The Impact of the Nasal Trauma in Childhood on the Development of the Nose in Future

Diagnostic utility of ultrasound in pediatric nasal bone fractures: a systematic review and meta-analysis

Ultrasonography, a radiation-free and cost-effective modality, stands out as a promising tool for evaluating nasal bone fractures. Despite limited literature on its pediatric application, there is an increasing recognition of its potential to enhance diagnostic precision. To evaluate the diagnostic efficacy of ultrasound in detecting pediatric nasal bone fractures. Employing established guidelines, a systematic review and meta-analysis were conducted through a comprehensive literature search in PubMed, Scopus, Web of Science, and Embase databases until December 5, 2023. Inclusion criteria encompassed studies reporting diagnostic accuracy measures of ultrasound in pediatric patients with nasal bone fractures. Data extraction and analysis were undertaken for the selected studies. Involving four studies with 277 patients, ultrasound demonstrated a pooled sensitivity of 66.1% (95% CI: 35.1-87.5%) and specificity of 86.8% (95% CI: 80.1-91.4%) in diagnosing pediatric nasal fractures. The area under the receiver operating characteristic curve (AUC) was 0.88 (95% CI: 0.72-0.93). After excluding an outlier study, sensitivity and specificity increased to 78.0% (95% CI: 65.6-86.9%) and 87.8 (95% CI: 78.1-93.6%), respectively, with an AUC of 0.79 (95% CI: 0.75-0.94). Pooled positive and negative likelihood ratios were 5.11 (95% CI: 2.12-9.15) and 0.40 (95% CI: 0.14-0.77) before exclusion and 6.75 (95% CI: 3.47-12.30) and 0.26 (95% CI: 0.15-0.40) after exclusion of an outlier study, respectively. This study highlighted ultrasonography's utility in diagnosing pediatric nasal bone fractures with high accuracy and specificity. However, caution is advised in relying solely on ultrasound due to suboptimal overall diagnostic performance, evident in likelihood ratios.

Outcome Evaluation of Using Bone-Cartilaginous Units to Correct Deviated Noses in Rhinoplasty

Background: Aesthetic and functional problems related to a deviated nose are challenging to correct with rhinoplasty. Objective: To compare the outcome of rhinoplasty using nasal septal bone-cartilaginous units (BCUs) as measured by pre- and postoperative patient-reported outcomes and photograph analysis. Methods: A retrospective chart review was conducted on rhinoplasty patients who had BCU placed between February 2018 and March 2021. Three-dimensional photographic measurements were assessed before and at least 1 year after surgery using Mirror software. Data on patient satisfaction were collected by the Nasal Obstruction Symptom Evaluation (NOSE) and the Rhinoplasty Outcomes Evaluation (ROE) questionnaires. Statistical analysis was completed with independent t-tests and Wilcoxon signed-rank test. Results: Twenty-eight patients were enrolled with a mean age of 34.52 ± 13.7 years (range 20-77 years) and mostly female (61%). The degree of nasal deviation (from 1/82° ± 1/52° to 0/13° ± 0/45°) and the width of the middle nasal third to palpebral fissure length (from 1/28° ± 0/18° to 1/19° ± 0/19°) significantly changed (p-value <0.001). NOSE and ROE scores also improved significantly postoperation (p-value <0.001). Conclusion: The bone-cartilaginous unit graft was effective in rhinoplasty for nasal deviations and may be considered an option.

Craniofacial Growth and Development: A Primer for the Facial Trauma Surgeon

Understanding craniofacial growth and development is important in the management of facial trauma in the growing pediatric patient. This manuscript is a review of craniofacial growth and development and clinical implications of pediatric facial fractures.

Subperichondrial Hematoma of Alar Cartilage: A Case Report

Introduction

Cartilage deformation may develop due to congenital and trauma-related hematomas. Early diagnosis and treatment are imperative to prevent aesthetic and functional complications related to alar cartilage hematomas.

Case Report

An 8-year-old male presented with a major alar cartilage hematoma with a nasal fracture as a result of trauma. The patient underwent surgery on the 1st day of trauma for alar cartilage hematoma drainage and nasal bone reduction. No functional or cosmetic complications were observed in the patient's postoperative 1st month.

Conclusion

Subperichondral hematomas of the alar cartilage are rarely observed after nasal trauma and early diagnosis and treatment are important to prevent possible complications.

