Trend analysis of nasal bone fracture

Surgical treatment of nasal fractures may benefit from intraoperative 3D imaging

This retrospective study aimed to assess the effects of the use of intraoperative three-dimensional (3D) imaging on outcomes in surgical treatment of nasal fractures. Furthermore, we investigated whether the use of intraoperative imaging improves outcomes and decreases the frequency of corrective surgeries compared to published literature. This retrospective descriptive study included patients who underwent operative treatment for nasal fractures with the use of intraoperative 3D imaging between January 2015 and January 2020 at a University Hospital. The primary outcome measure was patient satisfaction, which was assessed through patient charts about subjective esthetic problems and nasal obstruction. The secondary outcome measures were the number of intraoperative images and necessity of intra- and postoperative revisions. All the outcomes were evaluated using regression analysis. Of the 172 patients, secondary rhinoplasty and intraoperative revision were performed in 10 (6 %) and 93 (54 %) patients, respectively. Postoperatively, 19 (11 %) and 12 (7 %) patients complained of subjective esthetic problems and nasal obstruction, respectively. The intraoperative revision rate in patients undergoing surgical treatment of nasal fractures with intraoperative 3D imaging was >50 %. However, the incidence of postoperative secondary revision, nasal obstruction, and subjective esthetic problems was lower than that reported in the literature not having an intraoperative imaging. Our findings suggest that prompt quality control of the operative result enables immediate correction and prevents postoperative revision.

Establishment of a Finite Element Model of Normal Nasal Bone and Analysis of Its Biomechanical Characteristics

Nasal bone is a long, paired series of small bones, which is narrow at the top and broad at the bottom, that forms the base of the nasal dorsum. Together with the nasal part of the frontal bone, the frontal process of the maxilla and the middle plate of the ethmoid bone constitute the bone scaffold of the external nose. In this paper, the DICOM image data file was imported into the Mimics software for 3D reconstruction. At the same time, the Geomagic software was used for relevant image processing, and the finite element software ANSYS was used to establish a finite element model to analyze the stress characteristics of the nasomaxillary complex. Results. The maximum principal stress and maximum strain force at the lower segment of nasal bone and the junction of nasal bone and maxilla were relatively large. When the same external force acts on the lower segment of the nasal bone and the angle is 0° (sagittal force), the maximum principal stress and maximum strain force are the smallest. When the angle continues to increase, the maximum principal stress and maximum strain force continue to increase.

Efficacy of closed reduction of nasal fractures-a retrospective analysis with focus on factors affecting functional and aesthetic outcomes

BACKGROUND

Nasal bone fractures are the most common type of facial bone fractures. While the nasal anatomy and closed reduction techniques of nasal fractures are well described, there is a paucity of data reporting on the need for revision rhinoplasty. The objective of this study is to analyze the factors affecting the outcome and need for revision rhinoplasty in patients who underwent closed reduction for nasal bone fracture.

METHODS

From 2010 to 2020, a total of 417 consecutive patients underwent closed nasal reduction. Medical files of the patients were reviewed retrospectively. The rate of rhinoplasty after fracture consolidation was determined. Factors influencing the need for revision rhinoplasty were assessed using univariable and multivariable logistic regression analyses.

RESULTS

Forty-seven patients (11.3%) required revision rhinoplasty after fracture healing. Patients who had suffered an additional septum fracture were more likely to undergo rhinoplasty. The risk of the need for open revision rhinoplasty after fracture healing was increased for patients complaining of airway obstruction at the time of cast removal after closed reduction.

CONCLUSION

A certain number of patients will require secondary revision rhinoplasty after closed reduction of a nasal fracture. Subjective airway obstruction at the time of cast removal after closed reduction is a predictor for revision rhinoplasty. Prospective studies are required to support the findings of this investigation.

