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Xu T, Yi X, Xia S, Wu S. Comparison of outcomes for general and local anesthesia in the management of nasal bone fractures: a meta-analysis. Eur J Med Res 2024; 29:306. [PMID: 38825676 PMCID: PMC11145784 DOI: 10.1186/s40001-024-01896-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/21/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND This meta-analysis aimed to perform a head-to-head comparison of the role of general anesthesia (GA) and local anesthesia (LA) in the management of patients with nasal bone fractures (NBFs). METHODS PubMed, Embase, and Web of Science were comprehensively searched. Studies investigating the clinical outcomes of GA and LA in the management of NBFs were included. Pooled odds ratios (OR) with the respective 95% confidence intervals (CIs) were calculated. Heterogeneity between the included studies was evaluated. The risk of bias in the included studies was assessed. RESULTS Eight studies were included in this meta-analysis. The pooled ORs for cosmetic results, residual septal deformity, the need for further surgery, patients' satisfaction with the anesthesia procedure, and patients' satisfaction with the surgery results were 0.70 (95% CI 0.18, 2.64; z = - 0.53, p = 0.5957), 1.11 (95% CI 0.37, 3.30; z = 0.18, p = 0.8558), 1.19 (95% CI 0.65, 2.20; z = 0.56, p = 0.5760), 1.57 (95% CI 0.92, 2.69; z = 1.65, p = 0.0982), and 1.00 (95% CI 0.55, 1.80; z = - 0.00, p = 0.9974). CONCLUSIONS Insignificant difference on clinical outcomes was observed between GA and LA in the manipulation of patients with NBFs, and the choice of anesthetic approach should be based on the tolerability of the methods and the severity of nasal fractures.
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Affiliation(s)
- Ting Xu
- Department of Otolaryngology Head and Neck Surgery, Wuxi Clinical College, Nantong University, No. 68 Zhongshan Road, Liangxi District, Wuxi, 214002, Jiangsu, China.
- Department of Otolaryngology Head and Neck Surgery, The Second People's Hospital of Wuxi, Wuxi, China.
| | - Xinsheng Yi
- Department of Otolaryngology Head and Neck Surgery, The Second People's Hospital of Wuxi, Wuxi, China
| | - Shitong Xia
- Department of Otolaryngology Head and Neck Surgery, The Second People's Hospital of Wuxi, Wuxi, China
| | - Sihai Wu
- Department of Otolaryngology Head and Neck Surgery, The Second People's Hospital of Wuxi, Wuxi, China
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Gokani SA, Sadik HS, Espehana A, Jegatheeswaran L, Luke L, Philpott C, Nassif R. Manipulation under anaesthesia of fractured nasal bones - a 10-year retrospective study. J Laryngol Otol 2023; 137:1126-1129. [PMID: 36373494 DOI: 10.1017/s0022215122002432] [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: 11/16/2022]
Abstract
BACKGROUND Nasal bone fractures are treated by manipulation under general or local anaesthesia procedures. Data on long-term benefits of manipulation under local anaesthesia are limited. This study aimed to quantify the proportion of patients requiring septoplasty or septorhinoplasty after manipulation under general and local anaesthesia procedures. METHODS Anonymised data were collected from electronic records of all patients who underwent manipulation under anaesthesia at our centre over a 10-year period, including demographics, manipulation under anaesthesia timing and further surgery requirements. RESULTS The study identified 625 manipulation under general anaesthesia and 52 manipulation under local anaesthesia procedures. Manipulation under local anaesthesia procedures were performed earlier (local anaesthesia = 9 days, general anaesthesia = 15 days; p < 0.05) and were more likely to achieve manipulation (local anaesthesia = 83 per cent, general anaesthesia = 76 per cent; p < 0.05). There was no difference between techniques in the percentage of patients requiring further surgery. CONCLUSION This paper describes a large cohort of patients who underwent manipulation under anaesthesia over a 10-year period. Manipulation under local anaesthesia procedures have increased since the coronavirus disease 2019 pandemic, and the results are comparable to manipulation under general anaesthesia, with reduced delays between injury and manipulation.
