total of 90 patients with nasal bone fractures who underwent closed nasal reduction were identified. The mean age of patients was 24.9 years. The male-to-female ratio was 2.2:1. Postoperative deformity was reported in 14 patients (15.6 percent). Four of the 90 patients (4.4 percent) were found to have avulsion of their upper lateral cartilage from the nasal bone. Nine of the 14 subjects (64.3 percent) presenting with secondary deformity were managed with external manipulation, avoiding a secondary operation. Five patients (5.5 percent) from the original cohort of 90 underwent revision surgery., Conclusions: By using the described protocol to treat nasal fractures, we have seen a low rate of postreduction deformity and a small percentage of need for secondary operation. The overall success rate of closed nasal reduction with postoperative manipulation (when necessary) was identified to be 94.5 percent. Using this protocol, surgeons may see a decrease in secondary deformities following closed nasal reduction procedures., Clinical Question/level of Evidence: Therapeutic, IV.

The risk of complications warrants treatment of most dislocated nasal fractures. Other injuries including other facial fractures and septal haematoma must be treated if present at the initial presentation. The usual treatment for a simple nasal fracture is closed reduction in local anaesthesia after five to seven days. Complicated cases require open reduction in general anaesthesia. Later revision of the deviated nose may become necessary in patients suffering from complications such as persistent nasal stenosis and/or deformity.

Objectives: To determine the most common mechanisms of traumatic nasal deformity referred to pediatric otolaryngology. To examine the efficacy of closed reduction of nasal fractures in children and adolescents based on the parents' and surgeons' ratings of post-reduction nasal symmetry., Methods: Case series and chart review within an urban, tertiary pediatric otolaryngology practice., Results: 100 cases of traumatic nasal deformity met inclusion criteria over a 3-year study period. The mean age at presentation was 13 years (4 weeks-18 years); 55% were male and 70% were over the age of 12 years. The most common mechanism of injury was sports-related trauma (28%), followed by accidental trauma (21%), interpersonal violence (10%), motor vehicle collision (6%) and alcohol-related (2%). Of these 100 cases, 22% underwent closed reduction within a 14-day period following injury. All patients achieved symmetry in the operating room immediately following reduction. 21 of 22 post-reduction patients were assessed for nasal symmetry at the postoperative visit (7-10 days following surgery). The operating surgeon was satisfied with nasal symmetry in 43% of cases and the parent(s) satisfied in 81% of cases. Both parent and surgeon were satisfied with post-reduction symmetry 33% of the time., Conclusion: The most common sources of traumatic nasal deformity in children and adolescents vary by age. In cases meriting operative intervention, parents appear to be satisfied with early postoperative results following closed reduction in approximately 80% of cases, however a result in which both parent and surgeon agree with successful re-establishment of symmetry occurs in only one-third of cases., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: The reliability of X-ray radiography for diagnosing nasal bone fractures (NBFs) remains controversial. Recent studies show that, for determining the orientation and location of the displaced/depressed fracture, nasal sonography is as accurate as facial computed tomography. This retrospective study compared conductor-assisted nasal sonography (CANS) to conventional diagnostic tools and reported subjective patient satisfaction and discomfort after closed reduction combined with tube technique., Methods: This retrospective study reports the results of 329 refinement treatments for nasal bone fracture (including 199 men and 130 women) performed from 2005 to 2011. All patients were assessed with CANS and completed a survey immediately prior to removing the packing. Questionnaires were adapted from the nasal obstruction symptom evaluation (NOSE) scale., Results: The study found that CANS has a 97.2% rate of accuracy in diagnosing NBF. The visual analog scale scores of nasal obstruction, nasal congestion, sleep disturbance, trouble breathing, and inability to move air through the nose were analyzed. The experimental group scores were significantly different from the control group for all scores (p < 0.001)., Conclusion: Compared to conventional methods, CANS is more accurate for detecting NBF. We recommend its use as an alternative tool for diagnosing a nasal fracture. Because the tube technique balances pressure between the nasopharynx and middle ear during swallowing, patient comfort is enhanced. Application of these modifications can improve accuracy in diagnosing NBF and can improve the quality of NBF treatment., (Copyright © 2014. Published by Elsevier Taiwan.)

