• 대한두개안면성형외과학회지
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• 제14권2호
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• pp.81-88
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• 2013

Background: To suggest the need of more aggressive reduction techniques than closed reduction (CR) technique in nasal fracture treatment, we identified the usefulness of algorithm oriented treatment of nasal fracture that includes indirect open reduction (IOR) and external fixation (EF) as well as the CR. Methods: We compared the clinical course of the group A (n=128) where only the CR was performed regardless of the pattern of the nasal fracture and the group B (n=127) where algorithm oriented treatment including IOR and EF as well as CR was performed depending on the pattern of nasal fracture. And the degree of postoperative pain after CR and IOR technique was compared through the dose of analgesics and pain scores. Results: More than 80% of patients were satisfied the result of reduction in both group A and B. Good contour of nasal bone after reduction was showed 71% of group A and 81% of group B without significant difference. Minor (p>0.05) and major (p<0.05) deformity after reduction were less occurred in the group B than group A. Postoperatively, the dose of analgesics was significantly lower after IOR technique than CR technique (53 mg vs. 142 mg) (p<0.05). Conclusion: Algorithm oriented treatment of nasal fracture including IOR and EF as well as CR reduce major deformity after reduction than treatment of CR alone. It is useful to perform the more aggressive reduction techniques such as IOR and EF according to the pattern of fracture in treatment of nasal fracture.

• 한국임상수의학회지
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• 제23권3호
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• pp.361-365
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• 2006

A spayed female, 5-year-old, weighing 2.7 kg, domestic short hair cat was referred to Veterinary Medical Teaching Hospital, Seoul National University. The clinical signs of this patient were weight loss, sneezing, respiratory distress, nasal discharge, epistaxis, ocular discharge, left exophthalmos, and left facial edema and deformity. The laboratory tests represented mild leukocytosis. On the skull radiographs, soft tissue density filled nasal cavity with loss of turbinate detail was found. Destructive and lytic changes of the left nasal bone with soft tissue swelling were identified. On the thorax radiographs, there were a tracheobronchial lymph node swelling and a soft tissue round mass in the left caudal lung field. On computed tomographic scan images, asymmetrical destruction of turbinate and nasal septum and increased soft tissue opacity in the nasal cavity were identified. Destruction of the lateral maxillary bone, invasion to the left retrobulbar region, and craniodorsal deviation of the left eye were seen. Also, there was lysis of hard palate and cribriform plate. Invasion to the brain was found. The patient was diagnosed as nasal lymphoma by cytology and histopathology.

• Archives of Plastic Surgery
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• 제32권5호
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• pp.555-560
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• 2005

The nose is shaped as a pyramid and is the most prominent portion of the face. Nasal bone fractures are thus more frequent than those of the maxilla and zygoma. Whether the nasal bone fractures are corrected or not due to unnecessity of surgical treatment, the incidence of posttraumatic deformity occurs frequently. In Asian patients, even the corrected noses look low-lying and flat. To resolve these problems, we corrected the posttraumatic deformity of the nose with a combined procedure of nasal ostectomy and augmentation rhinoplasty. From 2000 to 2004, this procedure was performed in fifteen patients with posttraumatic nasal deformity. There were four female and eleven male patients with an average age of 32 years(range 19 to 52 years). All patients had previous trauma history. Of these, closed reduction was performed on 13 patients and no treatment was 2 patients. The deformed noses were corrected through lower columellar incision, by ostectomy or osteomy, and augmentation with silicone implant. We gained satisfactory results of correcting the deformed noses, except one case with implant deviation. Our method for the correction of traumatic nasal deformity proves to be simple and safe. The camouflage effect with silicone implant overcomes an unsatisfactory correction and brings a excellent cosmetic results.

