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Trujillo O, Lee C. Nasal Fractures: Acute, Subacute, and Delayed Management. Otolaryngol Clin North Am 2023; 56:1089-1099. [PMID: 37353368 DOI: 10.1016/j.otc.2023.05.004] [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] [Indexed: 06/25/2023]
Abstract
Nasal fractures are very common. The literature describes early intervention (<14 days) with closed techniques as cost-effective, minimizing the need for possible secondary surgeries and improved early patient satisfaction. However, the authors observe a measurably high rate of subsequent open treatment after closed treatment, particularly where there is significant septal involvement in the fracture. Moreover, delayed intervention (>3 months) with an open approach has many advantages over early closed technique, including lower revision rate, improved ability for rigid fixation and support, and the ability to correct severe dorsal or caudal L-strut deformities, nasal valve issues, and severe nasal bony deviation/deformities.
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Affiliation(s)
- Oscar Trujillo
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, 180 Fort Washington Avenue HP8, New York, NY 10032, USA.
| | - Clara Lee
- Department of Otolaryngology-Head & Neck Surgery, Columbia University Irving Medical Center, 180 Fort Washington Avenue HP8, New York, NY 10032, USA
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Kumar M, Panneerselvam E, Prabhu K, Ganesh SK, Vb KKR. Prospective cohort study on short-term evaluation of septoplasty as early management of naso-septal fractures - A correlation of clinical outcomes with computational fluid dynamic parameters. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:639-644. [PMID: 35853555 DOI: 10.1016/j.jormas.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 06/12/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Post-traumatic deviated nasal septum (PTDNS) leads to impaired breathing and poor esthetics. The aim of this study was to assess treatment outcomes of early septoplasty for correction of PTDNS and correlate it with computational fluid dynamic (CFD) parameters. METHODS This prospective cohort study included patients who underwent early septoplasty for PTDNS. Outcome variables were clinical (pain, nasal symmetry, and nasal obstruction) and computational (velocity, pressure, wall shear stress and Reynold's number). The cohort consisted of two groups: patients with history of closed reduction for nasal fractures (CR) and patients without (NCR). The primary outcome measure was response to treatment. Correlation between clinical and computational parameters, and influence of closed reduction on septoplasty outcomes were the secondary and tertiary outcomes, respectively. Descriptive and inferential statistics were performed to analyze data. Level of significance was fixed at 5% (α = 0.05). RESULTS The sample included 12 patients, of which 5 underwent CFD analysis. Pain score reduced from a pre-operative mean of 7.3 to 0.5 post-operatively (p<0.001). All patients demonstrated reduction of nasal obstruction (p<0.001) and deviation (p<0.001) post-operatively. CFD analysis revealed post-operative reduction of velocity (p = 0.005) and Reynold's number (p = 0.007), with positive correlation between nasal obstruction and CFD parameters. Though patients in the CR group demonstrated reduced nasal deviation and obstruction before septoplasty, as compared to the NCR group, their outcomes were comparable following septoplasty. CONCLUSION Early septoplasty improves functional and esthetic outcomes in patients with PTDNS. CFD simulation is a predictable method to objectively evaluate nasal function.
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Affiliation(s)
- Muthu Kumar
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Elavenil Panneerselvam
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India.
| | - Komagan Prabhu
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Sriraam Kasi Ganesh
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
| | - Krishna Kumar Raja Vb
- Department of Oral & Maxillofacial Surgery, SRM Dental College & Hospital, Ramapuram Campus, Ramapuram, Chennai, India
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Abstract
This article outlines current methods in the evaluation and management of nasal fractures including clinical workup, imaging, and treatment.
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Affiliation(s)
- Kelly C Landeen
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21(st) Ave S7 South, Nashville, TN 37232, USA
| | - Kyle Kimura
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21(st) Ave S7 South, Nashville, TN 37232, USA
| | - Scott J Stephan
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, 1215 21(st) Ave S7 South, Nashville, TN 37232, USA.
