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Abstract Background This meta-analysis aimed to perform a head-to-head comparison of the role of general anesthesia (GA) and local anesthesia (LA) in the management of patients with nasal bone fractures (NBFs). Methods PubMed, Embase, and Web of Science were comprehensively searched. Studies investigating the clinical outcomes of GA and LA in the management of NBFs were included. Pooled odds ratios (OR) with the respective 95% confidence intervals (CIs) were calculated. Heterogeneity between the included studies was evaluated. The risk of bias in the included studies was assessed. Results Eight studies were included in this meta-analysis. The pooled ORs for cosmetic results, residual septal deformity, the need for further surgery, patients’ satisfaction with the anesthesia procedure, and patients’ satisfaction with the surgery results were 0.70 (95% CI 0.18, 2.64; z = − 0.53, p = 0.5957), 1.11 (95% CI 0.37, 3.30; z = 0.18, p = 0.8558), 1.19 (95% CI 0.65, 2.20; z = 0.56, p = 0.5760), 1.57 (95% CI 0.92, 2.69; z = 1.65, p = 0.0982), and 1.00 (95% CI 0.55, 1.80; z = − 0.00, p = 0.9974). Conclusions Insignificant difference on clinical outcomes was observed between GA and LA in the manipulation of patients with NBFs, and the choice of anesthetic approach should be based on the tolerability of the methods and the severity of nasal fractures.

Background: This meta-analysis aimed to perform a head-to-head comparison of the role of general anesthesia (GA) and local anesthesia (LA) in the management of patients with nasal bone fractures (NBFs). Methods: PubMed, Embase, and Web of Science were comprehensively searched. Studies investigating the clinical outcomes of GA and LA in the management of NBFs were included. Pooled odds ratios (OR) with the respective 95% confidence intervals (CIs) were calculated. Heterogeneity between the included studies was evaluated. The risk of bias in the included studies was assessed. Results: Eight studies were included in this meta-analysis. The pooled ORs for cosmetic results, residual septal deformity, the need for further surgery, patients' satisfaction with the anesthesia procedure, and patients' satisfaction with the surgery results were 0.70 (95% CI 0.18, 2.64; z = − 0.53, p = 0.5957), 1.11 (95% CI 0.37, 3.30; z = 0.18, p = 0.8558), 1.19 (95% CI 0.65, 2.20; z = 0.56, p = 0.5760), 1.57 (95% CI 0.92, 2.69; z = 1.65, p = 0.0982), and 1.00 (95% CI 0.55, 1.80; z = − 0.00, p = 0.9974). Conclusions: Insignificant difference on clinical outcomes was observed between GA and LA in the manipulation of patients with NBFs, and the choice of anesthetic approach should be based on the tolerability of the methods and the severity of nasal fractures. [ABSTRACT FROM AUTHOR]

Nasal bone fractures are the most common fractures of the facial skeleton and are often accompanied by bony, cartilaginous, and soft tissue injuries. These injuries are often complex, and when untreated or inadequately treated, can lead to posttraumatic nasal deformity. The most common deformities are the crooked nose and the saddle nose. Both deformities may result in significant cosmetic and functional concerns. The treatment of these deformities can be complex, requiring careful evaluation of the nose and thoughtful planning to correct the cosmetic deformity and restore functional integrity. The rhinoplasty surgeon will benefit from having a large repertoire of techniques to achieve these repairs. In this article, we discuss the options and concepts for the management of nasal bone fractures as well as complicated posttraumatic nasal deformity. Level of evidence is not available. [ABSTRACT FROM AUTHOR]

Given the demands of a busy high-volume trauma center, trauma radiologists are expected to evaluate an enormous number of images covering a multitude of facial bones in a short period of time in severely traumatized patients. Therefore, a comprehensive checklist, search pattern, and practical approach become indispensable for evaluation. Moreover, fracture complex classification conveys abundant information in a succinct shorthand fashion, which can be a large asset in a busy high-volume trauma center: reliably helping clinicians communicate urgent findings, make early treatment decisions, and effectively plan surgical approaches. Traditionally, radiologists' approach the CT axial dataset in top-down fashion: navigating their descent craniocaudal. However, a bottom-up approach may be advantageous, especially when it comes to facial fracture complex classification. Four key anatomic landmarks of the face, when evaluated sequentially in bottom-up fashion, are favorable to rapid single-sweep facial fracture characterization: the mandible, the pterygoid plates, the zygoma, and the bony orbits. That is, when done in succession: 1. Clearing the mandible rules out a panfacial smash fracture. 2. Clearing the pterygoid plates effectively rules out a Le Fort I, II, and III fracture. 3. Clearing the zygoma effectively rules out a zygomaticomaxillary complex (ZMC) type fracture. 4. Clearing the bony orbits effectively rules out a naso-orbital-ethmoid (NOE) fracture. Following this process of exclusion and elimination; as one ascends through the face, fracture characterization becomes more manageable and straightforward. Besides identifying all of the fractures and using the appropriate classification system, the radiologist also needs to recognize key clinically relevant soft tissue injuries that may be associated with facial fractures and thus should address these in the report. • Clearing the mandible rules out a Panfacial Smash type fracture. • Clearing the pterygoid plates effectively rules out a Le Fort type fracture. • Clearing the zygoma effectively rules out a Z.M.C. type fracture. • Clearing the bony orbits effectively rules out N.O.E. type fracture. [ABSTRACT FROM AUTHOR]