• Archives of Plastic Surgery
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• 제37권4호
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• pp.433-442
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• 2010

Purpose: Many authors reported about the posttraumatic nasal aesthetic complications. However, the studies for functional or intranasal complications are not enough yet. We identified relatively high prevalence of nasal obstruction and olfactory dysfunction in nasal synechiae, and the synechiae formation was a frequently occurred after the nasal bone reduction. And then, the aim of this study is to identify the usefulness of the treatment of intranasal synechiae. Methods: We reviewed the data from 10 patients with symptomatic intranasal synechiae from June 2007 to June 2009. We enforced evaluation with preoperative CT in all patients but postoperative CT within complicated patients. We studied 10 patients with intranasal synechiae who had persistence postoperative symptoms. We studied the patients who were operated by removal of synechiae and ancillary surgical treatments in the last two years. Results: In the previous report, the incidence of intranasal synechiae was 15% (n=62) and symptomatic synechiae was 16% (10/62). We classified the nasal bone fracture according to Stranc classification. In this paper, the incidence of treated intranasal synechiae was 13% (2/15) in Frontal Impact (FI) Type I, 11% (2/18) in FI Type II, 100% (2/2) in FI Type III, 0% (0/2) in Lateral Impact (LI) Type I, 25% (3/12) in LI Type II, and 33% (1/3) in LI Type III, respectively. After removal of synechiae, all patients improved nasal obstruction and little improved olfactory disturbance. Conclusion: Simple removal of synechiae by scissors improved postoperative symptoms and complications such as nasal obstruction and olfactory dysfunction. After removal of synechiae, all patients improved nasal obstruction, however, little improved anosmia. So, we thought that olfactory dysfunction may result in many intranasal factors. First of all, education of delicate procedure regarding this subject should be empathized accordingly.

• 대한두개안면성형외과학회지
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• 제22권2호
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• pp.93-98
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• 2021

Background: Pediatric nasal fractures, unlike adult nasal fractures, are treated surgically as early as 7 days after the initial trauma. However, in some cases, a week or more elapses before surgery, and few studies have investigated the consequences of delayed surgery for pediatric nasal fractures. The purpose of this study was to evaluate the postoperative outcomes of pediatric nasal fractures according to the time interval between the initial trauma and surgery. Methods: The records of pediatric patients under 12 years old who underwent closed reduction of nasal bone fracture from March 2012 to February 2020 were reviewed. The interval between trauma and surgery was divided into within 7 days (early reduction) and more than 7 days (delayed reduction). Postoperative results were classified into five grades (excellent, good, moderate, poor, and very poor) based on the degree of reduction shown on computed tomography. Results: Ninety-eight patients were analyzed, of whom 51 underwent early reduction and 47 underwent delayed reduction. Forty-two (82.4%) of the 51 patients in the early reduction group showed excellent results, and nine (17.6%) showed good results. Thirty-nine (83.0%) of the 47 patients in the delayed reduction group showed excellent results and eight (17.0%) showed good results. No statistically significant difference in outcomes was found between the two groups (chi-square test p= 0.937). However, patients without septal injury were significantly more likely to have excellent postoperative outcomes (chi-square test p< 0.01). Conclusion: No statistically significant difference was found in the outcomes of pediatric nasal fractures between the early and delayed reduction groups. Successful surgical results were found even in patients who received delayed reduction (more than 7 days after trauma).

• 대한두개안면성형외과학회지
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• 제20권4호
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• pp.228-232
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• 2019

Background: The epidemiology of nasal fractures varies according to factors such as the era and area of the study, as well as the age of the patient. We compared the characteristics and causes of pediatric nasal fractures. Methods: A total of 2,321 patients with nasal fractures from 2010 to 2017 were examined. The patients were divided into age groups using the Korean school system of age classification. The causes of injury were divided into five groups: violence, fall or slip down, sports, road traffic accidents, and others. Fractures were classified using the Stranc and Robertson standard: vector of force and plane of fracture. Results: Violence was the most common cause of nasal fracture in patients older than 12 years. Violence was a significantly less frequent cause among patients younger than 12 years old than among adolescent and adult patients. Nasal fractures due to violence were not observed in patients younger than 10 years. Plane 2 and lateral force fractures were the most common; however, in patients younger than 12 years, frontal force fractures were significantly more frequent than were lateral force fractures. Conclusion: As children may simply be injured due to a fall or slip down, it is important for the parents and guardians to ensure their safety. As they become older, children should abstain from violence and be monitored. It is therefore very important to ensure that the environment is free of violence in order to prevent such injuries.

