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Hafner J, Wagner MEH, Heinz P, Schönegg D, Essig H, Blumer M. Surgical treatment of nasal fractures may benefit from intraoperative 3D imaging. J Craniomaxillofac Surg 2024; 52:855-859. [PMID: 38724288 DOI: 10.1016/j.jcms.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/18/2024] [Accepted: 04/27/2024] [Indexed: 07/23/2024] Open
Abstract
This retrospective study aimed to assess the effects of the use of intraoperative three-dimensional (3D) imaging on outcomes in surgical treatment of nasal fractures. Furthermore, we investigated whether the use of intraoperative imaging improves outcomes and decreases the frequency of corrective surgeries compared to published literature. This retrospective descriptive study included patients who underwent operative treatment for nasal fractures with the use of intraoperative 3D imaging between January 2015 and January 2020 at a University Hospital. The primary outcome measure was patient satisfaction, which was assessed through patient charts about subjective esthetic problems and nasal obstruction. The secondary outcome measures were the number of intraoperative images and necessity of intra- and postoperative revisions. All the outcomes were evaluated using regression analysis. Of the 172 patients, secondary rhinoplasty and intraoperative revision were performed in 10 (6 %) and 93 (54 %) patients, respectively. Postoperatively, 19 (11 %) and 12 (7 %) patients complained of subjective esthetic problems and nasal obstruction, respectively. The intraoperative revision rate in patients undergoing surgical treatment of nasal fractures with intraoperative 3D imaging was >50 %. However, the incidence of postoperative secondary revision, nasal obstruction, and subjective esthetic problems was lower than that reported in the literature not having an intraoperative imaging. Our findings suggest that prompt quality control of the operative result enables immediate correction and prevents postoperative revision.
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Affiliation(s)
- Jan Hafner
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Priska Heinz
- Epidemiology, Biostatistics and Prevention Institute, Department of Biostatistics, University of Zurich, Zurich, Switzerland
| | - Daphne Schönegg
- Department of Cranio-Maxillo-Facial Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Harald Essig
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Michael Blumer
- Department of Oral and Maxillofacial Surgery, University Hospital Zurich, Zurich, Switzerland; Department of Cranio-Maxillo-Facial Surgery, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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Leapo L, Otteson T, Rodriguez K. Utility of CT or X-ray in the management of adult nasal fracture. Am J Otolaryngol 2024; 45:104136. [PMID: 38101124 DOI: 10.1016/j.amjoto.2023.104136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE The primary objective of this study is to evaluate the use of imaging in the management of nasal fracture in adults and determine if imaging is beneficial to clinical decision making when planning for surgery. A secondary objective of this study is to compare surgical rates for nasal fracture between pediatric and adult populations. METHODS This is a retrospective case-control study of 357 patients seen at University Hospitals Cleveland Medical Center from January 2015 through January 2020 with a diagnosis of nasal fracture. An odds ratio was calculated to determine likelihood of surgical intervention between patients who had imaging of the nasal bones and patients who did not. RESULTS 82 % of patients had either CT or X-ray imaging. The odds ratio of patients who had surgery after CT or X-ray imaging compared to patients who had surgery without prior imaging was 0.092 (95 % CI: 0.0448-0.1898, p-value <0.0001). A total of 54 (15 %) adult patients had surgery, in comparison to 50 % of pediatric patients with diagnosis of nasal fracture. 202 (57 %) of patients did not follow up after initial diagnosis by radiology. CONCLUSION The statistical analysis suggests that while CT and X-ray are frequently obtained in the setting of nasal fracture, patients without imaging are more likely to have surgery (p < 0.05) than patients with imaging. This indicates that imaging is likely unnecessary for surgical planning. Most adults do not pursue surgery, and surgical rates for adults with nasal fracture are much lower than those of pediatric patients with nasal fracture.
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Affiliation(s)
- Lizbeth Leapo
- Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH 44106, USA.
| | - Todd Otteson
- University Hospitals Cleveland Medical Center, Department of Otolaryngology, 11100 Euclid Ave, Cleveland, OH 44106, USA.
| | - Kenneth Rodriguez
- University Hospitals Cleveland Medical Center, Department of Otolaryngology, 11100 Euclid Ave, Cleveland, OH 44106, USA.
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Xue K, Liu K, Qi L. A Simple and Minimal Invasive Method in Reduction of Depressed Nasal Bone Fracture by Using a Foley Catheter Ballooning Technique. J Craniofac Surg 2023; 34:e617-e619. [PMID: 37485963 DOI: 10.1097/scs.0000000000009568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 06/25/2023] [Indexed: 07/25/2023] Open
Abstract
The nasal bone fracture is the most common type of facial bone fracture. Closed reduction with metal reduction instrument is commonly conducted for the treatment of a type II nasal bone fracture. The authors defined a new catheter dilation technique and used it in patients with type II depressed nasal bone fractures. Preoperative and postoperative nasal appearance and radiologic examination of the patients were compared. There was a statistically significant improvement in the nasal appearance of all patients. No recurrence or dorsal irregularity has been observed. This new, easily applicable catheter dilation method of closed reduction may be a simple and less invasive solution to treat type II nasal bone fractures.