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Affiliation(s)
- S A Gokani
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - H S Sadik
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - A Espehana
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - L Jegatheeswaran
- Department of ENT, Norfolk and Norwich University Hospital, Norwich, UK
| | - L Luke
- Department of ENT, James Paget University Hospital, Great Yarmouth, Norfolk, UK
| | - C Philpott
- Rhinology and ENT Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - R Nassif
- Department of ENT, Norfolk and Norwich University Hospital, Norwich, UK
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Bastianpillai J, Khan S, Acharya V, Tanna R, Pal S. How COVID-19 Changed Our Management of Nasal Bone Fractures and Its Impact on Patient Outcomes-A Retrospective Study. EAR, NOSE & THROAT JOURNAL 2020; 101:671-676. [PMID: 33302744 DOI: 10.1177/0145561320981439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Nasal bone fractures are a common presentation to the Ear, Nose and Throat (ENT) surgeon. Simple, closed fractures are assessed and considered for closed manipulation under anesthesia (MUA #nasal bones). Most departments perform this under general anesthesia (GA). Our protocol changed in the face of COVID-19, where procedures were alternatively performed under local anesthesia (LA) in the clinic, to cope with lack of elective theater capacity during the pandemic, while still allowing a nasal fracture service to take place. We present postoperative patient outcomes on breathing and shape, comparing GA versus LA. METHODS Patient records retrospectively analyzed (January 2020-August 2020), and patients undergoing MUA #nasal bones interviewed by telephone after one month. Exclusion criteria were open injuries or depressed nasal bones requiring elevation. Breathing and shape scores were evaluated subjectively using a Likert scale (1 = very unsatisfied, 5 = very satisfied). RESULTS Two hundred five nasal injury referrals were made (21 MUA #nasal bones under GA and 27 under LA). Manipulation under anesthesia #nasal bones significantly improved both breathing satisfaction scores (GA; 2.88 ± 0.24 to 4.06 ± 0.23, P < 0.05; LA; 2.86 ± 0.22 to 3.77 ± 0.27, P < 0.05) and aesthetic scores (GA; 2.00 ± 0.21 to 3.94 ± 0.23, P < 0.05; LA; 1.64 ± 0.19 to 3.59 ± 0.28, P < 0.05) in both GA and LA groups. There was no statistically significant difference between LA and GA in postoperative outcomes. There was a trend toward greater satisfaction for GA, though this was not statistically significant and may be impacted by the rate of cartilaginous deformity in the LA group. Both techniques were well tolerated and most patients would repeat the procedure in hindsight. CONCLUSIONS Local anesthesia could provide a safer, cheaper, and satisfactory alternative for performing MUA #nasal bones in the clinic for selected patients, particularly with reduction of elective theater capacity in the event of further COVID-19 surges. We recommend training junior ENT surgeons to perform this procedure under supervision with adequate protective measures.
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Affiliation(s)
| | - Shaharyar Khan
- ENT Department, Northwick Park Hospital, London, United Kingdom
| | - Vikas Acharya
- ENT Department, Northwick Park Hospital, London, United Kingdom
| | - Ravina Tanna
- ENT Department, Lister Hospital, Stevenage, United Kingdom
| | - Surojit Pal
- ENT Department, Northwick Park Hospital, London, United Kingdom
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Pinto R, Wright R, Ghosh S. Nasal fractures: a dedicated clinic providing reduction under local anaesthesia improves time to manipulation. Ann R Coll Surg Engl 2020; 102:418-421. [PMID: 32326744 DOI: 10.1308/rcsann.2019.0185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Guidelines for nasal injury state that assessment should be at 7-10 days post-injury and manipulation within 14 days. We performed a plan, do, study, act improvement cycle to assess whether a dedicated nasal fracture service led to better outcomes. MATERIALS AND METHODS A retrospective study was carried out of all patients undergoing manipulation under anaesthesia for nasal trauma between February 2013 and December 2016 in a district general hospital. A dedicated nasal fracture clinic providing manipulation under local anaesthesia was implemented followed by a prospective study of all patients presenting to the clinic between February and November 2017. Main outcome measures included time from injury to otolaryngology assessment, time from injury to manipulation and incidence of secondary septorhinoplasty. RESULTS The retrospective series involved 525 patients including 381 males (72.6%) and 144 females (27.4%). Mean time from injury to assessment was 10 days. Mean time from injury to surgery was 14.5 days. Mean time from assessment to surgery was five days. The incidence of septorhinoplasty was 2.3%. The prospective series involved 119 patients including 78 males (65.5%) and 41 females (34.5%). Following implementation of a nasal fracture clinic, mean time from injury to assessment and manipulation was 6.1 days and 5.4% of patients underwent septorhinoplasty for secondary deformity. DISCUSSION Implementation of a nasal fracture clinic providing reduction under local anaesthesia reduced the time to assessment and manipulation. The incidence of septorhinoplasty is low following reduction under general or local anaesthesia. Assessment earlier than seven days is feasible and advice for referral can be changed accordingly.
