Abstract
Background
Early manipulation of nasal fractures can negate the need for formal rhinoplasty. However, residual nasal deformity is reported in up to 50 % of cases. The aim of this study was to evaluate the outcome following manipulation of nasal fractures in a regional plastic surgery department and quantify the subsequent rhinoplasty conversion rate.
Methods
A retrospective review of all patients presenting with nasal fractures who had undergone manipulation under anaesthetic (MUA) in a single plastic surgery unit over a 7-year period was performed.
Results
Three hundred fifty-three MUA procedures were performed, the majority of which were in young males (76 %). Common causes included assault (54 %), sporting injuries (24 %) and falls (12 %). MUA was performed for nasal bone fracture (69 %) or bony and septal fracture (31 %). Only 37 % (130 patients) attended outpatient follow-up. Functional problems were identified in 17 % (22 patients), whilst 24 % (31 patients) noted residual deformity. Of these, 10 patients (3 %) accepted and underwent formal rhinoplasty surgery. This accounted for 17 % of all rhinoplasties carried out within the time period.
Conclusions
In our department, the outcome following manipulation of these injuries compares favourably with the literature, with the majority of patients having no major long-term sequelae. Our data suggest that many patients are happy to accept a degree of residual deformity and decline further surgery.
Level of Evidence: Level IV, risk / prognostic study
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References
Alvi A, Doherty T, Lewen G (2003) Facial fractures and concomitant injuries in trauma patients. Laryngoscope 113:102–106
Crowther JA, O’Donoghue GM (1987) The broken nose: does familiarity breed neglect? Ann R Coll Surg Engl 69:259–260
Chadha NK, Repanos C, Carswell AJ (2009) Local anaesthesia for manipulation of nasal fractures: systematic review. J Laryngol Otol 123:830–836
Kapoor PK, Richards S, Dhanasekar G et al (2002) Management of nasal injuries: a postal questionnaire survey of UK ENT consultants. J Laryngol Otol 116:346–348
Repanos C, Anderson D, Earnshaw J et al (2010) Manipulation of nasal fractures with local anaesthetic: a ‘how to do it’ with online video tutorial. Emerg Med Australas 22:236–239
Repanos C, Carswell AJ, Chadha NK (2010) Manipulation of nasal fractures under local anaesthetic: a convenient method for the Emergency Department and ENT clinic. Emerg Med J 27:473–474
Atighechi S, Baradaranfar MH, Akbari SA (2009) Reduction of nasal bone fractures: a comparative study of general, local, and topical anesthesia techniques. J Craniofac Surg 20:382–384
Rohrich RJ, Adams WP Jr (2000) Nasal fracture management: minimizing secondary nasal deformities. Plast Reconstr Surg 106:266–273
Khwaja S, Pahade AV, Luff D et al (2007) Nasal fracture reduction: local versus general anaesthesia. Rhinology 45:83–88
Waldron J, Mitchell DB, Ford G (1989) Reduction of fractured nasal bones; local versus general anaesthesia. Clin Otolaryngol Allied Sci 14:357–359
Supriya M, Clement WA, Ahsan F et al (2006) Satisfaction with cosmesis following nasal manipulation: do previous fractures matter? J Laryngol Otol 120:749–752
Fattahi T, Steinberg B, Fernandes R et al (2006) Repair of nasal complex fractures and the need for secondary septo-rhinoplasty. J Oral Maxillofac Surg 64:1785–1789
Higuera S, Lee EI, Cole P et al (2007) Nasal trauma and the deviated nose. Plast Reconstr Surg 120:64S–75S
Murray JA, Maran AG, Mackenzie IJ et al (1984) Open v closed reduction of the fractured nose. Arch Otolaryngol 110:797–802
Illum P (1991) Legal aspects in nasal fractures. Rhinology 29:263–266
Coulson C, De R (2006) Management of nasal injuries by UK accident and emergency consultants: a questionnaire survey. Emerg Med J 23:523–525
Harrison DH (1979) Nasal injuries: their pathogenesis and treatment. Br J Plast Surg 32:57–64
Colton JJ, Beekhuis GJ (1986) Management of nasal fractures. Otolaryngol Clin North Am 19:73–85
Illum P (1986) Long-term results after treatment of nasal fractures. J Laryngol Otol 100:273–277
Hung T, Chang W, Vlantis AC et al (2007) Patient satisfaction after closed reduction of nasal fractures. Arch Facial Plast Surg 9:40–43
Yilmaz MS, Guven M, Varli AF (2013) Nasal fractures: is closed reduction satisfying? J Craniofac Surg 24:e36–e38
Ondik MP, Lipinski L, Dezfoli S et al (2009) The treatment of nasal fractures: a changing paradigm. Arch Facial Plast Surg 11:296–302
Hwang K, Lee HS (2010) Early reexploration after closed reduction of nasal bone fracture. J Craniofac Surg 21:603–605
Conflicts of interest
Rieka Taghizadeh, Christopher John Lewis, Anna Barnard, Susan Stevenson and Matt Erdmann declare that they have no conflict of interest.
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This paper and its data conform to the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. However, for this type of retrospective study fomal consent from a local ethics committee is not required.
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Taghizadeh, R., Lewis, C.J., Stevenson, S. et al. Outcomes following manipulation of nasal fractures—the Durham experience. Eur J Plast Surg 39, 7–10 (2016). https://doi.org/10.1007/s00238-015-1142-x
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DOI: https://doi.org/10.1007/s00238-015-1142-x