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Kang BH, Kang HS, Han JJ, Jung S, Park HJ, Oh HK, Kook MS. A retrospective clinical investigation for the effectiveness of closed reduction on nasal bone fracture. Maxillofac Plast Reconstr Surg 2019; 41:53. [PMID: 31824891 PMCID: PMC6879701 DOI: 10.1186/s40902-019-0236-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/16/2019] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Byung-Hun Kang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 Republic of Korea
| | - Hyo-Sun Kang
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 Republic of Korea
| | - Jeong Joon Han
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 Republic of Korea
| | - Seunggon Jung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 Republic of Korea
| | - Hong-Ju Park
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 Republic of Korea
| | - Hee-Kyun Oh
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 Republic of Korea
| | - Min-Suk Kook
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, 42, Jebong-ro, Dong-gu, Gwangju, 61469 Republic of Korea
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Khajuria A, Osborne MS, McClleland L, Ghosh S. Improving the quality of assessment and management of nasal trauma in a major trauma centre (MTC): Queen Elizabeth Hospital, Birmingham. BMJ Open Qual 2019; 8:e000632. [PMID: 31803851 PMCID: PMC6887497 DOI: 10.1136/bmjoq-2019-000632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 11/05/2019] [Accepted: 11/09/2019] [Indexed: 11/19/2022] Open
Abstract
Background Nasal fractures present in 39% of patients with facial trauma. These patients are assessed in the emergency department followed by outpatient review in the senior house officer-led emergency ear, nose and throat (ENT) clinic. Inadequate treatment of nasal trauma can result in debilitating functional and aesthetic problems. Inexperienced junior doctors may be apprehensive in assessing nasal trauma resulting in time pressured clinics and suboptimal management. Measures A retrospective review of clinical noting over 3 months was carried out to gauge the extent of the problem. Three baseline measurements for satisfactory quality of assessments included: (1) 3/5 key symptoms elicited by the clinician (epistaxis, rhinorrhoea, nasal airway obstruction, dental malocclusion and diplopia). (2) Presence/absence of ‘septal haematoma’ (SH) and ‘deviated nasal septum’ (DNS) documented. (3) Patient follow-up within 2 weeks after the initial injury. Three Plan-Do-Study-Act (PDSA) cycles were conducted with implementation of interventions (proforma, clinic poster, patient information leaflet and training) as visualised in our ‘driver diagram’. Results The quality of nasal trauma assessments improved following each intervention. There was an increase from 86% to 100% patients being seen within 2 weeks of the injury. There was an improvement in quality of assessments following the teaching as two-thirds (PDSA cycle 2) followed by 100% (PDSA cycle 3) of clinical documentation included ‘rhinorrhoea’ and 83% (PDSA cycle 2) to 100% (PDSA cycle 3) included ‘nasal airway obstruction’. Similarly, two thirds (PDSA cycle 2) followed by 100% (PDSA cycle 3) examined and documented the presence/absence of SH and DNS. A 100% improvement in trainee confidence was reported. We are now conducting more comprehensive assessments of nasal trauma patients. Conclusion The need to provide relevant training and support to ENT junior doctors is crucial in their development, as well as to ensure delivery of high-quality patient-centred care.
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Affiliation(s)
- Apoorva Khajuria
- Ear, Nose & Throat (ENT) Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Max Sallis Osborne
- Ear, Nose & Throat (ENT) Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Lisha McClleland
- Ear, Nose & Throat (ENT) Department, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sandip Ghosh
- Diabetes and Endocrinology Department, Queen Elizabeth Hospital Birmigham, Birmingham, UK
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Morris S, Whittet H, Salamat A. Lateral nasal wall abscess following manipulation of fractured nasal bones. BMJ Case Rep 2019; 12:12/11/e232089. [PMID: 31772133 DOI: 10.1136/bcr-2019-232089] [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] Open
Abstract
Nasal fracture accounts for over 50% of facial fractures and is a frequent presentation to ear, nose and throat emergency clinics. Optimal management of nasal injuries with deformity is by manipulation under anaesthetic and should be offered when appropriate. A healthy 27-year-old woman presented with a lateral nasal wall mass with purulent discharge 1 month following manipulation. CT imaging revealed a mass arising from fragments of the nasal bone, consistent with an abscess. Bone fragments and purulent material were initially debrided, with a subsequent formal excision of a persistent granuloma performed with an excellent cosmetic outcome. This appears to be the first description of a granuloma resulting from a closed reduction-manipulation of a nasal fracture.
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Affiliation(s)
- Simon Morris
- ENT, Abertawe Bro Morgannwg University Health Board, Port Talbot, UK
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