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Affiliation(s)
- R Pinto
- Alder Hey Children's Hospital, Liverpool, UK
| | - R Wright
- Alder Hey Children's Hospital, Liverpool, UK
| | - S Ghosh
- Pennine Acute Hospitals NHS Trust, Manchester, UK
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Bagatin T, Bagatin D, Šakić L, Šakić K. IMPACT OF LOCAL INFILTRATION ANESTHESIA ON POSTOPERATIVE PAIN MANAGEMENT AFTER RHINOPLASTY IN DAY CARE SURGERY. Acta Clin Croat 2019; 58:62-66. [PMID: 31741561 PMCID: PMC6813470 DOI: 10.20471/acc.2019.58.s1.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Use of local infiltration anaesthesia with 2% lidocaine in combination with epinephrine 1/100000 in rhinoplasty and 0.25% levobupivacaine in this research as an adjunct to general anaesthesia is compared analysing the need for postoperative analgesia in rhinoplasty patients. 30 patients received lidocaine combined with epinephrine (LA) and other 30 patients received levobupivacaine (LB). Comparison is done with Visual Analogue Scale in 30 min and 1, 3, 6 h postoperatively. Also 24 h need for analgesic treatment was recorded. In conclusion postoperative analgesia in LB group with general anaesthesia was significantly prolonged (P = 0.038).
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Affiliation(s)
| | - Dinko Bagatin
- 1Department of Maxillofacial, Plastic, Reconstuctive and Aesthetic Surgery at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 2Department of General, Plastic, Reconstuctive and Aesthetic Surgery at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 3Department of Anaesthesiology and Pain therapy at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 4Department of Anaesthesiology, Reanimathology and Intensive medicine University hospital "Sveti Duh", Zagreb, Croatia; 5Faculty of Dental medicine and Health Osijek, Josip Juraj Strossmayer University in Osijek, Osijek, Croatia; 6Catholic University of Croatia, Zagreb, Croatia
| | - Livija Šakić
- 1Department of Maxillofacial, Plastic, Reconstuctive and Aesthetic Surgery at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 2Department of General, Plastic, Reconstuctive and Aesthetic Surgery at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 3Department of Anaesthesiology and Pain therapy at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 4Department of Anaesthesiology, Reanimathology and Intensive medicine University hospital "Sveti Duh", Zagreb, Croatia; 5Faculty of Dental medicine and Health Osijek, Josip Juraj Strossmayer University in Osijek, Osijek, Croatia; 6Catholic University of Croatia, Zagreb, Croatia
| | - Kata Šakić
- 1Department of Maxillofacial, Plastic, Reconstuctive and Aesthetic Surgery at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 2Department of General, Plastic, Reconstuctive and Aesthetic Surgery at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 3Department of Anaesthesiology and Pain therapy at Maxillofacial, General, Plastic, Reconstructive and Aesthetic Surgery Polyclinic "Bagatin", Zagreb, Croatia; 4Department of Anaesthesiology, Reanimathology and Intensive medicine University hospital "Sveti Duh", Zagreb, Croatia; 5Faculty of Dental medicine and Health Osijek, Josip Juraj Strossmayer University in Osijek, Osijek, Croatia; 6Catholic University of Croatia, Zagreb, Croatia