Objectives: Nasal fractures can result in obstruction of the nasal airflow and cosmetic deformities, and are treated either with observation, closed reduction, or a delayed rhinoplasty. In the pediatric patient, closed reduction is challenging due to anxiety and poor patient cooperation. Here, we describe the unique topical use of intranasal midazolam for anxiolysis in two pediatric patients at the time of closed reduction of nasal fractures, which has not been previously described., Methods: Retrospective case series., Results: In this case series, intranasal midazolam was used in two pediatric patients with isolated nasal fractures during closed reduction for anxiolysis in the Emergency department at a single academic medical institution between 2012 and 2013. There were no adverse outcomes and anxiolysis was achieved in both patients., Conclusions: Intranasal midazolam can provide effective anxiolysis for pediatric patients during closed reduction of nasal fractures., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Nasal fractures are the most common of all facial skeletal injuries. Untreated, these fractures frequently lead to functional and aesthetic problems. Careful history and physical assessment are critical to determine the extent of injury and to determine proper management. Critical aspects of assessment are discussed, as is the role of imaging in management. The unique aspects of pediatric nasal fractures and their management are reviewed. Fractures are classified based on the degree of injury and the involvement of the septum. A simple treatment algorithm is provided to help guide the selection of optimal treatment techniques. A review of instrumentation and treatment techniques is provided. The goal of treatment is to restore the nose to its preinjury shape and function and to minimize the need for secondary septorhinoplasty., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Acute management of complex nasal fractures in the adult nose is still frequently conducted using closed reduction techniques as first-line therapy. Treatment outcomes from closed reduction are often disappointing and secondary surgical corrections are required in a sizeable subset of patients. In response to the shortcomings of closed fracture manipulation, classic rhinoplasty techniques have been introduced to improve anatomic fracture reduction. Although these techniques improve the accuracy of skeletal reduction, they also weaken the nose, leaving it susceptible to the deformational forces of healing. To provide optimal anatomic fracture reduction and concomitant stabilization of the skeletal framework, we have been using contemporary strategies derived from open structure rhinoplasty and extracorporeal septal reconstruction for initial fracture treatment. Using wide-field exposure with open rhinoplasty, these strategies provide optimal fracture reduction and rigid stabilization of the septal L-strut using suture-based fixation and structural grafting techniques. The result is unsurpassed contour restoration and lasting architectural stability of the nose. When combined with power-driven instruments to cut, shape, mobilize, and create osseous suture holes, open structure stabilization of the disrupted skeletal framework establishes a new benchmark in acute fracture management., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

The nose is frequently traumatized in facial injuries and this often results from motor vehicle accidents, sports-related injuries, and altercations. Subsequently, posttraumatic nasal deformity is one of the most common reasons that patients seek consultation in the doctor's office. Depending on the type of nasal deformities, this can result in functional impairment and aesthetic problems. Two challenging problems to be addressed in the posttraumatic nose include the crooked nose deformity and the saddle nose deformity. The numerous publications on these two topics attest to the exacting surgical expertise required in its treatment. The key features in management of these conditions are discussed further., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Purpose: The aim of this study was to answer the following question: in patients with nasal bone fractures (NBFs), does closed reduction under local anesthesia (LA) produce comparable outcomes as closed reduction under general anesthesia (GA)?, Materials and Methods: A systematic review with meta-analysis and a comprehensive electronic search without date and language restrictions was performed in August 2014. The inclusion criteria were studies in humans, including randomized or quasi-randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies whose aim was comparing clinical outcomes between LA and GA for closed reduction of NBFs., Results: Eight publications were included: 3 RCTs, 2 CCTs, and 3 retrospective studies. Three studies showed a low risk of bias, and 5 studies showed a moderate risk of bias. There was no statistical difference between LA and GA for closed reduction of NBFs with regard to patient satisfaction with anesthesia, patient satisfaction with function of the nose, need for subsequent retreatment (septoplasty, septorhinoplasty, or rhinoplasty with refracture), and a patient's chosen treatment for a refracture of the nose. There was a statistical difference between LA and GA for closed reduction of NBFs with regard to patient satisfaction with the appearance of the nose., Conclusion: Regardless of the cost and risks associated with GA, the results of the meta-analysis showed that GA provides better patient satisfaction with anesthesia, appearance and function of the nose, and preference of treatment for a refracture of the nose. In addition, the meta-analysis showed that GA decreased the number of subsequent corrective surgeries (septoplasty, septorhinoplasty, and rhinoplasty) required., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