Alar Cartilage Hematoma: Case Report and Literature Review

Nasal hematomas can occur after nasal trauma. It can involve the septal, alar, or all levels, with the septum being the most commonly affected site. We present a case of alar hematoma in a five-year-old boy after nasal trauma. The patient came to the emergency room complaining of nasal pain, epistaxis, and nasal deformity. A complete ear, nose, and throat examination was performed, and X-ray and computed tomography imaging of the facial bone were done to confirm the presence of a nasal alar hematoma. The alar hematoma was successfully treated via surgical evacuation. Alar cartilage hematoma is a rare entity that can lead to undesirable complications when missed.

Etiology, pattern, and treatment of nose fractures: A 10-year cross-sectional cohort retrospective study

Background

Determining the etiology, epidemiology, pattern, and treatment of nasal bone fractures and the associated soft tissue injuries in a population will be beneficial for the prevention, rapid and correct diagnosis, and adequate management of this pathology in order to minimize postoperative complications.

Patients and Methods

This study retrospectively evaluated the patients admitted and treated for nasal bone fractures in a university clinic of oral and maxillofacial surgery in Romania over a 10-year period. Following statistical analysis, evaluation and correlation of the monitored variables, a P value < 0.05 was considered statistically significant.

Results

Nasal bone fractures had the highest incidence among men (88.30%), aged 20-29 years (33.33%), with no education (33.33%), interpersonal violence being the main cause in this category of patients (P = 0.004; P = 0.005; P = 0.005). In urban environment (55.9%), nasal bone fractures through aggression and road traffic accidents were predominant, while in rural areas (44.10%), those caused by domestic accidents and animal attacks prevailed (P = 0.551). Nondisplaced (81.10%), closed (85.60%) and involving the nasal septum fractures (51.35%) were preponderant. Hematoma was the most frequent associated soft tissue injury (86.49%), its incidence being increased in the case of displaced (P = 1.000) and open fractures (P = 0.692). The most frequent treatment method was close nasal reduction (CNR) + closed septoplasty (51.35%). The most frequent complication was malunion (7.2%), secondary to CNR without septoplasty (P = 0.037).

Conclusions

The main etiology of nasal bone fractures was interpersonal violence, which mainly affected men, aged 20-39 years, with a low level of education, living in urban areas. Implementing laws to fight interpersonal aggression and increase the education level of the population would lead to a considerable reduction in the incidence of this pathology. Patients treated by CNR + closed septoplasty and ORIF had the best postoperative evolution. Immediate septoplasty in the case of associated septal fractures significantly decreased the rate of postoperative complications.

Nasal Septal Hematoma and Abscess in Children: An Uncommon Otorhinolaryngology Emergency Revisited

OBJECTIVE

To evaluate the demographic factors, trauma type, treatment, and long-term results in patients with nasal septal hematoma (NSH) and nasal septal abscess (NSA) in pediatric age group.

METHODS

Between the years 2006 and 2019, patients who received a diagnosis of NSA and NSH were included for the study. Demographic data, the surgical findings, and long-term follow-up results were recorded.

RESULTS

A total of 68 patients were identified. Forty-five patients were diagnosed as NSA and 23 patients were diagnosed with NSA. Mean age of the patients was 7.00 ± 3.33 years. Patients did not differ in terms of age, gender, and etiology. Mean duration of the symptoms was significantly high in NSA group (4.11 ± 4.00 days for NSH and 7.61 ± 7.71 days for NSA, P = 0.011). Associated nasal fracture was significantly high in NSH group. Previous nasal examination was significantly high in NSA group. Epistaxis was present significantly high in NSH group (P = 0.013). Fever and purulent nasal discharge was observed significantly high in NSA group. Forty-seven (n = 47) patients can be reevaluated for long-term deformity (NSH, n = 34 [72.34%] and NSA, n = 13 [27.65%]). Mean follow-up period of the patients was 8.7 years. In total, 61.7% of the patients experienced minor or major sequelae. Both NSA and NSH groups did not differ in terms of minor sequelae and major sequelae. No sequleae was significantly high in NSH group (for NSH n = 17/34-(50,0%); for NSA n = 1/13- (7,7%), p = 0.008). Both NSA and NSH groups did not differ in terms of no sequelae and minor sequelae.

CONCLUSION

The NSH and NSA are uncommon conditions that needed prompt diagnosis and intervention.