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Jung GS, Kwon JH, Lee JW, Yang JD, Chung HY, Cho BC, Choi KY. A new approach to nasomaxillary complex type of nasal bone fracture: Clip operation. J Craniomaxillofac Surg 2017; 45:954-961. [PMID: 28462781 DOI: 10.1016/j.jcms.2017.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/23/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Nasal bone fractures comprise almost 40% of all facial injuries. Most are initially reduced using closed reduction. This study introduces a newly developed method, the clip operation via endonasal approach. MATERIALS AND METHODS The operation was performed in these patients by a single surgeon extensively experienced in facial bone fractures. An absorbable mesh plate made into a clip was used for fixation after open reduction via the endonasal approach. No screws were used for fixation. Nasal packing was removed the first day after surgery; aluminum splinting was removed the third week after surgery. Three-dimensional facial computed tomography and cephalolateral radiography were performed preoperatively and postoperatively. Plastic surgeon satisfaction and postoperative complications were assessed. RESULTS Fracture relapse was not observed. Reduction status was well maintained. Postoperative complications occurred, with a low final incidence of 1.8% in the third postoperative month. Plastic surgeon satisfaction was very high at 4.58. This operation takes 5-10 min, and is simple to perform. It entails a short hospitalization, and the duration during which nasal packing and aluminum splint are maintained is comparable. Undesirable functional, aesthetic complications and secondary surgery resulting from inaccurate relapse were reduced. CONCLUSION The clip operation is a useful technique for correcting nasal bone fractures, especially nasomaxillary complex type.
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Affiliation(s)
- Gyu Sik Jung
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Joon Hyun Kwon
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jeong Woo Lee
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Ho Yun Chung
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Byung-Chae Cho
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Kang Young Choi
- Department of Plastic and Reconstructive Surgery, Kyungpook National University School of Medicine, Daegu, Republic of Korea.
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Lennon P, Jaber S, Fenton JE. Functional and Psychological Impact of Nasal Bone Fractures Sustained during Sports Activities: A Survey of 87 Patients. EAR, NOSE & THROAT JOURNAL 2016. [DOI: 10.1177/014556131609500802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nasal bone fractures that require reduction are a common sequela of sports injuries. We conducted a survey to ascertain the outcomes of patients who had experienced a nasal bone fracture and who subsequently underwent manipulation under anesthesia. We reviewed data on 217 nasal bone fractures that had been seen at our institution over a 3-year period. Of these, 133 (61.3%) had occurred as a result of a sports activity. Thirty of the 133 patients (22.6%) had been managed conservatively, while the other 103 (77.4%) had undergone manipulation under anesthesia. We were able to contact 87 of the 103 patients (84.5%) by telephone, who served as the study population. The most common sports associated with these 87 injuries were hurling (n = 26; 29.9%), rugby (n = 22; 25.3%), Gaelic football (n =20; 23.0%), and soccer (n = 13; 14.9%). Patients who had undergone treatment within 2 weeks were significantly more satisfied with their outcome than were those who had been treated later (p < 0.01). Twenty-six patients (29.9%) reported that their injury had had a detrimental impact on their subsequent performance in their sport; 12 (13.8%) described a fear of reinjury when they returned to play, 7 (8.0%) experienced functional problems, 3 (3.4%) complained of diminished performance, and 4 others (4.6%) quit playing contact sports altogether. To the best of our knowledge, our study is the first to demonstrate that a fracture of the nasal bones may have a notable psychological impact on an athlete and that it can lead to diminished performance or a complete withdrawal from contact sports.