There is consensus that all patients should experience minimal pain following reduction of a fractured nasal bone. The issue requiring further study is what technique will provide patients with the greatest pain relief following the reduction of nasal fractures. This study investigated the use of an anterior ethmoidal nerve block as preemptive analgesia for the management of postoperative pain associated with reduction of nasal bone fractures. The medical documents of 85 patients were reviewed for a retrospective case-controlled comparative study. Patients in the nerve block group (n=45) were injected with 2% lidocaine containing epinephrine into the anterior ethmoidal nerve and dorsal periosteum, and those in the control group (n=40) were not. The rate of patients requiring postoperative injectable analgesics was compared between the two groups. The rate of patients who received a postoperative analgesic injection was significantly lower in the nerve block group than in the control group (P=0.034). The use of an anterior ethmoidal nerve block and dorsal periosteal injection of anaesthetic solution during reduction of fractured nasal bones under general anaesthesia resulted in the effective reduction of postoperative pain. Thus, this is regarded as a good method for enhancing patient quality of care and compliance in the reduction of fractured nasal bones., (Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Purpose: 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., Materials and Methods: 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., Results: During the follow-up period of 4 weeks to 6 months, all patients had satisfactory cosmetic results., Conclusions: The effectiveness of open reduction was obtained without noticeable scarring with our method of closed reduction using a Kirschner wire and a C-arm., (Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Objective: To assess if patients can safely self-assess their need for ear, nose, and throat (ENT) review following initial emergency department attendance for nasal trauma., Study Design: This prospective study was divided into 2 parts. The initial part evaluated an information sheet for patients to lead them through a self-assessment to establish if they require ENT review following nasal injury. The second part of the study investigated outcomes following the introduction of the self-assessment., Setting: This work was conducted at a District General Hospital in Scotland., Subjects and Methods: Forty-nine consecutive patients underwent self-assessment plus blinded otolaryngology assessment, after which self-assessment was introduced as routine. This was evaluated comparing outcomes of 49 new consecutive nasal injuries against the original group using subjective patient scores of nasal cosmesis and nasal airway following injury and any subsequent treatment., Results: There was no significant difference in outcome between the 2 study periods. After the introduction of self-assessment, there was a large reduction in the nonattendance rate for nasal injuries and in the attendances of patients with nasal injuries not requiring manipulation., Conclusion: In our institution, patients can be relied on to safely self-assess their nasal injuries to decide if they need ENT review when provided with appropriate information. This reduces the outpatient burden on the ENT department with no deterioration in subjective patient outcomes.

When repairing nasal fracture by closed reduction, an airway tube is useful for the pivot of the forceps. By placing the tube on the upper white lip and using it as a pivot, the fracture is reduced with Walsham forceps or Langenbeck elevator. This method is useful for all nasal fractures that are too firm to reduce by conventional closed reduction.

Nasal fractures have been reported as 1 of the 3 most commonly encountered pediatric facial bone fractures. The most common causes of nasal fractures in this age group are auto accidents (40%), sports injuries (25%), intended injuries (15%), and home injuries (10%). Nasal fractures are usually treated with closed reduction (Higuera S, Lee EI, Stal S. Nasal trauma and the deviated nose. Plast Reconstr Surg 2007;120:64S-75S). This results in a significant incidence of posttraumatic deformities, often requiring secondary surgical treatment. For this reason, it is paramount to pay careful attention to the underlying structural nasal anatomy during the initial diagnosis and management.