Maxillofacial injuries in general occur quite commonly following trauma and these injuries if not properly managed can negatively influence both the psychosocial and functional activities of the patient. This is as a result of the centrality of the facial region as a key factor in human identity, aesthetics, and general well-being. Fractures involving the facial skeleton may be isolated or complex. High velocity trauma is usually seen in urban and semi-urban areas while low velocity trauma is the common setting in rural areas. The pattern of faciomaxillary fractures vary with geographical area, socioeconomic condition, enforcements of law and order of a country. Trauma to the faciomaxillary region mandates special attention as important sensory systems are contained within the face (e.g. vision, auditory, somatic sensation, gustatory, olfaction and vestibular), also, vital structures in the head and neck region are intimately associated (airway, blood vessels, nerves and gastrointestinal tracts. It should be noted that the treatment outcome of maxillofacial fractures is mainly dependent among other things on the degree of injury, type of fracture, the expertise of the surgeon, and available technology. The aim of this study is to find out the incidence of faciomaxillary injuries resulting from various etiological factor Classification of facial bone fractures; Diagnosis and different treatment modalities. This is a prospective cross sectional study comprising of 75 patients who were having different faciomaxillary fractures and visited to L.G. hospital from December 2020 to April 2022. Patients were evaluated thoroughly by history taking, proper examination and routine investigations. In general examination consciousness, orientation to time, place and person, neck movements, and general mobility of the patients were checked. In local examination- facial oedema, facial asymmetry, skin lacerations, deep cuts, decreased mouth opening, improper teeth occlusion, teeth loss, nasal bleeding, black eye, eyeball movements and redness of eyes were checked. In specialized radiological investigations x- rays, 2D & 3D Computed Tomography (CT) of Facial bones were done in all cases. CT Brain and CT Cervical spine were done in patients if needed. From our study, it seems reasonable to assume that road traffic accident remains the leading cause of faciomaxillary fractures and is closely followed by fall especially among men in their productive years. It is necessary to diagnose faciomaxillary fracture at the earliest to prevent the complications of fractures such as infection and malocclusion, for that thorough clinical examination and radiological investigations are very important. 3D CT face is the gold standard investigation in case of different faciomaxillary fractures. In isolated fractures nasal bone fractures remains the most affected bone of the facial skeleton followed by mandible. Among the different sites of mandibular fractures body of the mandible is the most common site for mandibular fractures. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective To summarize the epidemiology and clinical characteristics of nasal bone fracture in children in order to provide clinical basis for the prevention and treatment of nasal bone fracture. Methods The clinical data of children with nasal trauma admitted to our department in recent 5 years were analyzed retrospectively. They were divided into four groups according to age, growth, development, and behavioral ability. All cases underwent nasal bone closed reduction under general anesthesia. Statistical analysis was performed with SPSS 25.0. Results The incidence of nasal bone fracture was the most in school-age group, and the difference was statistically significant (χ² =103.5, P<0.01). Fall was the most common cause of nasal fracture in children. The proportion of unilateral fracture (79.91%) was much higher than either bilateral fracture (13.08%) or traumatic nasal septum deviation (7.01%). There was no significant difference between the satisfaction of postoperative nasal packing and unpacking (P>0.05). Conclusions Parents should strengthen care of children, especially of school-age children to prevent the nasal bone fracture. Nasal unpacking was prefer to for patients with no active bleeding in the nasal cavity after closed reduction in order to improve the comfort. [ABSTRACT FROM AUTHOR]