Assessment of artificial intelligence-aided reading in the detection of nasal bone fractures

BACKGROUND: Artificial intelligence (AI) technology is a promising diagnostic adjunct in fracture detection. However, few studies describe the improvement of clinicians’ diagnostic accuracy for nasal bone fractures with the aid of AI technology. OBJECTIVE: This study aims to determine the value of the AI model in improving the diagnostic accuracy for nasal bone fractures compared with manual reading. METHODS: A total of 252 consecutive patients who had undergone facial computed tomography (CT) between January 2020 and January 2021 were enrolled in this study. The presence or absence of a nasal bone fracture was determined by two experienced radiologists. An AI algorithm based on the deep-learning algorithm was engineered, trained and validated to detect fractures on CT images. Twenty readers with various experience were invited to read CT images with or without AI. The accuracy, sensitivity and specificity with the aid of the AI model were calculated by the readers. RESULTS: The deep-learning AI model had 84.78% sensitivity, 86.67% specificity, 0.857 area under the curve (AUC) and a 0.714 Youden index in identifying nasal bone fractures. For all readers, regardless of experience, AI-aided reading had higher sensitivity ([94.00 ± 3.17]% vs [83.52 ± 10.16]%, P< 0.001), specificity ([89.75 ± 6.15]% vs [77.55 ± 11.38]%, P< 0.001) and AUC (0.92 ± 0.04 vs 0.81 ± 0.10, P< 0.001) compared with reading without AI. With the aid of AI, the sensitivity, specificity and AUC were significantly improved in readers with 1–5 years or 6–10 years of experience (all P< 0.05, Table 4). For readers with 11–15 years of experience, no evidence suggested that AI could improve sensitivity and AUC (P= 0.124 and 0.152, respectively). CONCLUSION: The AI model might aid less experienced physicians and radiologists in improving their diagnostic performance for the localisation of nasal bone fractures on CT images.

Epidemiology and patterns of nasal bone fracture in elderly patients in comparison to other age groups: an 8-year single-center retrospective analysis

Background: Nasal bone fractures are the most common type of facial bone fracture, but are under-studied in adults above 65 years of age. Therefore, we investigated the epidemiology and patterns of nasal bone fractures among older adults in comparison to different age groups.Methods: This retrospective study included 2,321 nasal bone fracture patients who underwent surgery at our hospital from January 2010 to December 2017. The patients were classified by age as preschoolers, school-age children, young and middle-aged adults, and the elderly. We performed pairwise comparisons between elderly patients and each other age group in terms of sex, cause of injury, and fracture type.Results: The 2,321 nasal bone fracture patients included 76 elderly patients (50 men [65.8%] and 26 women [34.2%]). In these patients, the two most common injury causes were falling or slipping down (n = 39; 51.3%) and road traffic accidents (n = 19; 25.0%). According to the Stranc and Robertson classification, the most common force vector was lateral, and plane 2 fractures with lateral forces predominated.Conclusion: The elderly showed similar patterns of nasal bone fractures to those observed in young and middle-aged adults, but significant differences from preschoolers (in the injury vector and plane of fracture) and from school-age children (in the sex ratio and plane of fracture). However, elderly patients presented significantly different epidemiological characteristics compared to the other three groups. Therefore, it is necessary to improve the quality of life of the elderly and prepare for the upcoming super-aged society by taking steps to reduce the incidence and severity of fractures. Possible options for doing so include strengthening individual-level safety factors and expanding the social safety net for the elderly.

Antibiotic use in nasal bone fracture: a single-center retrospective study

Background

Prophylactic antibiotics are used to prevent surgical wound infection; however, proper indications must be followed with careful consideration of the risks and benefits, especially in clean or clean-contaminated wounds. Nasal bone fractures are the most common type of facial bone fracture. The most common method for treating nasal bone fracture is closed reduction, which is performed inside the nasal cavity without an incision. The purpose of this study was to determine the need for antibiotic use in the closed reduction of nasal bone fractures.

Methods

A retrospective study was conducted using data from the National Insurance Service Ilsan Hospital of the Republic of Korea between 2016 and 2018. The records of patients who underwent closed reduction of nasal bone fracture were reviewed and classified according to sex, age, comorbidities, perioperative antibiotic usage, postoperative complications, nasal packing, anesthesia type, surgeon’s specialty, and operation time.

Results

Among the 373 patients studied, the antibiotic prescription rate was 67.3%. Just 0.8% of patients were prescribed preoperative antibiotics only, 44.0% were prescribed postoperative antibiotics only, and 22.5% were prescribed both preoperative and postoperative antibiotics. There were no cases that satisfied the definition of “surgical site infection.” Furthermore, 2.1% of infection-related complications (e.g., mucosal swelling, synechia, and anosmia) occurred only in the antibiotic usage group. The use of nasal packing, anesthesia type, and surgeon’s specialty did not show any difference in infection-related complication rates.