Aim: Nasal fractures are commonly treated by primary closed reduction. However, studies suggest this produces unacceptable functional and aesthetic results. Many patients require revision surgery. We aimed to assess patient satisfaction following closed reduction of nasal fractures., Methods: Retrospective chart review of patients with nasal fractures treated by closed reduction at the Wellington Regional Plastic, Maxillofacial and Burns Unit, New Zealand over a 2-year period was undertaken. Digital manipulation under general anaesthetic was performed. Patients were followed-up by telephone with a structured interview., Results: Of 116 consecutive patients, 74 (65%) were successfully contacted. 65 (88%) were satisfied with functional outcome, and 64 (86%) with aesthetic outcome. Of the 34 patients reporting incomplete correction, 12 (35%) would consider revision surgery., Conclusion: Patients treated with closed reduction of nasal fracture performed under general anaesthetic with digital manipulation reported high levels of satisfaction with functional and aesthetic outcomes. Revision rate is low.

Nasal fractures are the most common facial fractures and displaced fractures may cause considerable cosmetic concern. Traditionally, displaced nasal fractures have been manipulated under general anaesthesia (GA) performed within 2 weeks of the injury. Despite evidence for the benefit of local anaesthesia (LA), nasal fractures are still most commonly reduced under GA. We have presented a method of reduction of simple nasal fractures under LA in an outpatient setting. This has the advantage of being painless, simple to attempt and cost-effective. If reduction is inadequate then a general anaesthetic reduction is still possible. A recent comprehensive systematic review of all the available evidence did not show any significant difference (in terms of cosmesis, pain or nasal obstruction) between using LA and GA methods and highlighted the evidence base to support LA. We describe our method of assessment and treatment of displaced nasal fractures and provide an online tutorial (http://sciencestage.com/v/22194/local-anaesthetic-nasal-fracture-reduction.html). It is important to keep in mind that any concerns should be referred to an otolaryngology specialist for further management and that practitioners attempting this technique should first receive training from an otolaryngologist.

Background: Nasal fractures are the commonest facial fracture. They can cause morbidity in terms of nasal obstruction and cosmesis. They can be treated by simple external digital manipulation, provided they are seen and assessed in a timely fashion. This manipulation is commonly done under general anaesthetic (GA), which utilises precious resources and may cause delays in treatment., Summary of Evidence for Proposed Method: A recent comprehensive systematic review has shown local anaesthetic (LA) to be comparable to GA in terms of cosmesis, airway patency and patient acceptability. The experience for the patient is akin to that of a dental filling, and can be made more painless with the use of topical anaesthesia., Proposed Method: In the current age of evidence-based medicine and drive for cost-effective management decisions, it is thought that LA manipulation may offer a superior option to GA. A simple method for manipulation under LA is presented that can be done in the Emergency Department.

Background: Nasal bone fracture is a common injury, but its repair can be unexpectedly difficult. To date, intranasal gauze packing has been used to support the nasal bone in position and to maintain contact between the mucosa of the septum and the cartilage. This gauze packing, however, has a tendency to shift, resulting in an inflammatory response characterized by a foul odor until removal, which detracts from the comfort of the patient. We developed a novel device, the nasal bone clip (NBC), which provides a satisfactory nasal airway and improved comfort., Methods: A 1.2-mm Kirschner wire and a small piece of hydrocolloid wound dressing are used. The single wire is bent into a double-curved shape, after which each of the 2 tips is curled with pliers. The end of the wire in the nasal passage is covered with a piece of wound dressing to protect the mucosa. After reduction, the external portion of the wire is inserted on the surface of the splint., Results: The NBC was applied in 14 cases: 12 instances of fresh fractures and 2 of old fractures; there were 8 men and 6 women; their mean age was 19.9 years. Complications were not observed; moreover, no patients exhibited problems during the treatment., Conclusions: The advantages of the NBC are that all materials are available in the operating room or outpatient department, it is low cost, it is readily installable and detachable, it affords superior support for gauze packing, it provides effective external splinting with intranasal support, it never disturbs the nasal airway, and it offers comfort.

Naso-orbital-ethmoidal fractures are arguably the most challenging fractures of the facial skeleton to restore properly. This article discusses their proper diagnosis, describes some of the controversies in their management, and makes recommendations regarding their proper treatment.

