Olfactory Dysfunction in Nasal Bone Fracture

Effectiveness of out-fracture of the inferior turbinate with reduction nasal bone fracture

BACKGROUND

The nasal bone, being the most protruding bone in the center of the facial bones, is particularly susceptible to damage. Nasal bone fractures can often result in secondary deformation and dysfunction of the nose, including septal fractures. Studies on functional or intra-nasal complications have been rarely reported after nasal bone fracture reduction.

AIM

To evaluate the severity of nasal obstruction and its improvement following nasal bone fracture reduction using inferior turbinoplasty.

METHODS

We conducted a retrospective review of data from 50 patients with symptomatic nasal obstruction between January to December 2010. All patients underwent preoperative Computed tomography evaluation, and symptom changes and nasal cavity volume were analyzed using a visual analog scale and acoustic rhinometry before and after surgery. Closed reduction and out-fracture of both inferior turbinates performed by the same surgeon. Treatment outcomes were assessed by comparing changes in the nasal airway volume measured using acoustic rhinometry before and after surgery. The minimal cross-sectional area (MCA) was also analyzed based on the Stranc classification.

RESULTS

Before reduction, the mean MCA for all cases was 0.59 ± 0.06 cm2, which represented an 11% decrease compared to the average size of a Korean adult (0.65 ± 0.03 cm2). The MCA for frontal impact was 0.60 ± 0.02 cm2 and for lateral impact, it was 0.58 ± 0.03 cm2. After reduction via inferior turbinoplasty, the MCA improved to 0.64 ± 0.04 cm2.

CONCLUSION

This study suggests that turbinoplasty is helpful in addressing nasal obstruction. Out-fracture of the inferior turbinate is an effective and durable technique that can be easily performed to enlarge the nasal airway with minimal morbidity.

Effect of head impacts and chemical irritation on elite athletes' olfaction

Limited research exists on athletes' olfaction. As diet is an elementary part of an athlete's lifestyle and training, it is important to know whether the sport discipline itself carries a risk for olfactory impairment. The aim of this study was to evaluate whether elite swimmers (chemical irritation), boxers (head impact) or soccer players (head impact) are at risk for impaired olfaction. Elite-level male swimmers (n = 30), boxers (n = 35) and soccer players (n = 30) aged 18-40 years were recruited from Finnish sport clubs. Floorball players (n = 30) were recruited as a control group. All participants filled in a questionnaire about their training history, nasal and sinonasal diseases, asthma, nasal operations and traumas, smoking and self-evaluation of olfaction and taste function. Sniffin' Sticks odour identification test with 12 different odorants and anterior rhinoscopy were performed on all participants. The mean score from the smelling test did not differ between the sport groups. Sinonasal diseases and bronchial asthma were more common among swimmers than among the other athletes. Rhinitis symptoms were common among all athletes. Boxing, soccer or swimming does not seem to affect sense of smell. The majority of our participating elite athletes had normal olfaction, even if they had had a long history of active sports.Highlights Boxing, soccer or swimming does not seem to affect sense of smell.Rhinitis symptoms were prevalent among all elite athlete groups in our study.Athletes with hyposmia can perceive their own decreased olfaction.Swimmers have more bronchial asthma and sinus diseases than other athlete groups.

Olfactory Dysfunction and its Course in Patients With Nasal Bone Fracture

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.

The Effect of Functional Nasal Surgery on Olfactory Function

BACKGROUND

Functional and aesthetic nasal operations are some of the most common plastic surgery procedures performed in the United States. The purpose of the study was to evaluate the effects of septoplasty, septorhinoplasty, and rhinoplasty procedures on postoperative olfactory function and their relationship to nasal airflow and quality of life.

METHODS

A systematic review and meta-analysis was performed evaluating olfactory function following nasal surgery. Preoperative and postoperative values for olfaction, nasal airflow, and quality of life/nasal symptoms were analyzed. The effect size was calculated from each study and used for meta-analysis. As studies evaluated patients at different points in the postoperative period, the latest time point reported by each study was used in the meta-analysis. The 95 percent confidence interval of the effect size was calculated for each study. Study quality was assessed using the Jadad and Methodological Index for Nonrandomized Studies instruments. All included studies were Level of Evidence II.

RESULTS

There were 25 included studies. Following nasal surgery, patients experienced significant improvements in olfaction (p < 0.001), nasal airflow (p < 0.001), and quality of life/nasal symptoms (p < 0.001). Patients often experienced a transient decrease in olfaction immediately after surgery, followed by improvement postoperatively. Preoperative olfactory dysfunction rates were low and postoperative dysfunction was equally low. Olfaction improvement was directly correlated with improvement in nasal airflow and quality of life.