Facial bone fractures must be diagnosed and treated as early as possible to avoid complications and sequelae. CT images need to be analyzed to detect fractures, but the analysis is time-consuming, and enough specialists are not available to analyze them. Many classification and object detection studies are being conducted to address these issues. The ability of classification-based studies to pinpoint the exact location of fractures is limited. Object detection-based research, by contrast, is problematic because the shape of a fracture is ambiguous. We propose a computer-aided facial bone fracture diagnosis (CA-FBFD) system to address the aforementioned challenges. This system adopts the object detection model YoloX-S, which is trained using only IoU Loss for box prediction, along with CT image Mixup data augmentation. For training, we used only nasal bone fracture data, whereas for testing, we used several other facial fracture data. During evaluation, the CA-FBFD system achieved an average precision of 69.8% for facial fractures, which is better than the baseline YoloX-S model by a large margin of 10.2%. In addition, the CA-FBFD system achieved a sensitivity/person of 100% for facial fractures, which is considerably better than that exhibited by the baseline YoloX-S model by a margin of 66.7%. Therefore, the CA-FBFD system can effectively minimize the labor of doctors who need to determine facial bone fractures in facial CT.

In treating a nasal bone, an incomplete nasal bone reduction can result in nasal deformity, both aesthetic and functional, requiring a secondary operation. A 60-year-old female with a traumatic comminuted nasal bone fracture with septal fracture was initially treated with closed reduction, which later resulted in a saddle nose and a completely occluded nasal cavity. Later, the patient underwent a revision operation of extracorporeal septorhinoplasty with rib cartilage graft, and the postoperative course was uneventful. Herein, we present a case of complications occurring after inadequate treatment of septal fracture. Physicians should thoroughly evaluate the extent of the nasal bone fracture, including the integrity of the nasal septum, and manage accordingly.

Introduction ENTUK guidelines recommend that manipulation of nasal bones (MNB) should be performed within 14 days of injury. However, evidence suggests treatment under general anaesthetic remains effective up to 5 weeks after injury. With the SARS-CoV-2 pandemic leading to delays in referral and limited access to theatre, local practice changed to offer delayed MNB under local anaesthetic. This prospective study assesses the effectiveness of MNB delayed until 3 weeks or later from time of injury when performed mostly under local anaesthetic. Methods Data was prospectively collected between April and November 2020. All patients referred to ENT with a new nasal bone deformity presenting more than 21 days after injury were included. Demographic information, injury details and patient satisfaction was recorded for each patient. Results 11 patients were included. Average age was 32.6 years (Range 8-65 years). 10 procedures (91%) were performed under local anaesthetic, with 1 (9%) performed under general anaesthetic. 9 patients (82%) gained complete reduction of the deformity, and 1 patient (9%) gaining partial reduction. 10 patients (91%) patients were satisfied with the cosmetic outcome. Conclusion This study supports the small volume of recent literature showing that delayed manipulation of nasal bones is effective and additionally demonstrates that efficacy is maintained when performed under local anaesthetic. [ABSTRACT FROM AUTHOR]

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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. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the identification of nasal bone fractures and their clinical diagnostic significance for three-dimensional (3D) reconstruction of maxillofacial computed tomography (CT) images by applying artificial intelligence (AI) with deep learning (DL)., Methods: CT maxillofacial 3D reconstruction images of 39 patients with normal nasal bone and 43 patients with nasal bone fracture were retrospectively analysed, and a total of 247 images were obtained in three directions: the orthostatic, left lateral and right lateral positions. The CT scan images of all patients were reviewed by two senior specialists to confirm the presence or absence of nasal fractures. Binary classification prediction was performed using the YOLOX detection model + GhostNetv2 classification model with a DL algorithm. Accuracy, sensitivity, and specificity were used to evaluate the efficacy of the AI model. Manual independent review, and AI model-assisted manual independent review were used to identify nasal fractures., Results: Compared with those of manual independent detection, the accuracy, sensitivity, and specificity of AI-assisted film reading improved between junior and senior physicians. The differences were statistically significant ( P <0.05), and all were higher than manual independent detection., Conclusions: Based on deep learning methods, an artificial intelligence model can be used to assist in the diagnosis of nasal bone fractures, which helps to promote the practical clinical application of deep learning methods., Competing Interests: None., (IJBT Copyright © 2024.)