Conclusion

According to the study findings, the routine use of perioperative antibiotics is not recommended in uncomplicated nasal bone fracture surgery.

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.

Sport and Recreational Causes of Nasal Bone Fractures

OBJECTIVE

Nasal bone fractures are the most common facial bone fractures. However, there is limited literature on the etiology of these fractures, particularly distribution across sports and other recreational activities.

METHODS

The Nationwide Electronic Injury Surveillance System (NEISS) national injury database was queried for emergency department visits involving the diagnosis of nasal or nose fractures associated with sports and recreation activities over the most recent 10 year span available. Demographic, disposition, and weighted incidence were analyzed.

RESULTS

Total incidence of nasal fractures across 10 years was 158 979. The mean age of nasal bone fractures was 20.4 years old. Nasal fractures were more common in males (74.6%) and white patients (54.1%). National estimated incidence of nasal fractures decreased from 21 028 in 2009 to 11 108 in 2018, a reduction of 47.2%. The most common causes among all patients were basketball (23.2%), baseball (17.1%), softball (9.8%), soccer (7.4%), and football (7%). In pediatric patients, the most common cause was baseball (25.1%). The majority (98.1%) of patients were discharged from the emergency department, while 0.9% of patients were admitted.

CONCLUSION

The most common recreational causes of nasal fractures are sports, with the most common being non-contact sports like basketball and baseball. However, the incidence of nasal bone fractures due to recreational causes nationwide has decreased significantly over the past 10 years. This may reflect improved safety protocols among athletes.

Trudności opiniodawcze związane z ciężkimi obrażeniami części twarzowej i mózgowej czaszki powstałymi w wyniku uderzenia pięścią

Cel pracy: Porównanie charakteru obrażeń części twarzowej i mózgowej czaszki skutkujących zgonem lub ciężkim uszczerbkiem na zdrowiu, powstałych w wyniku uderzania pięścią w część twarzową czaszki. Ocena i konfrontacja obu grup w zakresie ostatecznej prawno-karnej kwalifikacji czynu. Analiza uzasadnień wyroków sądów pod kątem strony podmiotowej czynu zabronionego. Próba zweryfikowania hipotezy zakładającej możliwość spowodowania zgonu albo ciężkiego uszczerbku na zdrowiu przez jedno uderzenie pięścią w część twarzową czaszki. Materiał i metody: Prawomocne orzeczenia Wydziałów Karnych Sądów Powszechnych dotyczące sytuacji, w których przyczynę zgonu lub ciężkiego uszczerbku na zdrowiu stanowiły obrażenia części twarzowej i mózgowej czaszki powstałe wyłącznie od uderzania pięścią w część twarzową czaszki. Ocena poszczególnych przypadków w obrębie każdej z grup pod kątem podobieństw i różnic. Analiza porównawcza obu grup. Wyniki: W przypadkach obrażeń części twarzowej czaszki przyczynę zgonu stanowiło uduszenie gwałtowne w przebiegu aspiracji krwi do dróg oddechowych, jednak prawno-karna kwalifikacja działania sprawców w tych przypadkach była zróżnicowana. W jednej sytuacji śmierć była wynikiem obrażeń części mózgowej czaszki, które niezwykle rzadko występują jako następstwo uderzenia pięścią w część twarzową czaszki. Ciężki uszczerbek na zdrowiu spowodowany był utratą widzenia w oku, zwykle wskutek pęknięcia gałki ocznej. Wnioski: Pomimo zbliżonych okoliczności urazu inny mechanizm odpowiadał za doprowadzenie do zgonu, a inny za spowodowanie ciężkiego uszczerbku na zdrowiu. Za spowodowanie najpoważniejszych skutków (śmierć i ciężki uszczerbek na zdrowiu) w ani jednym przypadku nie odpowiadało takie samo obrażenie. Jedno uderzenie pięścią w część twarzową czaszki może doprowadzić zarówno do śmierci, jak i do ciężkiego uszczerbku na zdrowiu. Prawno-karna ocena uderzania pięścią w twarz może być bardzo zróżnicowana. Opinion-related difficulties related to severe injuries of the facial and cerebral parts of the skull resulting from punching Aim: Comparison of injuries to the facial and cerebral parts of the skull causing death and grievous bodily harm, resulting solely from punches to the facial area of the skull. Assessment and confrontation of both groups in terms of the final criminal-legal classification of the perpetrator’s acts. Review of reasons for court judgements with a focus on the subjective elements of the prohibited act. Attempt to verify the hypothesis assuming that death or grievous bodily harm can be caused by a single punch to the facial part of the skull. Material and methods: Final judgements passed by criminal divisions of common courts of law in cases where death or grievous bodily harm was caused by injuries to the facial and cerebral parts of the skull resulting solely from punches to the facial area of the skull. Assessment of individual cases within each group to determine similarities and differences. Comparative analysis of both groups. Results: The cause of death in cases involving injuries to the facial part of the skull was rapid suffocation following blood aspiration into the respiratory tract. However, the criminal-legal classification of the perpetrators’ actions in these cases was varied. In one case, death resulted from injuries to the cerebral part of the skull, which are extremely rare as a result of a punch to the facial area within the skull. Grievous bodily harm was due to the loss of vision in the eye, typically due to eyeball rupture. Conclusions: Even though the circumstances of the injuries were similar, different mechanisms were responsible for causing death and grievous bodily harm in the victims. The most severe consequences (death and grievous bodily harm) were not caused by injuries of the same type in any of the cases studied. A single punch to the facial part of the skull may be enough to lead to either grievous bodily harm or death, but the criminal-legal assessment of punching to the face can vary greatly.