CONCLUSIONS

Functional and aesthetic nasal operations appear to significantly improve olfaction, which is directly correlated with nasal airflow. Some studies report a transient worsening of these measures in the immediate postoperative period, which subsequently improved at later time points.

Demographic Factors of Nasal Bone Fractures and Social Reflection

INTRODUCTION

The nose is the most protruding central part of the face, and nasal bone fractures are the most common of facial bone fractures, leading up to 39%. Despite its high frequency, not many studies handled the etiology of nasal bone fractures, leading to the necessity of a recent demographic study.

MATERIALS AND METHODS

A total of 1111 patients diagnosed with nasal bone fracture from 2013 to 2018 at our institute were evaluated. A retrospective review of the various demographic and etiologic characteristics was done.

RESULTS

Numerous factors associated with nasal bone fractures were analyzed. Male patients were 3.3 times greater than the number of female patients, and twenties were the most common age range. Violence was the overall most common cause of injury, while slip down was the most common cause for females. Upon monthly distribution, the highest incidence of nasal bone fractures occurred in September, followed by March and December. The authors further divided the patients by time zone of the fractures, and male patients were most commonly injured from midnight to 3 AM, while female patients were 6 PM to 9 PM.

CONCLUSION

Our findings represent a recent urban data of various etiologic factors of nasal bone fracture. The concept of school violence has been widely used since 1990s, and our data reflects that violence of the youth is a serious issue of the society. The mechanism of injury differed among sexes and age groups, and such discrepancies will aid physicians to better understand facial bone fracture patients and educate them in the future.

Significance of Medial Osteotomy on the Olfactory Function in Patients Who Underwent Septorhinoplasty

OBJECTIVE

This study was designed to explore the impact of medial osteotomy on olfactory function.

METHODS

This nonrandomized, prospective study included 60 adult patients who underwent open technique septoplasty (group 1), rhinoplasty with only lateral osteotomy (group 2), and septorhinoplasty with medial and lateral osteotomies (group 3). Olfactory functions were evaluated by using the Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory test. The CCCRC test includes the butanol threshold test and smell identification test using common smells. The butanol threshold test and smell identification test scores of each group were recorded preoperatively and at 1st and 4th months and compared.

RESULTS

Each group is consisted of 20 patients. The preoperative smell identification test and butanol threshold test scores were similar in each group. The smell identification test, butanol threshold test, and CCCRC olfactory test scores of the 1st month were statistically significantly low in group 3. There was no statistically significant difference between the groups at 4th month postoperatively.

CONCLUSION

The present study is the first analysis of the effect of medial osteotomy on olfactory function. Medial osteotomy may decrease the olfactory function in early time, but afterwards olfaction could recover at preoperative levels.

Comparison of Efficacy Outcomes of Lidocaine Spray, Topical Lidocaine Injection, and Lidocaine General Anesthesia in Nasal Bone Fractures Surgeries: A Randomized, Controlled Trial

Background

Lidocaine is widely used as a general and local anesthetic in minor or major surgeries. The objective of the study was to compare postoperative pain relief and adverse events using different forms of lidocaine administration in patients following closed nasal bone reduction surgery.

Material/Methods

A total of 381 patients with a solitary nasal fracture that could be managed with closed reduction were included in this study and divided into 3 groups of 127 patients in each group. Patients had received 1% lidocaine HCl with epinephrine (LL group), inserted a mesh impregnated with lidocaine spray (TL group), or 1 mg/kg/h lidocaine infusion (GL group) before surgeries. Patients also received morphine when the pain was not controlled. The postoperative pain was assessed at 6 hours and 48 hours after surgery. Postoperative vomiting and nausea were evaluated. Repeated ANOVA/Tukey-Kramer multiple comparisons test was performed at 95% confidence level.

Results

At 6 hours after surgery, patients in the general lidocaine (GL) group reported decreased postoperative pain compared with those in the topical lidocaine (TL) group (P<0.001, q=6.633) and LL group (P<0.001, q=8.056). The morphine consumption within 48 hours was least in GL group than TL group (P<0.001, q=172.9) and LL group (P<0.001, q=226.42). Lidocaine infusion caused nausea (P<0.001, q=6.742) and vomiting (P<0.001, q=4.306).

Conclusions

Topical lidocaine anesthesia had the same postoperative pain relief and the least adverse events as local and general lidocaine anesthesia.