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Affiliation(s)
- Paul Lennon
- Department of Otolaryngology-Head and Neck Surgery,
University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Sam Jaber
- Department of Otolaryngology-Head and Neck Surgery,
University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - John E. Fenton
- Department of Otolaryngology-Head and Neck Surgery,
University Hospital Limerick, Dooradoyle, Limerick, Ireland
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Al-Moraissi EA, Ellis E. In Reply. J Oral Maxillofac Surg 2016; 74:1106-8. [DOI: 10.1016/j.joms.2016.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 11/30/2022]
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Kelly E. In Regard to Local Versus General Anesthesia for the Management of Nasal Bone Fractures: A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2016; 74:1105-6. [PMID: 26917202 DOI: 10.1016/j.joms.2016.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 01/17/2016] [Accepted: 01/18/2016] [Indexed: 11/29/2022]
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Basheeth N, Donnelly M, David S, Munish S. Acute nasal fracture management: A prospective study and literature review. Laryngoscope 2015; 125:2677-84. [PMID: 25959006 DOI: 10.1002/lary.25358] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 02/10/2015] [Accepted: 04/06/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Functional and cosmetic deformities are common after nasal injuries and at times necessitate advanced surgery to reverse the effects of trauma. This study was designed to study the factors related to nasal injury and patient parameters in influencing the acute management of nasal injuries and its outcome. STUDY DESIGN Prospective study. METHODS Nasal injuries from County Waterford in Southeast Ireland were referred to a new Cost-Neutral Nasal Fracture Clinic. The first 400 patients from this prospective audit, referred to Waterford Regional Hospital from August 2009 through December 2010, were included in this study. Twenty-one variables, including satisfaction scores using Visual Analog Scale (VAS), were studied. Data was obtained at each stage of management, from initial assessment in ears, nose, and throat (ENT) casualty to being seen and further reviewed in consultant-based specialty clinic. RESULTS Men outnumbered women 72: 28, and the mean age was 26.89 (0.4 years-87 years). Patients presenting time to the ENT casualty after the injury ranged between 1 and 90 days (mean 10.5 days). The interval between injury and intervention was on an average 6.1 days. Accident (41%) and soccer (46%), among the sports group, were predominantly related to nasal injury. The overall satisfaction rate was 77.5% for breathing and 85.6% for cosmesis. One hundred twenty-seven (31.8%) patients were referred to and managed from the septorhinoplasty clinic. Overall, 11% required septorhinoplasty. Patient satisfaction was seen in manipulation performed up to 5 weeks postinjury. CONCLUSION Our databank is the largest prospectively studied series of nasal-fracture management from Ireland. The incidence of nasal fracture in the southeast of Ireland is 0.37%. Age, gender, mode of injury, and type of sport influenced the satisfaction rates in this study. This type of service may not be practical in all ENT departments, but a regional center may be an idea worth considering.
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Affiliation(s)
- Naveed Basheeth
- Department of Otorhinolaryngology, Waterford Regional Hospital, Waterford, Ireland
| | - Martin Donnelly
- Department of Otorhinolaryngology, Waterford Regional Hospital, Waterford, Ireland
| | - Smyth David
- Department of Otorhinolaryngology, Waterford Regional Hospital, Waterford, Ireland
| | - Shandilya Munish
- Department of Otorhinolaryngology, Waterford Regional Hospital, Waterford, Ireland
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Al-Moraissi EA, Ellis E. Local versus general anesthesia for the management of nasal bone fractures: a systematic review and meta-analysis. J Oral Maxillofac Surg 2014; 73:606-15. [PMID: 25577456 DOI: 10.1016/j.joms.2014.10.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/08/2014] [Accepted: 10/13/2014] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Essam Ahmed Al-Moraissi
- Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
| | - Edward Ellis
- Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center, San Antonio, TX
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Kim HS, Lee HK, Jeong HS, Shin HW. Decreased postoperative pain after reduction of fractured nasal bones using a nerve block of the anterior ethmoidal nerve. Int J Oral Maxillofac Surg 2013; 42:727-31. [PMID: 23528745 DOI: 10.1016/j.ijom.2013.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 12/07/2012] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- H-S Kim
- Department of Plastic and Reconstructive Surgery, Myongji Hospital, Kwandong University College of Medicine, Gyeonggi-do, Republic of Korea
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Cannon CR, Cannon R, Young K, Replogle W, Stringer S, Gasson E. Characteristics of nasal injuries incurred during sports activities: analysis of 91 patients. EAR, NOSE & THROAT JOURNAL 2012; 90:E8-12. [PMID: 21853433 DOI: 10.1177/014556131109000816] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nasal injuries are among the most common sports injuries. We conducted a prospective, observational study of 91 patients, aged 7 to 60 years (mean: 18.3), who had sustained a nasal injury while engaging in a sport, exercise, or other recreational physical activity. We found that a substantial proportion of these injuries occurred in females (29.7% of cases). A high percentage of injuries (86.8%) occurred in those who had been participating in a noncontact sport; the sport most often implicated was basketball (26.4%). Also, injuries were more common during organized competition as opposed to recreational play (59.3 vs. 40.7%). Of the 91 nasal injuries, 59 (64.8%) were fractures, most of which were treated with a closed reduction. Almost all of the patients in this study (92.3%) were able to return to their sport. We conclude that most sports-related nasal fractures are not preventable.
