• Archives of Plastic Surgery
• /
• 제35권5호
• /
• pp.589-596
• /
• 2008

Purpose: The nasal bone fracture is most common fracture in facial bone injuries. Regardless of the severity or type of fracture, closed reduction has traditionally been the common method of treatment. However, through detailed pre-operative evaluation, we found out that many patients consider rhinoplasty prior to trauma due to aesthetic desire or nasal deformity with or without septal deviation. In treatment of nasal bone fracture, we focused not only on the fracture management but also on the patients' desire prior to trauma, and we made additional operation according to patients' desire with fracture reduction and gained rewarding outcomes. Methods: From March 2005 to June 2007, total 263 patients were treated for nasal bone fracture. Among these patients, 57 patients (21%) had the additional operation with nasal fracture reduction. The additional operations were categorized in three types: augmentation rhinoplasty with tip plasty (40%), septoplasty only (16%), corrective rhinoplasty (44%). The mean follow-up period was 5.6 months and results were evaluated by scoring. Results: Forty four of 57 patients (77%) were highly satisfied regardless of any additional operation kinds. The complications were one septal perforation, two displacement of implant and four remnant nasal deformities. For the septal perforation, no further management was performed because we lost the contact with the patient. Then 4 of the other complicated patients were revised. Conclusion: In general, many physicians tend to consider nasal fracture as a simple trauma. However through the strict history taking, physical examination and professional counseling, we could catch the patient's cosmetic desire and get the eyes on new concept: the nasal fracture is not only a trauma but a cosmetic and functional field. In the treatment of nasal bone fracture, if additional rhinoplasty is performed, patients will be more satisfied and we also can expect higher profits.

• 대한두개안면성형외과학회지
• /
• 제21권5호
• /
• pp.283-287
• /
• 2020

Background: Closed reduction is the standard treatment for nasal bone fractures, which are the most common type of facial bone fractures. We investigated the effect of closed reduction on quality of life. Methods: The 15-dimensional health-related quality of life survey was administered to 120 patients who underwent closed reduction under general anesthesia for nasal bone fractures from February 2018 to December 2019, on both the day after surgery and 3 months after surgery. Three months postoperatively, the presence or absence of five nasal symptoms (nose obstruction, snoring, pain, nasal secretions, and aesthetic dissatisfaction) was also evaluated. Results: The quality of life items that showed significant changes between immediately after surgery and 3 months postoperatively were breathing, sleeping, speech, excretion, and discomfort. Low scores were found at 3 months for breathing, sleeping, and distress. There were 31 patients (25.83%) with nose obstruction, 25 (20.83%) with snoring, 12 (10.00%), with pain, 11 (9.17%) with nasal secretions, and 29 (24.17%) with aesthetic dissatisfaction. Conclusion: Closed reduction affected patients' quality of life, although most aspects improved significantly after 3 months. However, it was not possible to rule out deterioration of quality of life due to complications and dissatisfaction after surgery.

• Archives of Plastic Surgery
• /
• 제36권1호
• /
• pp.61-65
• /
• 2009

Purpose: Most nasal bone fractures involve the septum; either or both of the ethmoidal perpendicular plate(EPP) and quadrangular cartilage(QC). Unlocked tension from the underlying quadrangular cartilage and poorly reducted bony septum are obstacles to the successful reduction of nasal bone. So we compared the preliminary outcome of septoplasty as a primary treatment with the untreated septum in nasal bone fractures. Methods: We performed a retrospective study of 215 patients underwent reduction of nasal fracture between January 2002 and February 2008. We graded patients into four groups according to the amount of deviation and direction of force by CT. Our indication for septoplasty and combined procedures was the deviation of EPP or QC over 50% from the midline. We interviewed part of the patients by telephone regarding the subjective esthetic and functional outcomes. Results: Forty five of 215 patients (21 percent) underwent septoplasty and combined procedures (cartilage graft, etc) after the informed consent. Patients who underwent septoplasty significantly satisfied with the outcome of esthetic appearance and nasal patency compared with patients who underwent simple closed reduction despite of having septal deviation over 50 percent from the midline. (p < 0.05) Conclusion: Septal surgery and esthetic consideration shoud be made even in simple nasal reductions. And if CT scans reveal severe deviation of septum, septoplasty should be considered as a primary treatment.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제36권6호
• /
• pp.266-272
• /
• 2014