• 대한두개안면성형외과학회지
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• 제17권1호
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• pp.14-19
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• 2016

Background: Most nasal bone fractures are corrected using non-invasive methods. Often, patients are dissatisfied with surgical outcomes following such closed approach. In this study, we compare surgical outcomes following blind closed reduction to that of ultrasound-guided reduction. Methods: A single-institutional prospective study was performed for all nasal fracture patients (n=28) presenting between May 2013 and November 2013. Upon research consent, patients were randomly assigned to either the control group (n=14, blind reduction) or the experimental group (n=14, ultrasound-guided reduction). Surgical outcomes were evaluated using preoperative and 3-month postoperative X-ray images by two independent surgeons. Patient satisfaction was evaluated using a questionnaire survey. Results: The experimental group consisted of 4 patients with Plane I fracture and 10 patients with Plane II fracture. The control group consisted of 3 patients with Plane I fracture and 11 patients with Plane II fracture. The mean surgical outcomes score and the mean patient dissatisfaction score were found not to differ between the experimental and the control group in Plane I fracture (p=0.755, 0.578, respectively). In a subgroup analysis consisting of Plane II fractures only, surgeons graded outcomes for ultrasound-guided reduction higher than that for the control group (p=0.007). Likewise, among the Plane II fracture patients, those who underwent ultrasound-guided reduction were less dissatisfied than those who underwent blind reduction (p=0.043). Conclusion: Our study result suggests that ultrasound-guided closed reduction is superior to blind closed reduction in those patients with Plane II nasal fractures.

• Archives of Plastic Surgery
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• 제32권5호
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• pp.667-670
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• 2005

Congenital facial cleft is a rare entity and appears along by the line of different processes of the facial development. An isolated cleft of the nose has been reported not often in the literature. We treated a patient with an isolated nasal cleft associated with undefined cranial anomaly. On 3D CT scan was seen a bony cleft traversing the pyriform aperture lateral to the anterior nasal spine. The nasal septum and frontal process of the maxilla were intact. There also was found bilateral bony defects in the frontal bone and bilateral frontal boss. The nasal cleft and frontal defect and boss were corrected by two stages: anterior two-third of the cranial vault with bilateral frontal boss was remodeled at the age of two years and the nasal cleft was repaired with a local rotation flap at age 3.

• 한국임상수의학회지
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• 제28권4호
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• pp.452-456
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• 2011

5 year-old female Siberian husky which was 27 kg had presented with a recurrent rhinitis with chronic discharge and cough. A nasal foreign material had been suggested by a finding of a bone density ($0.3{\times}0.3$ cm) in the left nasal cavity on X-ray and CT-scanning. Soft tissue opacity in frontal sinus and nasal cavity was increased and foreign material was located beside turbinate bone in the left nasal. We found that there was the increase in the number of eosinophil and mast cell by the nasal cytology test. These results mentioned above indicated that the rhinitis by nasal foreign body was suspicious. We decided that the transfrontal rhinotomy could be the proper procedure to approach the material in this case. After rhinotomy, the foreign body and severe sticky discharge were removed. Drain was placed through the hole and into the frontal sinus and nasal cavity which were flushed two times a day for 7 days. The clinical signs such as cough and nasal discharge were shown to be improved in the every visiting for the re-check. On the $40^{th}$ day after surgery, we could confirm that the most of soft tissue density in the frontal sinus and nasal cavity was decreased by CT-scanning. However, foreign body was not identified by histological examination. For the treatment of chronic rhinitis caused by foreign body, the surgical method such as rhinotomy can be applied, when it is difficult to remove it in the guide of the nasal endoscope.

• Archives of Plastic Surgery
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• 제50권4호
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• pp.389-392
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• 2023

A 14-year-old girl had a midfacial trauma event caused by hitting against an opening door and experienced discomfort and swelling of the columella and upper lip. Physical examination revealed mild tenderness on light palpation without any discomfort with upper lip movement. A computed tomography scan of the maxillofacial bones with three-dimensional reconstruction showed a fracture of the anterior nasal spine with obvious leftward displacement, mild-deviation of the caudal aspect of the nasal septum, and no sign of nasal bone fracture. Open reduction and internal fixation was performed with regard to aesthetic and functional concerns, including nasal septum deviation. The postoperative course was uneventful, and healing proceeded normally without complications. Herein, we emphasize the importance of differential diagnosis of isolated anterior nasal spine fractures in patients with midfacial trauma and clinicians' strategic decision-making in treatment modalities.