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Fracture of bone of nasal sinus — Clinical Guidelines

Overview

Nasal bone fractures are common facial injuries often resulting from trauma, frequently requiring prompt diagnosis and appropriate management to prevent complications such as deformity and functional impairment. 1 3

Diagnosis

Key Diagnostic Criteria: Presence of trauma history, physical examination findings (swelling, bruising, deformity), and imaging confirmation.

Recommended Tests:

- Computed Tomography (CT): Gold standard for detailed fracture assessment 2 10. - Ultrasonography: Emerging alternative with comparable sensitivity and specificity to CT, particularly useful in emergency settings 4 8.

Grading: Radiologic classification systems using CT axial views to determine fracture type and severity 9.

Management

First-Line Treatments:

- Closed Reduction: Standard approach for most fractures, often using metal reduction instruments 1 5. - Intra-nasal Packing: Post-reduction packing with materials like biodegradable synthetic polyurethane foam to stabilize the fracture site 6.

Adjunctive Treatments:

- AI-Based Diagnostic Algorithms: Utilize deep learning for rapid and accurate diagnosis from CT images 2. - Novel Devices: Balloon catheter dilation apparatus for depressed fractures to minimize iatrogenic injury 3. - Kirschner Wire and C-arm: For precise closed reduction of impacted fractures 7.

Special Populations

Pediatrics: Specific considerations for growth plate involvement and cosmetic outcomes may necessitate specialized imaging and conservative management approaches 1.

Elderly: Increased risk of comorbidities and fragility fractures; careful assessment and management to avoid complications 1.

Key Recommendations

Utilize computed tomography (CT) for definitive diagnosis and classification of nasal bone fractures to guide treatment (Evidence: Strong 1 2 10).

Employ closed reduction as the primary treatment method, supplemented with appropriate intra-nasal packing materials to ensure stability (Evidence: Moderate 1 5 6).

Consider ultrasonography as a rapid diagnostic tool in emergency settings when CT is not immediately available, given its comparable efficacy to CT (Evidence: Moderate 4 8).

For impacted fractures, utilize Kirschner wire guided by C-arm fluoroscopy to achieve accurate reduction (Evidence: Weak 7).

In cases of depressed fractures, explore the use of balloon catheter dilation apparatus to reduce iatrogenic injury during reduction (Evidence: Expert opinion 3).

References

1 Sun Y, Zhang L, Wang P, Zhang S, Xu C, Wu Q et al.. Study of 2,881 Nasal Bone Fractures using Multivariate Analysis. Alternative therapies in health and medicine 2024. link 2 Jeong Y, Jeong C, Sung KY, Moon G, Lim J. Development of AI-Based Diagnostic Algorithm for Nasal Bone Fracture Using Deep Learning. The Journal of craniofacial surgery 2024. link 3 Xue K, Liu K, Ge J, Qi L. A Novel Balloon Catheter Dilation Apparatus for the Treatment of Depressed Nasal Bone Fracture. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2023. link 4 Lee IS, Lee JH, Woo CK, Kim HJ, Sol YL, Song JW et al.. Ultrasonography in the diagnosis of nasal bone fractures: a comparison with conventional radiography and computed tomography. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2016. link 5 Kim JH, Lee JH, Hong SM, Park CH. Open reduction of nasal bone fractures through an intercartilaginous incision. Acta oto-laryngologica 2013. link 6 Moon SH, Baek SO, Jung SN, Seo BF, Lee DC, Kwon H. Efficacy of biodegradable synthetic polyurethane foam for packing nasal bone fractures. The Journal of craniofacial surgery 2012. link 7 Kang SJ, Kim JW. Proposed method for closed reduction of impacted nasal bone fractures using a Kirschner wire and a C-arm. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2012. link 8 Javadrashid R, Khatoonabad M, Shams N, Esmaeili F, Jabbari Khamnei H. Comparison of ultrasonography with computed tomography in the diagnosis of nasal bone fractures. Dento maxillo facial radiology 2011. link 9 Han DS, Han YS, Park JH. A new approach to the treatment of nasal bone fracture: radiologic classification of nasal bone fractures and its clinical application. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2011. link 10 Bremke M, Wiegand S, Sesterhenn AM, Eken M, Bien S, Werner JA. Digital volume tomography in the diagnosis of nasal bone fractures. Rhinology 2009. link 11 Motomura H, Muraoka M, Tetsuji MY, Ozawa MT, Nose MK. Changes in fresh nasal bone fractures with time on computed tomographic scans. Annals of plastic surgery 2001. link

Fracture of bone of nasal sinus