Abstract Background The nasal bone is the most protruding bony structure of the facial bones. Nasal bone fracture is the most common facial bone fracture. The high rate of incidence of nasal bone fracture emphasizes the need for systematical investigation of epidemiology, surgical techniques, and complications after surgery. The objective of this study is to investigate the current trends in the treatment of nasal bone fractures and the effectiveness of closed reduction depending on the severity of the nasal bone fracture. Patients and methods A total of 179 patients with a nasal bone fracture from 2009 to 2017 were enrolled. Their clinical examination, patient’s records, and radiographic images of nasal bone fractures were evaluated. Results Patients ranged from children to elderly. There were 156 (87.2%) males and 23 (12.8%) females. Traffic accident (36.9%) was the most common cause of nasal fracture. Orbit fracture (44 patients, 24.6%) was the most common fracture associated with a nasal bone fracture. Complications after surgery included postoperative deformity in 20 (11.2%) patients, nasal obstruction in 11 (6.1%) patients, and olfactory disturbances in 2 (1.1%) patients and patients with more severe nasal bone fractures had higher rates of these complications. Conclusion Closed reduction could be performed successfully within 2 weeks after injury.

Abstract Background Nasal bone fracture is the most common type of facial fracture, and the high incidence of severe emergence agitation occurring after closed reduction of the nasal bone fracture can be challenging to manage. The purpose of this trial was to evaluate whether pre-operative administration of dexmedetomidine is effective in reducing the incidence and severity of emergence agitation in adults undergoing closed reduction of nasal bone fractures. Methods In this randomized controlled trial, 90 patients who were scheduled to undergo closed reduction of a nasal bone fracture were prospectively included and were randomly assigned to either the control group (n = 45; 0.9% saline infusion) or the dexmedetomidine group (n = 45; 1 μ/kg over 10 min, pre-operatively). The primary endpoint was Aono’s four-point scale scores after anesthesia. The recovery time and numeric rating scale score were assessed as secondary endpoints. Results Aono’s four-point scale scores were lower in the dexmedetomidine group than in the control group (median: 1 [1] vs. 1 [1, 2], 95% confidence interval of difference: 0.01 to 0.02, P = 0.02). The number, severity, and duration of agitation episodes were significantly lower in the dexmedetomidine group than in the control group. Furthermore, the number of patients exhibiting intraoperative movement was lower in the dexmedetomidine group. Conclusions Pre-operative administration of dexmedetomidine demonstrated several significant benefits, such as a lower incidence of emergence agitation, reduced agitation severity, and a shorter duration of agitation. Additionally, we observed more stable maintenance of intraoperative anesthesia with less movement during the surgery. Trial registration Identifier: KCT0000585 (registration date: 12–19- 2012).

Introduction: Nasal bone fracture occurs due to its vulnerable position and reduced biomechanical resistance to traumas. If not timely treated, it can result in permanent functional and esthetic damage. Methods: A retrospective and cross-sectional study conducted on 91 patients above 17 years of age with nasal bone fractures in the Department of Otorhinolaryngology and Head and Neck surgery of a tertiary care hospital in Kavre. Results: Road traffic accident was the most common cause of fracture (45.1%) followed by fall (36.3%), violence (13.2%), sports-related accidents (4.4%) and occupational accidents (1.1%). Class I fracture was seen in 70 (76.9%), Class II in 17 (18.7%), and Class III in 4 (4.4%). A closed reduction procedure was performed in 74 (81.30%) of the cases, closed reduction with septoplasty was done in 10 (11%), closed reduction with augmentation rhinoplasty was performed for 3 (3.3%), closed reduction with inferior turbinoplasty was required in 3 (3.3%) whereas closed reduction with debridement was done in 1(1.1%). Conclusion: Nasal bone fracture is a complex clinical issue which needs to be addressed early. Violence prevention programs along with drinking and driving campaigns need to be more strengthened to decrease the alarmingly high frequency of nasal bone fracture in the current scenario.

Introduction Fracture of nasal bone, the commonest facial fracture is frequently encountered in ENT practice. This study was conducted to assess the causes, presentation and management of fracture nasal bone in a tertiary care center. Methods A retrospective chart review was done of patients admitted from August 2017 to July 2019 for management of isolated nasal bone fracture in the department of ENT and Head and Neck Surgery, Tribhuvan University Teaching Hospital. Results Thirty-five patients (31 males and 4 females) of 13 to 86 years (mean age 26 years) underwent closed reduction of fracture nasal bone. The injury was sustained following physical assault in 13/35 (37%), fall from height in 10/35 (29%), road traffic accident in 8/35 (23%) and sports injury in 4/35 (11%). Pain, epistaxis, swelling over nasal dorsum, nasal deformity and wound were the presenting symptoms which most often occurred in combination. Close reduction was done under local anesthesia in 28/35 (80 %) and under general anesthesia in 7/35 (20%). The time between trauma and closed reduction ranged from 1 to 16 days with a mean of 6.2 days. Conclusion Nasal bone fracture needing reduction was common following physical assault in males predominently of 21 to 30 years. A combination of pain, epistaxis and nasal deformity was the commonest presentation. Closed reduction of fracture under local anesthesia within 16 days of trauma was the usual practice. [ABSTRACT FROM AUTHOR]

