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Improving Results in Closed Nasal Reduction: A Protocol for Reducing Secondary Deformity

Farber, Scott J. M.D.; Nguyen, Dennis C. M.D.; Parikh, Rajiv P. M.D.; Jang, Judy L. M.D.; Woo, Albert S. M.D.

Plastic and Reconstructive Surgery: January 2017 - Volume 139 - Issue 1 - p 51–59
doi: 10.1097/PRS.0000000000002847
Cosmetic: Original Articles

Background: Nasal fractures are the most common facial fracture. Improper reduction is a common occurrence, resulting in a residual deformity that requires secondary surgery. A treatment protocol for nasal fracture management is presented with the aim of reducing secondary deformities requiring corrective surgery.

Methods: After institutional review board approval, a retrospective review of all closed nasal reductions performed by a single surgeon between 2006 and 2015 was conducted. Patient age, sex, presence of secondary deformity, and need for a correctional operation were recorded. Clinical records were analyzed for evidence of postoperative deformity and need for subsequent manipulation or surgery.

Results: A total of 90 patients with nasal bone fractures who underwent closed nasal reduction were identified. The mean age of patients was 24.9 years. The male-to-female ratio was 2.2:1. Postoperative deformity was reported in 14 patients (15.6 percent). Four of the 90 patients (4.4 percent) were found to have avulsion of their upper lateral cartilage from the nasal bone. Nine of the 14 subjects (64.3 percent) presenting with secondary deformity were managed with external manipulation, avoiding a secondary operation. Five patients (5.5 percent) from the original cohort of 90 underwent revision surgery.

Conclusions: By using the described protocol to treat nasal fractures, we have seen a low rate of postreduction deformity and a small percentage of need for secondary operation. The overall success rate of closed nasal reduction with postoperative manipulation (when necessary) was identified to be 94.5 percent. Using this protocol, surgeons may see a decrease in secondary deformities following closed nasal reduction procedures.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

St. Louis, Mo.

From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine.

Received for publication December 21, 2015; accepted August 8, 2016.

Disclosure: The authors have no pertinent financial disclosures to report.

Scott J. Farber, M.D., Plastic and Reconstructive Surgery, Washington University in Saint Louis, 660 South Euclid Avenue, Campus Box 8238, St. Louis, Mo. 63110, farbers@wudosis.wustl.edu

©2017American Society of Plastic Surgeons