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Open fracture of nasal bones — Clinical Guidelines

Overview

Nasal bone fractures are common facial injuries, often resulting from trauma, particularly in adolescents and young adults. These fractures can vary significantly in severity and complexity, influencing treatment approaches and outcomes.

Diagnosis

Clinical Presentation: Typically involves deformity, pain, swelling, and sometimes epistaxis.

Radiographic Imaging: CT scans are recommended for detailed fracture pattern analysis 1 21.

Classification Systems: Various classifications exist, including topographic and computed tomography-based systems, aiding in prognosis and treatment planning 2.

Management

Closed Reduction: Preferred initial treatment for most nasal bone fractures, often performed under local or general anesthesia 8 25.

Surgical Navigation: Useful for precise reduction, especially in complex fractures 5 9.

Anesthesia Techniques: Local anesthesia is effective and well-tolerated 23 25. Intravenous sedation with local anesthesia can also be considered for patient comfort 26.

Fixation Methods: Bioabsorbable plates or interfragmentary wires for open fractures with lacerations 19. Fibrin glue may be used in severe comminuted fractures 16.

Post-Reduction Care: Nasal packing and monitoring for airway patency are crucial 10 18.

Special Populations

Pediatrics: Specialized techniques like the use of Walsham forceps or alternative methods such as the little finger for repositioning are recommended 13 20.

Elderly: Consideration of comorbidities and potential complications in airway management is essential 18.

Key Recommendations

Use CT Imaging for Detailed Assessment: Essential for accurate fracture classification and treatment planning (Evidence: Moderate 1 21).

Closed Reduction Under Local Anesthesia: Effective and well-tolerated for most nasal bone fractures (Evidence: Moderate 8 23 25).

Incorporate Surgical Navigation for Complex Fractures: Enhances precision in reduction procedures (Evidence: Weak 5 9).

Monitor Airway Patency Post-Reduction: Critical, especially in sports-related injuries (Evidence: Moderate 10 18).

Consider Bioabsorbable Fixation for Open Fractures: Provides stable fixation through open lacerations (Evidence: Weak 19).

References

1 Hwang K, Yoon JM. Analysis of Nasal Bone Fractures: A 17-year Study of 3785 Patients. The Journal of craniofacial surgery 2023. link 2 Aydin Savas S, Aydin IE. The effect of a new topographic classification on determining the prognosis of nasal fracture and treatment modality. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES 2023. link 3 Xiao CC, Kshirsagar RS, Hoerter JE, Rivero A. Sport and Recreational Causes of Nasal Bone Fractures. The Annals of otology, rhinology, and laryngology 2022. link 4 Byun IH, Lee WJ, Roh TS, Hong JW. Demographic Factors of Nasal Bone Fractures and Social Reflection. The Journal of craniofacial surgery 2020. link 5 Chung JH, Yeo HD, Yoon ES, Lee BI, Park SH. Comparison of the Outcomes of Closed Reduction Nasal Bone Fractures With a Surgical Navigation System. The Journal of craniofacial surgery 2020. link 6 Westfall E, Nelson B, Vernon D, Saltagi MZ, Mantravadi AV, Schmalbach C et al.. Nasal bone fractures and the use of radiographic imaging: An otolaryngologist perspective. American journal of otolaryngology 2019. link 7 Jeon M, Kim Y. Correlation Between the Existing Classifications of Nasal Bone Fractures and Subjective Patient Satisfaction. The Journal of craniofacial surgery 2018. link 8 Das TA, Aslam AS, Mangalath U, Abida R, Nair RB, Soman S. Evaluation of Treatment Outcome Following Closed Reduction of Nasal Bone Fractures. The journal of contemporary dental practice 2018. link 9 Kim ST, Jung JH, Kang IG. Is Surgical Navigation Useful During Closed Reduction of Nasal Bone Fractures?. The Journal of craniofacial surgery 2017. link 10 Patel Y, Goljan P, Pierce TP, Scillia A, Issa K, McInerney VK et al.. Management of Nasal Fractures in Sports. Sports medicine (Auckland, N.Z.) 2017. link 11 Lanigan A, Lospinoso J, Bowe SN, Laury AM. The Nasal Fracture Algorithm: A Case for Protocol-Driven Management to Optimize Care and Resident Work Hours. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2017. link 12 Ayatollahi V, Vafaiyan M, Hatami M, Behdad S. Two Different Concentrations of Ketofol for Procedural Sedation and Analgesia in Closed Reduction of Nasal Fracture. The Journal of craniofacial surgery 2016. link 13 Aldelaimi TN. New maneuver for fixation of pediatric nasal bone fracture. The Journal of craniofacial surgery 2011. link 14 Han DS, Han YS, Park JH. A new approach to the treatment of nasal bone fracture: the clinical usefulness of closed reduction using a C-arm. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2011. link 15 Rollin M, De Zoysa N, Mochloulis G. Manipulation of fractured nose using mallet and champagne cork. The Journal of laryngology and otology 2011. link 16 Jeong HS, Moon MS, Lee HK, Kim KS. Use of fibrin glue for open comminuted nasal bone fractures. The Journal of craniofacial surgery 2010. link 17 Park CH, Kwon TK, Lee JH, Hong SJ, Joung HH, Kim HS. Endoscopically assisted reduction of nasal bone fractures. Rhinology 2009. link 18 Chun KW, Han SK, Kim SB, Kim WK. Influence of nasal bone fracture and its reduction on the airway. Annals of plastic surgery 2009. link 19 Kim MG, Kim BK, Park JL, Minn KW, Baek RM, Han KN. The use of bioabsorbable plate fixation for nasal fractures under local anaesthesia through open lacerations. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2008. link 20 Ichida M, Komuro Y, Koizumi T, Shimizu A, Yanai A. A repositioning technique for nasal fracture using the little finger. The Journal of craniofacial surgery 2008. link 21 Hwang K, You SH, Kim SG, Lee SI. Analysis of nasal bone fractures; a six-year study of 503 patients. The Journal of craniofacial surgery 2006. link 22 Supriya M, Clement WA, Ahsan F, Cain AJ. Satisfaction with cosmesis following nasal manipulation: do previous fractures matter?. The Journal of laryngology and otology 2006. link 23 Walshe P, Harney M, McConn Walsh R, Walsh M. Manipulation of nasal bone fractures under local anaesthetic. Irish medical journal 2003. link 24 Won Kim S, Pio Hong J, Kee Min W, Wan Seo D, Kyu Chung Y. Accurate, firm stabilization using external pins: a proposal for closed reduction of unfavorable nasal bone fractures and their simple classification. Plastic and reconstructive surgery 2002. link 25 Green KM. Reduction of nasal fractures under local anaesthetic. Rhinology 2001. link 26 Newton CR, White PS. Nasal manipulation with intravenous sedation. Is it an acceptable and effective treatment?. Rhinology 1998. link

Open fracture of nasal bones