Study examines treatment and outcomes for nasal fractures

Sep 21, 2009

Both minimally invasive and traditional open approaches can successfully repair nasal fractures, provided the procedure is matched to the individual fracture, according to a report in the September/October issue of Archives of Facial Plastic Surgery. A treatment algorithm based on factors such as fracture type and degree of septal deviation (displacement of the bone and cartilage separating nostrils) may help surgeons choose the appropriate treatment.

Nasal fractures are common, but treatment of these injuries remains controversial among surgeons, according to background information in the article. Some recommend no intervention at all, whereas others favor extensive open surgery using rhinoplasty techniques. Treatment is typically divided into closed reduction (minimally invasive repair) or open reduction techniques. "Closed reduction is a relatively simple procedure, at times producing acceptable outcomes," the authors write. "However, advocates of open reduction purport better cosmetic results and a high likelihood that closed reductions will eventually need a second operation using an open reduction technique."

"Deciding which technique to use for a given nasal fracture can be challenging. Not all fractures can be treated using closed techniques and, conversely, not all fractures require the time and expense of an open reduction," they continue. Michael P. Ondik, M.D., and colleagues at Penn State Hershey Medical Center, Hershey, Pa., studied 86 patients who received treatment for nasal fractures (41 who had closed treatments and 45 who had open treatments) at the facility between 1997 and 2007. Fractures were classified as one of five types, revision rates were calculated for each group, pre- and post-operative photographs were rated and available patients were interviewed about aesthetic, functional and quality of life issues.

The revision rate for all fractures was 6 percent, including 2 percent for closed treatment and 9 percent for open treatment. Many closed treatment cases were classified as type II fractures, or simple fractures that included septal deviation, whereas most open treatment cases were classified as type IV fractures (severely deviated nasal and septal fractures). "There was no statistical difference in revision rate, patient satisfaction or surgeon photographic evaluation scores between the closed and open treatment groups when fractures were treated in the recommended fashion," the authors write.

A treatment algorithm that considers fracture type, whether the fracture is impacted (in which bone fragments are wedged together) or incomplete, the degree of septal deviation and whether previous treatments have failed could help surgeons determine the best approach to each individual fracture, the authors note.

"A successful management algorithm should provide each patient with an aesthetically and functionally superior repair, leaving the most invasive repairs for only those patients who require it and allowing simple fractures to be managed relatively conservatively. Our results validate this approach and effectively 'even out' the outcomes between the open and closed groups," they conclude. "We believe that our classification system and management algorithm represent a new paradigm in nasal fracture management."

More information: Arch Facial Plast Surg. 2009;11[5]:296-302.

Source: JAMA and Archives Journals (news : web)

Explore further: New technology that is revealing the science of chewing

add to favorites email to friend print save as pdf

Related Stories

Make or break time for osteoporosis treatment

Mar 10, 2008

Women who do not comply with treatment instructions for osteoporosis or who do not respond to treatment are more likely to suffer further fractures, which seriously affects their quality of life.

Cell injections accelerate fracture healing

Feb 12, 2009

Long bone fractures heal faster after injections of bone-building cells. Research published in the open access journal BMC Musculoskeletal Disorders has shown that osteoblast cells cultured from a patient's own bone marrow ...

Recommended for you

Obese British man in court fight for surgery

Jul 11, 2011

A British man weighing 22 stone (139 kilograms, 306 pounds) launched a court appeal Monday against a decision to refuse him state-funded obesity surgery because he is not fat enough.

2008 crisis spurred rise in suicides in Europe

Jul 08, 2011

The financial crisis that began to hit Europe in mid-2008 reversed a steady, years-long fall in suicides among people of working age, according to a letter published on Friday by The Lancet.

New food labels dished up to keep Europe healthy

Jul 06, 2011

A groundbreaking deal on compulsory new food labels Wednesday is set to give Europeans clear information on the nutritional and energy content of products, as well as country of origin.

Overweight men have poorer sperm count

Jul 04, 2011

Overweight or obese men, like their female counterparts, have a lower chance of becoming a parent, according to a comparison of sperm quality presented at a European fertility meeting Monday.

User comments : 0

More news stories

Low Vitamin D may not be a culprit in menopause symptoms

A new study from the Women's Health Initiative (WHI) shows no significant connection between vitamin D levels and menopause symptoms. The study was published online today in Menopause, the journal of The North American Menopa ...

Patent talk: Google sharpens contact lens vision

(Phys.org) —A report from Patent Bolt brings us one step closer to what Google may have in mind in developing smart contact lenses. According to the discussion Google is interested in the concept of contact ...

Wireless industry makes anti-theft commitment

A trade group for wireless providers said Tuesday that the biggest mobile device manufacturers and carriers will soon put anti-theft tools on the gadgets to try to deter rampant smartphone theft.