Quality of life of patients with nasal bone fracture after closed reduction

Background

Closed reduction is the standard treatment for nasal bone fractures, which are the most common type of facial bone fractures. We investigated the effect of closed reduction on quality of life.

Methods

The 15-dimensional health-related quality of life survey was administered to 120 patients who underwent closed reduction under general anesthesia for nasal bone fractures from February 2018 to December 2019, on both the day after surgery and 3 months after surgery. Three months postoperatively, the presence or absence of five nasal symptoms (nose obstruction, snoring, pain, nasal secretions, and aesthetic dissatisfaction) was also evaluated.

Results

The quality of life items that showed significant changes between immediately after surgery and 3 months postoperatively were breathing, sleeping, speech, excretion, and discomfort. Low scores were found at 3 months for breathing, sleeping, and distress. There were 31 patients (25.83%) with nose obstruction, 25 (20.83%) with snoring, 12 (10.00%), with pain, 11 (9.17%) with nasal secretions, and 29 (24.17%) with aesthetic dissatisfaction.

Conclusion

Closed reduction affected patients’ quality of life, although most aspects improved significantly after 3 months. However, it was not possible to rule out deterioration of quality of life due to complications and dissatisfaction after surgery.

Big Data Statistical Analysis of Facial Fractures in Korea

BACKGROUND

The big data provided by Health Insurance Review and Assessment (HIRA) contains data from nearly all Korean populations enrolled in the National Health Insurance Service. We aimed to identify the incidence of facial fractures and its trends in Korea using this big data from HIRA.

METHODS

We used the Korean Standard Classification of Disease and Cause of Death 6, 7 for diagnosis codes. A total of 582,318 patients were included in the final analysis. All statistical analyses were performed using SAS software and SPSS software.

RESULTS

The incidence of facial fractures consistently declined, from 107,695 cases in 2011 to 87,306 cases in 2016. The incidence of facial fractures was the highest in June 2011 (n = 26,423) and lowest in January 2014 (n = 10,282). Nasal bone fractures were the most common, followed by orbit and frontal sinus fractures. The percentage of nasal bone fractures declined, whereas those of orbital fractures increased from 2011 to 2016 (P < 0.001). Among orbital fractures, inferior wall fractures were the most common, followed by medial wall fractures. Among mandibular fractures, angle fractures were the most common, followed by condylar process and symphysis fractures. Although it was difficult to predict the most common type of zygomatic and maxilla fractures, their incidence consistently declined since 2011.

CONCLUSION

We observed trends in facial fractures in Korea using big data including information for nearly all nations in Korea. Therefore, it is possible to predict the incidence of facial fractures. This study is meaningful in that it is the first study that investigated the incidence of facial fractures by specific type.