Unlabelled: The aim of the current study of nasal bone fracture reduction carried out under topical, local, and general anesthesia was to suggest a proper treatment of patients with nose fractures., Method: The patient candidates for close nasal bone reduction (CNR) were divided into 3 groups: topical anesthesia (TA), local anesthesia (LA), and general anesthesia (GA), and CNR was performed. After reduction, pain scores and satisfaction and failure rates after 2 and 30 days were noted. All the patients were followed up for at least 1 month., Results: The mean pain scores (TA = 2.35, LA = 2.47, and GA = 1.9) showed no significant difference among these 3 groups (P > 0.05). The percentages of the patients' satisfaction in the groups were as follows: TA = 84.6%, LA = 83.8%, and GA = 91.7%. These values had no statistical difference (P > 0.05). There was no significant difference among the failure rates on the second day and after 1 month of follow-up (after 2 d, TA = 10%, LA = 18%, and GA = 14%, and after 1 month, TA = 2%, LA = 7%, and GA = 5%)., Conclusions: If the selection of patients is done properly, CNR under TA/LA will have considerable success in comparison with GA. Topical anesthesia is suggested in simple nasal fracture with unilateral depression or minimal displacement.

Objective: To investigate the outcomes from nasal fracture reduction performed under local anaesthesia (LA) and general anaesthesia (GA)., Method: A randomised multi-centred prospective trial and cohort analysis. Patients were randomised into two groups, 74 (53%) underwent closed reduction under LA, 65 (47%) patients underwent closed reduction under GA., Main Outcome Measures: Pain scores and patient toleration of local or general nasal manipulation was noted., Results: The pain score ranged from 0 (no pain) to 10 (unbearable pain). The mean pain score in the LA group was 3, compared to 2 in the GA group. LA manipulation was tolerated equally well as GA manipulation by 85% of the patients in each group. The number of patients requiring a septorhinoplasty was compared between LA 19/74 (26%), and GA 21/65 (32%). This failed to demonstrate a significant difference with a p value of 0.50. The absolute risk difference was 5% with a 95% confidence interval of (20% to -10%)., Conclusion: This trial clearly shows LA to be as effective as GA in the first line management of nasal fractures. The degree of septal displacement and presence of nasal tip deviation were associated with persistent nasal deformity following nasal fracture reduction.

Summary: Nasal bone fractures are the most common type of facial fractures. Previous studies have shown that most nasal fractures involve the septum, which can provide an obstacle to the successful reduction of nasal bone fractures. In particular, septal fractures in combination with simple nasal bone fractures are usually unrecognized and untreated at the time of injury. Furthermore, systemized treatment protocols and diagnostic tools for septal fractures in the case of simple nasal bone fracture have not previously been presented. In this study, the clinical findings of septal fractures in cases of simple nasal bone fracture were correlated with symptoms, signs, and computed tomography findings and assessed statistically. The patterns of septal fractures in simple nasal bone fractures were assessed by direct vision via hemitransfixion incision. Of the 52 patients with simple nasal bone fracture who presented over a 3-year period and were included in this study, 10 were female and 42 were male, with an average age of 33.8 years (age range, 18 to 61 years). Fifty of these patients (96.2 percent) showed septal fractures, and septoplasty or submucosal resection was performed on 41 patients (78.8 percent) who manifested severe septal fractures of perioperative septal grade 3 or higher. Closed reduction of the nasal bone fracture only was performed on the remaining 11 patients. Among the signs evident at physical examination, mucosal tearing was found to be statistically significant for septal fracture. Computed tomography was found to be very helpful in diagnosing septal fracture but could not predict its severity accurately (Spearman correlation coefficient between computed tomography septal grading and perioperative septal grading, 33.5 percent). Therefore, computed tomography could not be used as a definitive diagnostic modality for septal fractures in terms of deciding whether septoplasty or submucous resection was needed. It is evident that septal fractures are frequent in simple nasal bone fractures that are not combined with other facial bone fractures. This study confirms that there are differences between radiologic findings and perioperative findings. To reduce the incidence of posttraumatic nasal deformity, meticulous physical examinations with subsequent septoplasty or submucosal resection are needed in the treatment of simple nasal bone fracture.