Background: There are no studies about the treatment of nasal bone fractures in patients with dorsal augmentations using silicone implants. We aimed to describe the characteristics of nasal bone fracture in patients who underwent rhinoplasty and compare the difference between closed reduction and conservative treatment of nasal bone fractures in patients with a history of rhinoplasty. Methods: Between January 2013 and June 2018, a total of 463 patients were admitted to our center for nasal bone fracture; 17 patients with nasal bone fractures who underwent rhinoplasty were included, of which, five underwent closed reduction in the nasal bone and 12 underwent conservative treatment. Three of 12 patients who were initially treated conservatively underwent a secondary rhinoplasty for esthetic improvements. All patients were classified according to fracture site and the presence of a nasal septal fracture—in accordance with the modified Murray classification—and were analyzed for the correlation between fracture type and disease course. Results: The nasal bone fracture types per computed tomography findings were unilateral (n = 13), bilateral (n = 4), septal (n = 1), and M-type (n = 1). No significant differences in fracture site (P > 0.05) and the presence of a nasal septal fracture (P > 0.05) were found between the groups. Fracture type did not significantly differ among patients who underwent closed reduction, conservative treatment without secondary rhinoplasty, and secondary rhinoplasty (P > 0.05). Conclusions: Despite risking traumatic capsular rupture, implant removal is seldom required and closed reduction is recommended if visible deviations are present; otherwise, only conservative treatment is recommended. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To determine outcomes of patients with displaced nasal bone fractures after closed nasal reduction (CNR).Study Design: Retrospective patient review.Methods: Review of all patients presenting to the emergency department of a tertiary-care, level 1 trauma hospital with a nasal bone fracture over a 2-year period, followed by telephone survey after CNR.Results: Six hundred seven patients presented to the emergency department in 2015 and 2016 with a diagnosis of nasal bone fracture. Of these, 134 patients met inclusion criteria and underwent CNR without septal reduction. Those with sports-related injuries and those with a septal fracture identified on computed tomography imaging were significantly more likely to undergo CNR. Ninety-one patients completed the post-CNR telephone survey. Over 90% of patients were satisfied with the procedure. However, patients with septal fractures reported worse outcomes, as 53.6% versus 24.1% (P = .0025) disagreed that CNR improved nasal breathing. Of all patients, 11 (2%) eventually underwent septorhinoplasty, with the presence of septal fracture on imaging a significant risk factor.Conclusions: Nasal bone fractures are a common injury, often managed initially with CNR. Patients with septal fractures should be counseled on the high risk of posttraumatic nasal deformity and obstruction despite CNR. In addition, addressing a septal fracture found on imaging may be warranted with either closed septal reduction or early aggressive management given the poorer outcomes seen in the present study. Although these patients are more likely to have definitive treatment, many forego later intervention despite persistent symptoms, emphasizing the need for early intervention or close follow-up.Level Of Evidence: 3 Laryngoscope, 129:1784-1790, 2019. [ABSTRACT FROM AUTHOR]

Introduction: ENTUK guidelines recommend that manipulation of nasal bones (MNB) should be performed within 14 days of injury. However, evidence suggests treatment under general anaesthetic remains effective up to 5 weeks after injury. With the SARS-CoV-2 pandemic leading to delays in referral and limited access to theatre, local practice changed to offer delayed MNB under local anaesthetic. This prospective study assesses the effectiveness of MNB delayed until 3 weeks or later from time of injury when performed mostly under local anaesthetic., Methods: Data was prospectively collected between April and November 2020. All patients referred to ENT with a new nasal bone deformity presenting more than 21 days after injury were included. Demographic information, injury details and patient satisfaction was recorded for each patient., Results: 11 patients were included. Average age was 32.6 years (Range 8-65 years). 10 procedures (91%) were performed under local anaesthetic, with 1 (9%) performed under general anaesthetic. 9 patients (82%) gained complete reduction of the deformity, and 1 patient (9%) gaining partial reduction. 10 patients (91%) patients were satisfied with the cosmetic outcome., Conclusion: This study supports the small volume of recent literature showing that delayed manipulation of nasal bones is effective and additionally demonstrates that efficacy is maintained when performed under local anaesthetic., (Copyright © 2024 Ulster Medical Society.)