Purpose: This study was conducted in order to investigate the therapeutic effect of closed reduction according to a classification in patients with nasal bone fracture. Methods: The study was conducted retrospectively on 186 patients with a mean age of 38 years (range: 7 to 80 years). All patients were diagnosed by clinical and radiologic examination, and then classified according to Hwang's classification by computed tomography. The patients were further classified by their age, gender, causes of fracture, operation timing after fracture, concurrent facial bone fracture, and complications. All patients underwent the same reduction and treatment protocol and were then followed up regularly for at least three months. Results: The cause of the fracture was slip down, and the highest prevalence was shown in the 20s. The mean operation timing after fracture was 4.1 days (range: 1 to 14 days), and it tended to be longer in the case of defected septal bone or more severe fracture. The most common concurrent facial bone fracture was orbital blow-out fracture, and zygomaticomaxillary complex and maxillary fracture occured frequently. The largest number of complications occurred in class III and IIBs patients, and the main complication was postoperative pain. Conclusion: Results of nasal bone closed reduction on the 186 patients showed that serious complications rarely occurred. Closed reduction is generally an effective treatment for nasal bone fracture. However, in the case of severe concurrent septal bone fracture or comminuted fracture with depression, open reduction should be considered. Further study with a larger number of patients and further classification is required.

• Archives of Plastic Surgery
• /
• 제36권2호
• /
• pp.188-193
• /
• 2009

Purpose: Several authors reported about the post - traumatic nasal aesthetic complications. However, the study for functional or intra - nasal complications has been reported not enough. The aim of this study is to observe the incidence of intranasal synechia. Methods: We reviewed the data from 401 consecutive patients with nasal bone fracture from september 2006 to December 2007. We enforced evaluation with preoperative CT in all patients but postoperative CT within complicated patients. We classified the nasal bone fracture according to the anatomy and severity of fracture. Type I is nasal tip fracture(15%, n = 59), Type II is simple lateral without septal injury(38%, n = 152), Type III is simple lateral with septal injury(23%, n = 92), Type IV is closed comminuted(20%, n = 82), Type V is open comminuted or complicated(4%, n = 16). We studied 98 patients with nasal bone fracture who had postoperative symptoms or undergone postoperative endoscopic evaluation. And then we evaluated the postoperative endoscopic finding and nasal synechal formation after operation. Results: The incidence of intranasal synechiae was 15%(n = 62). According to the endoscopic findings, the incidence of intranasal synechiae was 10%(n = 6) in Type I, 8%(n = 12) in Type II, 16%(n = 15) in Type III, 24%(n = 20) in Type IV, and 56%(n = 9) in Type V. Additionally, the incidence of subjective nasal obstruction and olfactory dysfunction is 18%(n = 72) and 13%(n = 51). But the incidence of symptomatic synechiae of nasal obstruction and olfactory dysfunction is 92%(57/62) and 55%(34/62). Conclusion: We identified relatively high prevalence of nasal obstruction and olfactory dysfunction in nasal synechiae. Based on the results of this study, intranasal synechiae really caused airway obstruction(92%). Our data showed significant relationship between intranasal synechiae and severity of the fracture, because of increasing mucosal handling and destructive closed reductional procedures. First of all, education of delicate procedure regarding this subject should be empathized accordingly.