Nasal fractures are among the most common bony injuries and are among the most frequent reasons for referral to Otorhinolaryngology departments resulting in significant pressure on clinical resources. We present our experience of a Nasal Fracture Clinic dedicated to the assessment of nasal injuries. A prospective study has been undertaken using questionnaires regarding patient satisfaction and acceptability of manipulation under a local anaesthetic (LA). During our three-month study period 91 new patients with nasal injuries were seen; 43 patients were diagnosed to have a displaced nasal fracture requiring reduction. Reduction of the nasal fracture under LA was performed in 37 patients. We found that manipulation under LA was preferred by 94% of patients over the age of 14 years. We achieved a high patient satisfaction rate (80% after three months). The discomfort associated with reduction under LA did not exceed that of a minor dental procedure. No significant complications were encountered during the study period. We conclude that reduction of nasal fractures under LA is a safe and attractive alternative to reduction under a general anaesthetic (GA) and frees-up valuable clinical resources.

Nasal bone fractures are the most common among facial fractures and are the third most common fractures in the human frame. Although many forms of treatment have been introduced, controversy regarding the optimal treatment still remains. Nasal bone fractures are complex, with significantly varying types that are often undermanaged in closed reduction procedures. The authors' experiences with nasal bone fractures have shown that the baseline for surgical intervention depends on the type of fracture and the method of maintenance after reduction, both of which have considerable impact on the final result. Therefore, it is very important and challenging to determine the proper method of reduction and maintenance. The periosteal covering plays an important role in the splinting action after closed reduction, but sagging, depression, and instability remain major complications in some cases. The authors devised a new method of accurate, firm stabilization of the fractured nasal bone by using external pins in those unfavorable fractures determined radiologically to gain optimal reduction and fixation. In the present study, fractures were grouped into favorable and unfavorable fractures, the latter being those that remained unstable or impacted even after reduction and thus needed open reduction. Unfavorable fractures were divided into four subclasses according to radiologic findings: (1) type I (frontal), including chip or tip fractures, which often depress the upper lateral cartilage and tend to sag after reduction; (2) type II (lateral), or laterally depressed segmental fractures with a lateral shift of the arch in fragments or as a unit; (3) type III (mixed), or type II with septal involvement; and (4) type IV (complex), including open or multiple comminuted fractures. After an initial evaluation to determine the fracture type, closed reduction and external fixation were performed for types I, II, and III fractures and open reduction was performed for type IV fractures 5 to 7 days after the fracture. Closed reduction with the use of external pins was done in eight cases: type I (two), type II (four), and type III (two). The mean age of the patients was 27.8 years, and the average follow-up period was 11.7 months. Functional and aesthetic results were satisfactory. This new method for support and fixation is an alternative to the conventional closed reduction and a promising way to prevent secondary deformity.

Objectives/hypothesis: A graduated protocol involving closed reduction, septoplasty, osteotomies, upper lateral cartilage release, anterior perpendicular plate fracture, and camouflaging cartilage grafts yields a higher percentage of straight noses in cases of acute fracture than treatment with closed reduction alone., Study Design: Retrospective chart and literature review followed by a prospective, non-randomized sequential trial., Methods: Closed reduction was performed on 26 cases of acute nasal fracture and the results were compared with a subsequent series of 79 cases treated using a more complete protocol., Results: The cases treated with the more complete protocol yielded straighter noses. The difference was statistically significant using Wilcoxon rank sum analysis at the P=.028 level., Conclusions: Treatment of the acutely fractured nose involving an individually tailored protocol of closed reduction, septoplasty, osteotomies, release of the upper lateral cartilages, fracture of the anterior extension of the perpendicular plate of the ethmoid, and camouflaging cartilage grafts yields straighter noses than treatment by closed reduction alone.

Due to the nose's prominent location and functional and cosmetic importance, nasal fractures present a challenge to the facial plastic surgeon to restore all things to normal. Although little groundbreaking news has been reported recently in the literature on nasal fractures, there is ample literature already in print on virtually every topic concerning nasal fractures. This article concentrates on the details of actually managing nasal fractures, with comments on present-day coding of posttraumatic septorhinoplasty.

