|Year : 2015 | Volume
| Issue : 2 | Page : 37-39
Patient satisfaction following closed reduction of nasal bone fracture
Ahmad Al Arfaj1, Yasin S Subhan2, Tareq Al Otaibi3, Amani Ahmed Obeid4
1 Associate Professor and Consultant, Department of Otorhinolaryngology, King Abdulaziz University Hospital, Medical College, King Saud University, Riyadh, Saudi Arabia
2 Registrar, Department of Otorhinolaryngology, King Abdulaziz University Hospital, Medical College,King Saud University, Riyadh, Saudi Arabia
3 Fellow, Department of Otorhinolaryngology, King Abdulaziz University Hospital, Medical College,King Saud University, Riyadh, Saudi Arabia
4 Asst. Consultant, Department of Otorhinolaryngology, King Abdulaziz University Hospital, Medical College,King Saud University, Riyadh, Saudi Arabia
|Date of Web Publication||2-Jan-2020|
MD Ahmad Al Arfaj
Department of Otorhinolaryngology King Abdul Aziz Hospital PO. Box 245, Riyadh 11411
Source of Support: None, Conflict of Interest: None
Objective: To present the clinical profile of patients subjected to closed reduction of fractured nasal bone and review the outcome of the procedure from the patient’s perspective.
Methods: Patients with nasal bone fracture treated with closed reduction in King Abdulaziz University Hospital, Riyadh between 1 January 2008 and 31 December 2013 were included. The essential data consisting of personal details, history, examination, details of surgical corrections were charted. Patients were followed-up by a telephonic interview to obtain their level of satisfaction of the outcome.
Results: Of the 163 patients who were studied, 147 patients could be successfully contacted and interviewed, and 16 patients could not be contacted. Of the 147 patients, 65 (44%) patients expressed full satisfaction with the functional and aesthetic outcome; 42 (29%) patients were partially satisfied but would not consider revision surgery; 39 (27%) patients were not satisfied and would consider revision surgery.
Conclusion: Despite a relatively high patient satisfaction rate with the functional and aesthetic outcome of closed reduction of nasal fracture, a significant number of patients (27%) are unsatisfied.A thorough pre-operative evaluation of the nasal deformity including presence of pre-existing deformities and meticulous surgical correction might reduce the rate of the unsatisfactory outcome of the primary surgical procedure.
Keywords: closed reduction, nasal bones, patient satisfaction, aesthetic outcome
|How to cite this article:|
Al Arfaj A, Subhan YS, Al Otaibi T, Obeid AA. Patient satisfaction following closed reduction of nasal bone fracture. Saudi J Otorhinolaryngol Head Neck Surg 2015;17:37-9
|How to cite this URL:|
Al Arfaj A, Subhan YS, Al Otaibi T, Obeid AA. Patient satisfaction following closed reduction of nasal bone fracture. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2015 [cited 2022 Dec 8];17:37-9. Available from: https://www.sjohns.org/text.asp?2015/17/2/37/274654
| Introduction|| |
Fracture of nasal bone is a common condition generally treated by closed reduction. It is a simple maneuver carried out under local or general anesthesia and in many occasions performed by junior surgeons. Few studies have evaluated the functional and the cosmetic outcome of the procedure. The reported success rates ranged between 62 and 80 % ,,,. The purpose of this study was to present the age, sex, the causes and the treatment outcome of fracture nasal bone cases treated in King Abdulaziz Hospital, Riyadh over a 6 years period.
| Materials and Methods|| |
A review of the Health Information System (HIS) was done to pull out all the files of patients who were diagnosed as fracture of nasal bone in King Abdul Aziz University Hospital, King Saud University from 1 January 2008 to 31 December 2013.
Of all the 190 cases, 163 had undergone closed reduction. After approval from the IRB committee the files were retrieved and all these patients were called on the telephone. The author was able to review 147 patients, and the remaining 16 patients could not be contacted. The caller would introduce himself and explain the study and take verbal consent for their participation in the study. He would then ask a fixed format of questions about the outcome and enter it in the datasheet. Those datasheets would then be completed from information gathered from the file including type of trauma, date of presentation post trauma, presenting complaints etc. All the data was statistically analyzed using SPSS Software, Version 16.2008.
| Results|| |
The total number of patients with nasal trauma enrolled in this study was147; the mean age (3-39 years) was 17.5years. The male group was 77.6% (N=114) while the female group was 22.4% (N=33). The cause of the trauma is shown in [Table 1]. Football was the most common cause of nasal trauma in the male group (31.6%) while fall was the most common cause in female patients (48.5%). Patients presented to otolaryngology clinic more than 1 week after trauma were 72 patients (49%). The presenting features of the patients are shown in [Table 2]. The number of patient who complained of preoperative nasal deformity was 141 (96%). Depressed fracture was diagnosed in 62 patients (42.2%). The number of patients who had nasal obstruction due to trauma were 30 patients (20.4%). The number of the patients who had radiological study was 117 (79.6%). The surgical procedure was done by residents with consultant supervision in 136 cases (92.5%). One hundred and thirty patients (88.4%) had no packing post surgery; while 16 patients (10.9%) had post-operative packing. The overall satisfaction rate is shown in [Table 3].