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Affiliation(s)
- Ke Xue
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
- Department of Burn and Plastic Surgery, The Western Central Hospital of Hainan, Hainan
| | - Kai Liu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Lin Qi
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
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Vishwanath N, Rhee B, Sobti N, Beqiri D, Xi K, Lerner J, Woo AS. The Role of Antibiotics in Nasal Fractures after Closed Reduction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4886. [PMID: 37038410 PMCID: PMC10082294 DOI: 10.1097/gox.0000000000004886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/17/2023] [Indexed: 04/12/2023]
Abstract
Nasal fractures represent the most common fracture in facial trauma. The role of prophylactic antibiotics in these injuries is debated, given low infection rates and demonstrated risks of antibiotics. We studied the isolated effect of prophylactic antibiotics on infection rate in patients with nasal fracture after closed reduction. Methods Retrospective cohort study of a prospectively maintained facial trauma database was conducted. Demographics, comorbidities, fracture classifications, and management of patients who received antibiotics at the time of closed nasal reduction were compared against those who did not receive antibiotics. Infection rates between groups were analyzed. Multivariate analysis was conducted to control for confounding variables. Qualitative analysis was performed for patients who experienced infection following nasal fracture. Results A total of 282 patients met inclusion criteria (n = 144, antibiotic; n = 138, nonantibiotic). Six patients experienced infection. There was no difference in infection rate between antibiotic and nonantibiotic groups (2.0% versus 2.2%; P = 0.90). On multivariate regression, antibiotics did not significantly decrease odds of infection (OR 1.7 [0.17-13.6]; P = 0.64). Moreover, patients with open nasal fractures did not have significantly higher odds of infection (OR 1.9 [0.08-20.8]; P = 0.64). Similarly, increasing severity of injury based on Rohrich classification did not significantly impact odds of infection (OR 0.68 [0.23-1.9]; P = 0.46). All six infections were managed at the bedside, with zero infections following operating room management (P = 0.32). Conclusions Prophylactic antibiotics do not decrease infection rates following nasal fractures managed by closed reduction. Bedside management may be a risk factor for the development of infection; however, this finding requires further evaluation.
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Affiliation(s)
- Neel Vishwanath
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Ben Rhee
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Nikhil Sobti
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Dardan Beqiri
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Kevin Xi
- Brown University School of Public Health, Providence, R.I
| | - Julia Lerner
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
| | - Albert S Woo
- From the Department of Plastic and Reconstructive Surgery, The Warren Alpert Medical School of Brown University, Providence, R.I
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Olfactory Dysfunction and its Course in Patients With Nasal Bone Fracture. J Craniofac Surg 2023; 34:139-141. [PMID: 36036507 DOI: 10.1097/scs.0000000000008971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/25/2022] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Nasal bone fractures are the most common facial bone fractures. Although olfactory dysfunction is one of the most common complications in patients with nasal bone fractures, few studies on olfactory dysfunction in nasal bone fractures have been reported. The authors attempted to find the frequency and course of olfactory dysfunction and hypothesize its mechanism in patients with nasal bone fractures. METHODS Sixty-six patients who underwent closed reduction were examined using the Korean version of Sniffin' Sticks test (KVSS) II at preoperation, 1 month and 6 months postoperation. We categorized 30 points or more as "normosmia," 15 points or less as "anosmia," and the scores between them as "hyposmia." The authors only performed test in patients who subjectively complained of their loss of sense of smell at 1 and 6 months postoperation. RESULTS The authors classified the patients as "olfactory dysfunction" or "normal olfaction" using the Threshold-Discrimination-Identification score and subjective complaint of symptom. Olfactory dysfunction was seen on 31 of 66 patients (46.9%) preoperatively. Twenty-four patients (36.3%) showed olfactory dysfunction at 1 month postoperation, and 4 patients (6.0%) showed olfactory dysfunction at 6 months postoperation. Twelve of the 35 patients (34.3%) with normosmia shown in the preoperation had new olfactory dysfunction after the surgery. CONCLUSION Olfactory dysfunction is common complication in nasal bone fracture. However, this complication was recovered in most cases (93.9%). In addition, patients should receive explanations about the possibility of iatrogenic olfactory impairment after surgery, and a gentle maneuver is helpful for preventing iatrogenic damage.