Local anaesthesia is increasingly being used for nasal manipulation. Doubt remains over the discomfort associated with this procedure. We studied in a prospective manner, the acceptability and effectiveness of nasal manipulation with intravenous sedation and local anaesthesia, in a case series of thirty-five patients. Patients used linear analogue scales to assess outcome and pain associated with the procedure. More than half of the patients (60%) returned pain scores of only 1 out of 10. Thirty-two patients (90%) found the procedure less painful than receiving a tooth filling from the dentist, while thirty-four patients (97%) said they would undergo the same procedure again if they re-fractured their nose. The effectiveness of the treatment as assessed by an independent observer revealed that 90% of patients had achieved a significant reduction in their deformity (P = 1.27 x 10(-9).

Nasal fractures are one of the commonest reasons for patients being referred to ENT departments, but few studies have been published about the management of this condition. In particular, the efficacy of external splintage following manipulation has not been assessed. This was a prospective randomized study, which examined the results of manipulation under local anaesthetic and the benefit to be gained from external fixation with Plaster of Paris (POP) following this procedure. Accurate measurements of the degree of deviation of the nose pre- and post-manipulation were obtained using a camera mounted on a specially designed frame. Thirty-three out of 241 consecutive patients seen at a research clinic over the course of 12 months were included in the study. The mean deviation of the nasal bridge at presentation was 4.12 mm. Manipulation under local anaesthetic significantly improved the degree of deviation (mean 2.47 mm, P = 0.0011, 90% CI, 1-2 mm). Randomization of the patients, following manipulation, into POP/none-POP groups showed that external splintage of the nose appeared to be of little practical benefit.

Septic cavernous sinus thrombosis is a serious infective condition with a high mortality and morbidity. We report the first case to our knowledge of septic cavernous sinus thrombosis following manipulation of fractured nasal bone under general anaesthesia. The patient later developed complications of pneumonia with pleural effusion, a vegetative lesion of the mitral valve, and blindness.

Nasal fractures are very common in facial trauma but should not be considered minor injuries until they have been thoroughly assessed. Trauma care providers need to have an understanding of common mechanisms of injury, normal anatomy, and assessment techniques to make the diagnosis. Management of the injury will depend on whether the fracture is nondisplaced, displaced, open, or associated with a complication that necessitates a more aggressive approach.

I have used this splint on 16 patients between November 1992 and July 1993. The device works as well as or better than other similarly designed thermoplastic nasal splints that are commercially available, and it is significantly less expensive. Commercially available splints run about 5 to 10 dollars per unit. This device as described costs approximately 50 cents per unit. This method of external splinting of the nose is extremely reliable and satisfactory to both myself and the patient. No splint is unobtrusive, and I have found that my patients like these bright and colorful splints.

Over a 6-month period a record was kept of all patients presenting to the accident and emergency (A&E) department with nasal injuries. The results of the nasal radiographs were analysed to gauge their benefit. It was found that there was poor correlation between the radiological findings and the presence of external deformity, the latter determining the decision to carry out treatment. Routine radiographs of the nose are unnecessary in patients with nasal trauma.

Follow-up examinations in 92 patients with fractures of the bony nasal pyramid showed that repositioning had led to a functionally and cosmetically satisfying result in 38% of all cases only. Groups of patients were identified in which an increased number of therapeutic failures occurred and who, therefore, require exceptionally careful treatment in future. Therefore, --more emphasis must be placed on correct repositioning of the fractured nasal septum, --general anaesthesia permits a more exact correction of the nasal bones, --the nasal skeleton should be stabilized with plaster of Paris in addition to a tamponade, --finally, X-ray pictures in two directions make it easier to recognize the fracture and to control the success of repositioning.

An open reduction of nasal fractures in children is more burdensome for the patient, and for the department, than a closed reduction. We therefore made a follow-up examination of 79 patients, undergoing closed reduction of nasal fractures during the period from 1966 through 1975. Mean observation time was 11 years. A control group of 82 subjects was similarly examined. Among the patients, 52% had deformities of the external nose, compared with 22% in the control group - only 7 (9%) of the patients had severe deformities. Septal deviation occurred in 38% of the patients and 40% of the controls. A total of 6 patients in the fracture group were admitted for reoperation; none were readmitted from the control group. We conclude that the results of closed reduction are satisfactory, and that the results of larger, controlled studies must be awaited before the present treatment method is changed.