Current management techniques for acute nasal fractures result in a high incidence of posttraumatic nasal deformity (14 to 50 percent). Associated traumatic edema, preexisting nasal deformity, and occult septal injury account for most of these acute reduction failures. Working with a detailed patient history and a physical examination that included rigid nasal endoscopy, the authors formulated a clinical algorithm for acute nasal fracture management, the use of which can reduce the incidence of posttraumatic nasal deformity. In this article, the authors review the literature, then discuss their management techniques over the past 11 years in 110 cases with a 9 percent nasal revision rate. This low incidence of revision is attributed to complete nasal assessment (bony and septum), use of outpatient controlled general anesthesia, and primary septal reconstruction in cases with severe septal fracture dislocation.
The nose is the most prominent facial feature. A fracture of the nasal pyramid is the most common facial fracture, requiring less force than that for any other facial bone. 1-5 The increasing prevalence of this injury presents the plastic surgeon with challenging treatment options. Although nasal fractures are often discussed as minor injuries, 6 the incidence of posttraumatic nasal deformity remains high (14 to 50 percent). Revision rhinoplasty for traumatic nasal deformity is a difficult procedure, and thus guidelines are needed to optimize the management of acute nasal fracture.
The numerous factors that contribute to suboptimal aesthetic and functional end results include timing, edema, undetected preexisting nasal deformity, and occult septal deviation/injury. Over the past 11 years, we have worked to devise a clinical algorithm for acute nasal fracture management that includes a complete evaluation of the nasal deformity (both internal and external) and a precise anatomic reduction under controlled conditions. This algorithm can be used to improve long-term results and to reduce the incidence of posttraumatic nasal deformities.