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Juncar M, Tent PA, Juncar RI, Harangus A, Rivis M. Etiology, pattern, and treatment of nose fractures: A 10-year cross-sectional cohort retrospective study. Niger J Clin Pract 2021; 24:1674-1681. [PMID: 34782508 DOI: 10.4103/njcp.njcp_52_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Determining the etiology, epidemiology, pattern, and treatment of nasal bone fractures and the associated soft tissue injuries in a population will be beneficial for the prevention, rapid and correct diagnosis, and adequate management of this pathology in order to minimize postoperative complications. Patients and Methods This study retrospectively evaluated the patients admitted and treated for nasal bone fractures in a university clinic of oral and maxillofacial surgery in Romania over a 10-year period. Following statistical analysis, evaluation and correlation of the monitored variables, a P value < 0.05 was considered statistically significant. Results Nasal bone fractures had the highest incidence among men (88.30%), aged 20-29 years (33.33%), with no education (33.33%), interpersonal violence being the main cause in this category of patients (P = 0.004; P = 0.005; P = 0.005). In urban environment (55.9%), nasal bone fractures through aggression and road traffic accidents were predominant, while in rural areas (44.10%), those caused by domestic accidents and animal attacks prevailed (P = 0.551). Nondisplaced (81.10%), closed (85.60%) and involving the nasal septum fractures (51.35%) were preponderant. Hematoma was the most frequent associated soft tissue injury (86.49%), its incidence being increased in the case of displaced (P = 1.000) and open fractures (P = 0.692). The most frequent treatment method was close nasal reduction (CNR) + closed septoplasty (51.35%). The most frequent complication was malunion (7.2%), secondary to CNR without septoplasty (P = 0.037). Conclusions The main etiology of nasal bone fractures was interpersonal violence, which mainly affected men, aged 20-39 years, with a low level of education, living in urban areas. Implementing laws to fight interpersonal aggression and increase the education level of the population would lead to a considerable reduction in the incidence of this pathology. Patients treated by CNR + closed septoplasty and ORIF had the best postoperative evolution. Immediate septoplasty in the case of associated septal fractures significantly decreased the rate of postoperative complications.
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Affiliation(s)
- M Juncar
- Department of Oral and Maxillo-Facial Surgery, University of Oradea, Cluj-Napoca, Romania
| | - P A Tent
- Department of Oral and Maxillo-Facial Surgery, University of Oradea, Cluj-Napoca, Romania
| | - R I Juncar
- Department of Oral and Maxillo-Facial Surgery, University of Oradea, Cluj-Napoca, Romania
| | - A Harangus
- Department of Functional Genomics, Biomedicine and Translational Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - M Rivis
- Department of Dental Medicine, Discipline of Oral Surgery, 2nd "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
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Cohn JE, Othman S, Toscano M, Shokri T, Bloom JD, Zwillenberg S. Nasal Bone Fractures: Differences Amongst Sub-Specialty Consultants. Ann Otol Rhinol Laryngol 2020; 129:1120-1128. [PMID: 32506930 DOI: 10.1177/0003489420931562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nasal fractures constitute the largest proportion of facial trauma each year, however, there is no consensus management. In this study, we investingated the role of the consultant and the functional and aesthetic outcomes of procedures performed to address nasal bone fractures. METHODS A retrospective chart review of patients who sustained nasal bone fractures was conducted from 8/1/14 through 1/23/18. Categorical variables were analyzed using chi-squared testing and Fisher's exact test, where appropriate, while continuous variables were compared using Mann-Whitney U testing. RESULTS During the study period, 136 patients met inclusion criteria for full analysis. The mean age of this cohort was 47.6 ± 20.2 years with the majority identifying as African-American (53.7%) and male (67.2%). Otolaryngologists were significantly more likely to assess pre-operative nasal obstruction (100%) compared to plastic surgeons (24.1%) (P < .001). Otolaryngology elected operative management (53.3%) at a significantly higher rate than plastic surgery (24.1%) (P = .005). Additionally, otolaryngology was significantly more likely to manage patients in an outpatient setting (91.2%), whereas plastic surgery more commonly performed inpatient management (57.1%) (P = .006). Plastic surgery averaged a significantly shorter amount of time from presentation to operative management (7.3 ± 10.7 days) compared to otolaryngology (20 ± 27.7) (P = .019). Consulting service was not associated with a need for revision surgery. CONCLUSIONS Consultants across subspecialties differ in the management of nasal bone trauma. A more standardized approach is warranted by all individuals involved in the care of maxillofacial trauma patients.
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Affiliation(s)
- Jason E Cohn
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Sammy Othman
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Michael Toscano
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY, USA
| | - Tom Shokri
- Department of Otolaryngology-Head and Neck Surgery, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Jason D Bloom
- Department of Otolaryngology-Head & Neck Surgery, Division of Facial Plastic Surgery, University of Pennsylvania, Philadelphia, PA, USA.,Bloom Facial Plastic Surgery, Two Town Place, Bryn Mawr, PA, USA
| | - Seth Zwillenberg
- Department of Otolaryngology-Head and Neck Surgery, Einstein Medical Center, Philadelphia, PA, USA
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