• 대한두개안면성형외과학회지
• /
• 제12권2호
• /
• pp.93-96
• /
• 2011

Purpose: In most cases of nasal bone fracture, closed reduction with internal or external splint fixation approach is selected. However, because of indiscriminate insertion of the internal splint without considering of anatomical difference or deformity, insufficient fixation happens frequently that need additional fixation. Therefore, we suggest a new method for providing adequate support in reduced nasal bone by carving $Merocel^{(R)}$ that is fixed for the anatomical structure. Method: Closed reduction and internal fixation with carved $Merocel^{(R)}$ was performed in 15 nasal bone fracture patients from March, 2010 to July, 2010. Each patient was evaluated by physical examination, facial photographic check, simple X-ray, and computerized tomography. On the first day post-operation, location of packing and amount of reduction were checked by follow up X-ray and computerized tomography. In addition, patients' symptoms were evaluated. During the 3-month post-op follow up at out-patient clinic, operator, 2 doctors in training and one assistant performed the objective evaluations by physical examination on nasal dorsal hump, nasal deviation, nasal depression, nasal breath difficulty, and nasal airway obstruction. A survey of subjective patients' satisfaction in 4-stages was also performed. Results: The results of follow-up computerized tomography of the 15 patients revealed that 11 patients had good reduced state. Three patients with combined maxillary frontal process fracture had over reductions. A survey performed on the first day post-operation showed that 14 of 15 patients answered that their current symptoms were more than tolerable. At the 3-month follow-up physical exam, one case had a dorsal hump. However, there were no nasal deviations, nasal depressions, nasal breath difficulties, or nasal airway obstructions. Twelve of the 15 patients answered more than moderate on the 3-month survey. Conclusion: Intranasal packing after carving the $Merocel^{(R)}$ considering anatomical structure is a new effective method to promote proper-reduction, maintain stability, and minimize patients' symptoms by addition of a simple procedure.

• Archives of Plastic Surgery
• /
• 제37권5호
• /
• pp.626-632
• /
• 2010

Purpose: Nasal bone fractures are often classified as minor injury. However, the incidence of posttraumatic nasal deformity remains alarmingly high. It is because of unnoticed septal fracture. This study was conducted to determine the necessity of septoplasty for patients with nasal bone fracture accompanying grade I septal fractures. Methods: Among 105 patients with nasal bone fractures, 52 who had grade I septal fracture were diagnosed based on physical examination and computed tomography. Patients' age ranged from 14 to 65 years (mean 29.25 years), and 35 were male and 17 female. Patients were divided into 2 groups according to surgical treatment methods: patients who underwent closed reduction only (group 1, n=28) and those who underwent simultaneous closed reduction and septoplasty (group 2, n=24). The treatment outcomes were evaluated by comparing changes in nasal airway volume measured by acoustic rhinometry before the surgery, 3 months and 6 months after the surgery according to the timing of surgical repair and surgical treatment methods. Results: Nasal airway volume increased after the surgery by 17.8% in 3 months after the surgery, 25.2% in 6 months in group 1 and by 22.7% in 3 months, 35.8% in 6 months in group 2. The increase in airway volume after the surgery by 26.3% in 3 months after the surgery, 34.2% in 6 months after the surgery in operation within 1 week after trauma and by 12.1% in 3 months, 22.2% in 6 months after the operation later 1 week after trauma. The difference was statistically significant. Three patients in group 1 complained of intermittent nasal obstruction, two of whom showed a decrease in nasal airway volume by acoustic rhinometry. Conclusion: Most patients with nasal bone fractures accompanying grade I septal fractures have been treated with closed reduction in clinical settings. However, the results of this study suggest that septoplasty be performed after a correct diagnosis of septal fracture is made through comprehensive physical examination and computed tomography. Septoplasty is important to obtain more favorable outcomes and reduce complication.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제16권3호
• /
• pp.419-427
• /
• 1994