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Affiliation(s)
- C Ron Cannon
- Head and Neck Surgical Group, 1038 River Oaks Drive, Flowood, MS 39236, USA.
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Reduction of nasal bone fractures: a comparative study of general, local, and topical anesthesia techniques. J Craniofac Surg 2009; 20:382-4. [PMID: 19258905 DOI: 10.1097/scs.0b013e31819b945f] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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.
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Abstract
The goal of treatment for nasal fractures is to restore the pretraumatic state and normal function. The decision by the surgeon regarding the surgical approach should be based on the degree of injury, the presence of concomitant facial injuries, patient compliance, training of the surgeon, and the presence and degree of septal injury. The use of a closed or open approach will then depend on the extent of the injury.
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Affiliation(s)
- Vincent B Ziccardi
- Department of Oral and Maxillofacial Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ 07103-2400, USA.
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16
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Local anaesthesia for manipulation of nasal fractures: systematic review. The Journal of Laryngology & Otology 2009; 123:830-6. [PMID: 19470190 DOI: 10.1017/s002221510900560x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the most effective local anaesthetic method for manipulation of nasal fractures, and to compare the efficacy of local anaesthesia with that of general anaesthesia. METHOD Systematic review and meta-analysis. DATABASES Medline, Embase, Cochrane Library, National Research Register and metaRegister of Controlled Trials. INCLUDED STUDIES We included randomised, controlled trials comparing general anaesthesia with local anaesthesia or comparing different local anaesthetic techniques. Non-randomised studies were also systematically reviewed and appraised. No language restrictions were applied. RESULTS Five randomised, controlled trials were included, three comparing general anaesthesia versus local anaesthesia and two comparing different local anaesthetic methods. No significant differences were found between local anaesthesia and general anaesthesia as regards pain, cosmesis or nasal patency. The least painful local anaesthetic method was topical tetracaine gel applied to the nasal dorsum together with topical intranasal cocaine solution. Minimal adverse events were reported with local anaesthesia. CONCLUSIONS Local anaesthesia appears to be a safe and effective alternative to general anaesthesia for pain relief during nasal fracture manipulation, with no evidence of inferior outcomes. The least uncomfortable local anaesthetic method included topical tetracaine gel.
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Daniel M, Raghavan U. Relation between epistaxis, external nasal deformity, and septal deviation following nasal trauma. Emerg Med J 2006; 22:778-9. [PMID: 16244333 PMCID: PMC1726610 DOI: 10.1136/emj.2004.018994] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To find if the presence of epistaxis after nasal trauma can be used to predict post-traumatic external nasal deformity or a symptomatic deviated nasal septum. METHODS Retrospective analysis of all patients seen in the fractured nose clinic by the first author between 17 October 2003 and 27 February 2004. Presence of epistaxis, newly developed external nasal deformity, and the presence of a deviated nasal septum with new symptoms of nasal obstruction were noted. RESULTS A total of 139 patients were included in the study. Epistaxis following injury was noted in 106 (76%). Newly developed external nasal deformity was noted in 71 (51%), and 33 (24%) had a deviated nasal septum with new symptoms of nasal obstruction. Of the 106 patients with post-trauma epistaxis, 50 (67%) had newly developed external nasal deformity and of the 33 patients without post-traumatic epistaxis, 11 (33%) had nasal deformity (p<0.05). Post-trauma epistaxis was not associated with the presence of a newly symptomatic deviated septum (25% in patients with epistaxis after injury versus 18% if there was no epistaxis). CONCLUSIONS Presence of epistaxis after nasal trauma is associated with a statistically significant increase in external nasal deformity. However, one third of patients without epistaxis following nasal trauma also had external nasal deformity and hence all patients with a swollen nose after injury, irrespective of post-trauma epistaxis, still need to be referred to the fractured nose clinic.
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Affiliation(s)
- M Daniel
- Department of Otorhinolaryngology/Head & Neck Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK.
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