Background: The reliability of X-ray radiography for diagnosing nasal bone fractures (NBFs) remains controversial. Recent studies show that, for determining the orientation and location of the displaced/depressed fracture, nasal sonography is as accurate as facial computed tomography. This retrospective study compared conductor-assisted nasal sonography (CANS) to conventional diagnostic tools and reported subjective patient satisfaction and discomfort after closed reduction combined with tube technique. Methods: This retrospective study reports the results of 329 refinement treatments for nasal bone fracture (including 199 men and 130 women) performed from 2005 to 2011. All patients were assessed with CANS and completed a survey immediately prior to removing the packing. Questionnaires were adapted from the nasal obstruction symptom evaluation (NOSE) scale. Results: The study found that CANS has a 97.2% rate of accuracy in diagnosing NBF. The visual analog scale scores of nasal obstruction, nasal congestion, sleep disturbance, trouble breathing, and inability to move air through the nose were analyzed. The experimental group scores were significantly different from the control group for all scores (p

Introduction: Nose is the central part of face with special aesthetic value. It is commonly fractured in facial trauma. Most of the fractures are corrected by closed reduction. Aim: To assess the patient’s satisfaction following closed reduction of fracture nasal bone both in aesthetic and functional values. Materials and Methods: Retrospective chart review of patients with fracture nasal bone presenting to Manipal Teaching Hospital between 2012 October to 2015 March was performed. Manipulation was carried out with instrumentation under general anesthesia. Patients who had come for regular follow-up for at least two months were enrolled in the study. Their functional and aesthetic outcomes were assessed. Results: Out of 64 patients analyzed, 54 patients were satisfied in terms of facial aesthetics and 60 patients were satisfied with the functional outcome of the surgery. Conclusion: Patients treated with closed reduction of fracture nasal bone had moderate levels of aesthetic and high levels of functional satisfaction.

Purpose Nasal bone fractures comprise almost 40% of all facial injuries. Most are initially reduced using closed reduction. This study introduces a newly developed method, the clip operation via endonasal approach. Materials and methods The operation was performed in these patients by a single surgeon extensively experienced in facial bone fractures. An absorbable mesh plate made into a clip was used for fixation after open reduction via the endonasal approach. No screws were used for fixation. Nasal packing was removed the first day after surgery; aluminum splinting was removed the third week after surgery. Three-dimensional facial computed tomography and cephalolateral radiography were performed preoperatively and postoperatively. Plastic surgeon satisfaction and postoperative complications were assessed. Results Fracture relapse was not observed. Reduction status was well maintained. Postoperative complications occurred, with a low final incidence of 1.8% in the third postoperative month. Plastic surgeon satisfaction was very high at 4.58. This operation takes 5–10 min, and is simple to perform. It entails a short hospitalization, and the duration during which nasal packing and aluminum splint are maintained is comparable. Undesirable functional, aesthetic complications and secondary surgery resulting from inaccurate relapse were reduced. Conclusion The clip operation is a useful technique for correcting nasal bone fractures, especially nasomaxillary complex type. [ABSTRACT FROM AUTHOR]

Objectives: To prevent aesthetic and functional deformities, precisely closed reduction is crucial in the management of nasal fractures. Plain film radiography (PF), ultrasonography (USG), and computed tomography can help confirm the diagnosis and classification of fractures and assist in performing closed reduction. However, no study in the literature reports on precisely closed reduction assisted with PF measurements under the picture archiving and communication system (PACS). Methods: We retrospectively evaluated 153 patients with nasal bone fracture between January 2013 and December 2017. Surgeons conducted precisely closed reduction assisted with PF measurement of the distance between the fracture site and nasal tip under PACS on 34 patients (group A). Another group on 119 patients were reduced under surgeon's experience (group B). Results: No significant differences in age, gender, Arbeitsgemeinschaft fur Osteosynthesefragen (AO) classification, and reduction outcome were observed between group A and group B (P >.05). The operative time of the group A was significantly lower (12.50 ± 4.64 minutes) compared to group B (23.78 ± 11.20 minutes; P <.001). After adjusted age, gender, and AO classification, patients in group A scored 10.46 minutes less on the operative time than those in group B (P <.001). In addition, the severity of nasal bone fracture (AO classification, β = 3.37, P =.002) was positive associated with the operative time. Conclusions: In this study, closed reduction in nasal bone fracture assisted with PF measurements under PACS was performed precisely, thereby effectively decreasing operative time and the occurrence of complications. This procedure requires neither the use of new instruments or C-arm nor USG or navigation experience. Moreover, reduction can be easily performed using this method, and it requires short operative time, helps achieve great reduction, less radiation exposures, and is cost-effective. [ABSTRACT FROM AUTHOR]