Because of the prominence of the nose and its central location, it is the most frequently encountered fractures in the face. Yet reports about the nasal bone fractures are virtually rare in the oral and maxillofacial surgical literatures. This is a retrospective study on 19 nasal bone fractures treated in Chosun university hospital Department of Oral & Maxillofacial Surgery from Jan. 1991 to Sep. 1993, under admission to our Dept. and the obtained results were as follows. 1. Of the 240 patients with facial bone fractures, 28 patients suffered nasal fractures(12%) and male to female ratio was 5.3:1. 2. The most frequent cause was traffic accidents(39%)m, the next fall down(36%), first blow(4%). 3. The age frequency was the highest in the fifth decade (32%). 4. Clinical classification of nasal fractures was simple fractures(74%), combined fractures(26%), and single fractures(37%), combined fractures(63%). 5. The most frequently combined site was maxilla(50%). 6. Treatments of nasal fractures were closed reduction(63%), open reduction(5%), and secondary rhinoplasty(32%). 7. The initial treatment time from accident was 1.7 days in single fractures, and 3.5 days in combined fractures, and the period of splint retained was about 8.2 days in single fracture, about 8.7 in combined fracture. 8. It was necessary to treat secondarily in delayed treatment, and all treatment methods showed relatively good prognosis. 9. Closed reduction was treated under local anesthesia, but open reduction & secondary rhinoplasty was treated under general anesthesia except 1 case. 10. The complications were disturbance of swellings 5 cases, ethetic problem 5 cases, epiphora 3 cases, abnormal sensation 6 cases in relation with other fractures.

• 대한두개안면성형외과학회지
• /
• 제13권1호
• /
• pp.63-67
• /
• 2012

Purpose: Lipogranuloma is the reaction of adipose tissue to various oils, paraffin, and other hydrocarbons injected into subcutaneous tissue for cosmetic or other reasons. The authors experienced a case of sclerosing lipogranuloma on the nasal dorsum. Methods: A 42-year-old female, without a history of the injection of any foreign materials, was admitted on our hospital for a painless, irregular, and firm mass located on her nasal dorsum with step-off deformity. It was considered that the mass had developed after augmentation rhinoplasty. The size of mass had been increased after closed reduction of nasal bone fracture. On April 2011, under general anesthesia, the mass was removed by open rhinoplasty technique. In addition, a pathologic examination was performed. After the mass extirpation, dermofat graft was performed for the correction of depression deformity. Results: The histopathological findings demonstrated a Swiss cheese pattern with variably-sized vacuoles, which corresponded to lipid removed with tissue processing, and variable foreign body giant cell reaction, fat necrosis, and hyalinized fibrous tissue. The pathologic diagnosis is lipogranuloma replacing nasalis muscle. It has been considered that sclerosing lipogranuloma is caused by nerve injury during augmentation rhinoplasty and the ointment used after the closed reduction of nasal bone fracture, which infiltrated through the injured mucosa. Conclusion: During the treatment of rhinoplasty or nasal bone fracture, the nerve injury or the ointment use can lead to lipogranuloma. Therefore, careful dissection for avoidance of the nerve injury and limited use of ointment seems to be helpful in decreasing incidence of lipogranuloma.

• Archives of Plastic Surgery
• /
• 제32권1호
• /
• pp.37-42
• /
• 2005

The human nose is located in the center of the face and it's cosmetic importance is high. The contour of the nasal dorsum and side walls play a major role in the shaping of the nose, and even a slight distortion may results in significant variance of the human facies. However, in the case of patients with wide nasal bone, augmention rhinoplasty can make nasal planes look wide, resulting in bulbous appearing noses or lateral borders of the nasal implant may be visible after the surgery making the final cosmetic results unsatisfactory. To solve such problems, from march, 1999 to march, 2004, the authors have performed augmention rhinoplasty in 36 patients. The cause of operations were as follows: flat nose 20, hump nose 5, deviated nose 4, secondary rhinoplasty 7. Paramedian osteotomy was performed at a distance that was the same as the width of the implant from the midline(5 mm + 5 mm). To prevent it from connecting to the roof at the lateral osteotomy line, intentional green stick fracture of the roof was performed. Agumentation rhinoplasty was done with either Silicone or Gortex and ear cartilage as a supplement. The follow up period was 2 weeks to 13 months with an average of 5.5 months. There were no infections and postoperative bleeding. As a result, the nose was augmented higher and narrower than before which we and the patient both found highly satisfactory.