Ten-year statistics and observation of facial bone fracture

Relationship Between Nasal Fracture and Blowout Fracture: Can Nasal Fracture Be a Predictor of Blowout Fracture?

PURPOSE

Nasal and blowout fractures are the most common injuries from craniomaxillofacial trauma. Nasal fractures are easily diagnosed by clinical signs, such as pain and crepitus. However, blowout fractures are frequently asymptomatic and are easy to miss without computed tomographic (CT) scanning. This study analyzed the relation between the 2 fracture types to determine whether nasal fracture could be used as a predictor of blowout fracture.

MATERIALS AND METHODS

CT scans of 1,368 patients who underwent reduction surgery for nasal fracture were retrospectively reviewed. The pattern of nasal fractures (n = 1,368) was classified as frontal or lateral according to the direction of impact. Blowout fractures (n = 297) were classified into 3 types according to the position of the fracture: medial, inferior, or inferomedial wall. After calculating the number of patients in each group, the relation between nasal and blowout fracture types was statistically analyzed.

RESULTS

Of 305 patients with frontal-type nasal fractures, the incidence of medial, inferior, and inferomedial wall fracture was 26, 7, and 9, respectively. Of 1,063 patients with lateral-type nasal fractures, the incidence of medial, inferior, and inferomedial wall fracture was 118, 75, and 62, respectively. Medial wall fracture was most common in the 2 nasal fracture groups and showed a higher frequency in the lateral-type group.

CONCLUSIONS

This study showed a strong relation between nasal fractures and medial wall blowout fractures. If nasal fracture is suspected, especially the lateral type, then thorough examination for medial wall blowout fracture, with a high index of suspicion, should be performed.

A Comparison Between K-Wire Splinting and Intranasal Gauze Packing in Nasal Bone Fracture

BACKGROUND

The aim of this study was to compare the outcomes between Kirschner wire (K-wire) splinting and intranasal packing.

METHODS

The authors performed a retrospective and comparative analysis of subjective patient discomfort and objective postoperative computed tomography (CT) imaging after closed reduction for treating type II and type III nasal bone fractures from April 2010 to April 2013 in 2 groups, 1 with K-wire splinting and 1 with intranasal packing.

RESULTS

Complaints of nasal obstruction, dry mouth, loss of appetite, and sleep disturbance were significantly less in K-wire group. Mean scores for concerns about aesthetics/postoperative asymmetry did not differ significantly between groups. There was no significant difference in accuracy of reduction and support provided to the reduced nasal bones between groups.

CONCLUSIONS

The K-wire fixation can be considered a reliable and useful immobilization method for treating type II and type III nasal bone fractures.

Local versus general anesthesia for the management of nasal bone fractures: a systematic review and meta-analysis

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.

Manipulation of nasal fractures with local anaesthetic: a 'how to do it' with online video tutorial

Nasal fractures are the most common facial fractures and displaced fractures may cause considerable cosmetic concern. Traditionally, displaced nasal fractures have been manipulated under general anaesthesia (GA) performed within 2 weeks of the injury. Despite evidence for the benefit of local anaesthesia (LA), nasal fractures are still most commonly reduced under GA. We have presented a method of reduction of simple nasal fractures under LA in an outpatient setting. This has the advantage of being painless, simple to attempt and cost-effective. If reduction is inadequate then a general anaesthetic reduction is still possible. A recent comprehensive systematic review of all the available evidence did not show any significant difference (in terms of cosmesis, pain or nasal obstruction) between using LA and GA methods and highlighted the evidence base to support LA. We describe our method of assessment and treatment of displaced nasal fractures and provide an online tutorial (http://sciencestage.com/v/22194/local-anaesthetic-nasal-fracture-reduction.html). It is important to keep in mind that any concerns should be referred to an otolaryngology specialist for further management and that practitioners attempting this technique should first receive training from an otolaryngologist.

Local anaesthesia for manipulation of nasal fractures: systematic review

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.

Indirect open reduction through intercartilaginous incision and intranasal Kirschner wire splinting of comminuted nasal fractures

The majority of nasal fractures have been managed by using closed reduction and intranasal packing. In comminuted nasal fractures, open reduction and internal fixation may be indicated for accurate reduction and rigid fixation, but it is a very aggressive procedure. We developed a new technique for comminuted nasal fractures: indirect open reduction and intranasal Kirschner wire splinting. A periosteal elevator is used to elevate the mucoperiosteum posterior to the nasal bone through intercartilaginous incision and to reduce accurately the nasal bone, at the same time detecting the fracture lines. The Kirschner wire is used to insert between the nasal bone and the mucoperiosteum and to splint rigidly the nasal bone. During the follow-up period of 5 weeks to 4 months, 23 of 27 patients (85 percent) had successful cosmetic results. Four patients had slight cosmetic deformity but did not request a late rhinoplasty. Nineteen patients had accurate reduction on a computed tomography scan. Ten patients had undercorrection of the nasal septum on a computed tomography scan, and three patients had significant septal deviation with airway obstruction. Indirect open reduction through intercartilaginous incision and intranasal Kirschner wire splinting is a reliable and useful method for the treatment of comminuted nasal fractures because it achieves accurate reduction and rigid, long intranasal support, can be done comfortably under local anesthesia, permits early nasal breathing postoperatively, has no external scar, and minimizes complications such as nasal bleeding, soft-tissue injury, infection, and recurrent displacement.