Of the patient who had nasal obstruction, about 40%  of the patients expressed total satisfaction and 30% (N=9) were partially satisfied but not seeking other surgery; while 30% (N=9) were totally unsatisfied and were looking for further treatment.
| Discussion|| |
The central position of the nose and its anterior projection on the face makes it susceptible to injury, and therefore fractures of the nasal bones are the most common facial fractures and the third most common of the human skeleton . The main etiologies of nasal fractures worldwide are falls, violence, traffic accidents, and sport injuries . The number of cases of nasal bone fracture has been increasing with the increase in the number of injuries or car accidents . Most cases of nasal bone fracture can be diagnosed clinically by a routine nasal examination especially in the presence of crepitus and tenderness in palpation. However, radiological investigation plays an important part in the diagnosis and evaluation of nasal bone fractures. Most nasal bone fractures can be diagnosed with plain X ray and/or with computed tomography (CT). Radiography is also required for accurate treatment and postoperative evaluation . Although many authors have described classification systems for nasal fractures, there is no uniform system that has been universally advocated or applied. Stranc  described a classification system that is often cited in the literature. There is an increasing necessity for a satisfactory classification systems for nasal fractures.
There are several methods used for treating fractures of nasal bone including closed reduction, open reduction and septo-rhinoplasty. Closed reduction is the most common procedure used; that involves manipulation of nasal bones without incisions and performed either under local or anesthesia.
This retrospective study was carried out on 147 patients treated by closed reduction done under general anesthesia over a 6 years period. The male group were more involved in nasal trauma than females; by ratio of 3.4:1. This ratio is within the range described in the literature, which varied between 6:1 and 11.8:1 ,, This high vulnerability of male to most types of trauma may be associated with the fact that male have more outdoor activities and are involved in high risk jobs, thus being more vulnerable to accidents.
Many etiological factors have been associated with nasal bone fracture. In this study fall was the most common overall cause while football injury is the most common cause in the male group.
Analysis of the treatment results showed that about 44.2% of patients in this study were satisfied with closed reduction. Another 28.6% of the patients had some postoperative deformity but were not seeking further surgery. On the other hand, 26.5% of patients were totally unsatisfied and were looking for rhinoplasty procedure. The findings are comparable with 80% reported by Wild et al3, 71% reported by Watson et al  and by 65% by Yilmaz1 in adults and 62% in children . Similarly, in a study by Hung, 29% of patients were dissatisfied with closed reduction .These rather disappointing postoperative results indicate the need for improvement of our approach in the management of this common problem. Beekhuis advised to proceed for septorhinoplasty with osteotomy which have high percentage of straight nose then closed reduction . The optimal timing of closed reduction is not clear and varies throughout the literature , Generally, reduction should be done as soon as possible. The presence of edema might delay the reduction few days. In this study, patients presented later than 7 days for closed reduction have a high satisfaction rate than patient presented early for intervention. This could be due to the fact that presence of edema may adversely affect the outcome.
| Conclusion|| |
Closed reduction of fractured nose is a common procedure. However, the functional and the cosmetic results may not be satisfactory to a large section of the patients. A more thorough technique is required in order to achieve better outcome.
Financial Disclosure: No grants or financial support used for the completion of this study.
Conflict of Interest: None declared.
| References|| |
Yimaz MS, Guven M, Verli AF. Nasal fractures: is closed reduction satisfying? J Craniofac Surg.
Yimaz MS, Guven M, Verli AF: Efficacy of closed reduction for nasal fracture in children. Br J oral Maxill Surg.
Wild DC, EL Alami Conboy Reduction of nasal fractures under local anaesthesia: an acceptable practice? Sur J R Coll Surg Edinb Irel.
Watson DJ, Parker AJ, Slack RW, Griffiths MV. Local versus general anaesthesia in the management of fractured nose. Clin Otolaryngol.
1988; 13: 491-94.
Murray JA, Maran AG, Mackenzie IJ, Raab G. Open v closed reduction of the fractured nose. Arch Otolaryngol.
Scariot R, de Oliveira IA, Passeri LA, Rebellato NL, Müller PR. Maxillofacial injuries in a group of Brazilian subjects under 18 years of age. J Appl Oral Sci.
Atighechi S, Karimi G: Serial nasal bone reduction: A new approach to the management of nasal bone fracture. J Craniofac Surg.
Yabe T, Ozawa T, Sakamoto M, et al: Pre- and postoperative x-ray and computed tomography evaluation in acute nasal fracture. Ann Plast Surg.
Stranc MF, Robertson GA: A classification of injuries of the nasal skeleton. Ann Plast Surg.
Hachl O, Tuli T, Schwabegger A, Gassner R. Maxillofacial trauma due to work-related accidents. Int J Oral MaxillofacSurg.
Pombo M, Luaces-Rey R, Pértega S, Arenaz J, Crespo JL, García-Rozado A, et al. Review of 793 facial fractures treated from 2001 to 2008 in a coruña university hospital: types and etiology. Craniomaxillofac Trauma Reconstr.
Naveen Shankar A, Naveen Shankar V, Hegde N, Sharma, Prasad R. The pattern of the maxillofacial fractures - A multicentre retrospective study. J Craniomaxillofac Surg.
Hung, T., Chang, W., Vlastis, AC, et.al. Patient. Satisfaction After Closed Reduction of Nasal Fractures. Arch facial Plast Surg.
Beekhuis, G.,Symposium: Maxillofacial trauma, nasal fracture. Am Acad Ophthalmol Otol.
Descrosiers III AE, Thaller SR. Paediatric Nasal Fractures: Evaluation and Mangement. J Craniofac Surg.
Lee DH, Jang YJ. Pediatric nasal bone fractures: does delayed treatment really lead to adverse outcomes. Int J Pediatr Otorhinolaryngol.
[Table 1], [Table 2], [Table 3]