BackgroundReduction of nasal bone fracture can be performed under general or local anesthesia. The aim of this study was to compare general anesthesia (GA) and monitored anesthetic care (MAC) with dexmedetomidine based on intraoperative vital signs, comfort of patients, surgeons and nurses and the adverse effects after closed reduction of nasal bone fractures.MethodsSixty patients with American Society of Anesthesiologists physical status I or II were divided into a GA group (n = 30) or MAC group (n = 30). Standard monitorings were applied. In the GA group, general anesthesia was carried out with propofol-sevoflurane-N2O. In the MAC group, dexmedetomidine and local anesthetics were administered for sedation and analgesia. Intraoperative vital signs, postoperative pain scores by visual analog scale and postoperative nausea and vomiting (PONV) were compared between the groups.ResultsIntraoperatively, systolic blood pressures were significantly higher, and heart rates were lower in the MAC group compared to the GA group. There were no differences between the groups in the patient, nurse and surgeon's satisfaction, postoperative pain scores and incidence of PONV.ConclusionsMAC with dexmedetomidine resulted in comparable satisfaction in the patients, nurses and surgeons compared to general anesthesia. The incidence of postoperative adverse effects and severity of postoperative pain were also similar between the two groups. Therefore, both anesthetic techniques can be used during the reduction of nasal bone fractures based on a patient%s preference and medical condition.

Objective: The goal of our study was to compare physical examination with plain X-ray findings in patients with a suspected nasal bone fracture (NBF). Methods: The study included 403 patients who received a suspected NBF between 2014 and 2016; the files of these patients were retrospectively reviewed. In our tertiary hospital, patients with nasal bone trauma are principally admitted to the trauma and emergency department. Patients are first examined by a general surgeon for suspected NBF. Afterwards, lateral nasal radiography and otorhinolaryngology (ORL) consultations are requested. Presence of crepitation, radiologic findings, swelling, deviation of nasal axis, septal hematoma/fracture, and cause of trauma are all documented. Results: The 403 patients who presented to the trauma and emergency department for suspected NBF included 274 males and 129 females, the median age was 25±18.7 years (range, 2-106 years). When the correlation between positive clinical and radiologic findings was analyzed, crepitation was correlated with radiologic data in 155/156 (99.3%) cases, deviation of nasal axis in 135/142 (95%), septal hematoma 4/5 (80%), swelling in 103/134 (76.8%), laceration in 60/93 (64.5%), and epistaxis in 7/14 (50%). The correlation of crepitation, deviation of nasal axis, and swelling with radiologic evaluation were found statistically significant. Conclusion: Crepitation of nasal bone, deviation of nasal axis and swelling of the nasal dorsum were significantly correlated with plain X-ray imaging that had a positive finding of fracture. We believe that these results might have practical potential for diagnostic management and save time especially in crowded emergency departments. [ABSTRACT FROM AUTHOR]

The objective of this was to compare of traditional closed reduction and closed reduction in conjunction with osteotomy regarding patient satisfaction and complications. We performed a prospective randomized clinical trial of 80 patients with acute nasal bone fracture who underwent either traditional closed reduction (traditional CR) (n=38) or closed reduction (CR) in conjunction with osteotomy (n= 42). While patients in traditional CR group only underwent closed reduction, patients in CR in conjunction with osteotomy underwent closed reduction in conjunction with osteotomy for correcting the post reduction deformity. The study outcomes were complications, patient's satisfaction and deformity at 4 months follow-up after intervention. The rates of complications was seen in 37% and 42% in traditional CR group and CR in conjunction with osteotomy group, respectively (P<0.03). Also, the proportion of patients with complete correction in CR in conjunction with osteotomy group and traditional CR were 69% and 52.6, respectively. The proportion of patient's satisfaction from nose appearance in CR in conjunction with osteotomy group (35 of 42 patients (83.3%)) was significantly higher than traditional CR (24 of 38 patients (63.1%)) (P value=0.04).CR along with osteotomy is more effective than traditional CR regarding and patient's satisfaction and corrected deformity. So, it could be used for some of patients to prevent secondary and more aggressive procedure like open septorhinoplasty. [ABSTRACT FROM AUTHOR]

Purpose:Nasal bone fracture is the most common type of facial bone fracture. The optimal duration of the packing after closed reduction has been a controversial issue. The packing has several disadvantages such as blocking the nasal airway, causing infection and a headache, which is the most common immediate complication. The present study investigated the minimal and optimal duration of the nasal packing following reduction surgery of nasal bone fracture.Methods:A prospective study was performed for the patients undergoing reduction surgery following nasal bone fracture between July 2010 and June 2012. The patients were categorised into three groups according to the duration of nasal packing. For the patients treated between July 2010 and June 2011, nasal packing was maintained for 5 days. For those between July 2011 and December 2011, packing was maintained for 3 days. For those between January 2012 and June 2012, the packing was removed after 1 day. The computed tomography scan and the cephalolateral X-ray were checked at immediate postoperative period after packing removal and 6 months postoperatively. The alteration of heights, deviations, and nasal bone contours with time passage were compared among three groups. The patient satisfaction survey was also performed and compared.Results:A total of 530 patients including 322 of the 5-days packing group, 102 of the 3-days group, and 106 of the 1-day group were enrolled. There was no statistically significant difference between the groups in terms of heights, deviations, and nasal bone contours (p-value ≥ 0.05). In the patient satisfaction survey, the 1-day packing group complained of discomfort related to nasal packing and headache symptoms much less, compared to the other two groups.Conclusion:The present study demonstrated that 1-day packing had comparable postoperative outcome with reducing the patients’ discomfort. As such, a longer packing duration was not needed to achieve stable results one day is a reasonable packing time for most nasal bone fractures. [ABSTRACT FROM AUTHOR]

Summary Background The reliability of X-ray radiography for diagnosing nasal bone fractures (NBFs) remains controversial. Recent studies show that, for determining the orientation and location of the displaced/depressed fracture, nasal sonography is as accurate as facial computed tomography. This retrospective study compared conductor-assisted nasal sonography (CANS) to conventional diagnostic tools and reported subjective patient satisfaction and discomfort after closed reduction combined with tube technique. Methods This retrospective study reports the results of 329 refinement treatments for nasal bone fracture (including 199 men and 130 women) performed from 2005 to 2011. All patients were assessed with CANS and completed a survey immediately prior to removing the packing. Questionnaires were adapted from the nasal obstruction symptom evaluation (NOSE) scale. Results The study found that CANS has a 97.2% rate of accuracy in diagnosing NBF. The visual analog scale scores of nasal obstruction, nasal congestion, sleep disturbance, trouble breathing, and inability to move air through the nose were analyzed. The experimental group scores were significantly different from the control group for all scores ( p < 0.001). Conclusion Compared to conventional methods, CANS is more accurate for detecting NBF. We recommend its use as an alternative tool for diagnosing a nasal fracture. Because the tube technique balances pressure between the nasopharynx and middle ear during swallowing, patient comfort is enhanced. Application of these modifications can improve accuracy in diagnosing NBF and can improve the quality of NBF treatment. [ABSTRACT FROM AUTHOR]

Since the initiation of resident duty hour restrictions, significant controversy has arisen regarding its impact on surgical resident training. We reviewed a singular facet of the otolaryngology residency experience, nasal bone fracture management, to identify if treatment standardization would improve care and efficiency. For 1 year, otolaryngology consults for isolated nasal fractures were analyzed to assess consultation trends, rate of intervention, and resident work hour utilization. Following a review of the literature, an evidence-based algorithm for management of nasal fractures was developed. Analysis revealed a potential improvement in intervention rate from 20% to 100% with utilization of the algorithm, with an 84% decrease in overall emergency room and inpatient consultations. Sixty-three hours of otherwise lost resident time would be gained. In the setting of Accreditation for Graduate Medical Education duty hour restrictions, implementation of protocol-driven management may result in a decrease in work hours and serve as a model for more efficient otolaryngology care. [ABSTRACT FROM AUTHOR]

Abstract: One of the most frequently used packing materials in closed reduction of a nasal bone fracture is the hydroxylated polyvinyl acetate sponge (PVAS; Merocel®); however this may cause synechia, epistaxis, and pain. Synthetic polyurethane foam (SPF; Nasopore® Forte) has recently been used in septoplasty to prevent synechia or restenosis and haematoma formation. The purpose of this study was to compare the effects of PVAS and SPF on postoperative appearance and discomfort following the reduction of nasal bone fractures. We retrospectively reviewed all patient questionnaires and medical histories, and clinical photographs and computed tomography scans obtained before and after surgery. Outcomes were assessed using the Global Aesthetic Improvement Scale (GAIS) score and visual analogue scale (VAS) scores, which were used to assess discomfort during the 6-month follow-up period. Postoperatively, there was no statistically significant difference in the GAIS for the two packing materials (P >0.05). Postoperative epistaxis was observed at a significantly lower rate in the SPF group than in the PVAS group, whereas anterior rhinorrhea and posterior nasal drip occurred at significantly higher rates following removal of packing in the SPF group (P <0.05). The results of this study suggest that synthetic dissolvable polyurethane may be a reliable alternative material for nasal packing and postoperative management following the reduction of nasal bone fractures. [Copyright &y& Elsevier]