Nasal bone fracture (NBF) is the most common fracture of the facial skeleton and the third most common fracture of the body.[
1] It is estimated that on the facial region, NBFs are presented in almost 40% of the cases.[
2] In fact, according to the National Institute for Health Statistics, each year over 50,000 people suffer from a NBF in the United States.[
1] Furthermore, in our institution, nasal trauma accounts for more than 45% of office visits and 30% of all surgeries.[
3] This is due to the fact that the nose is the most anteriorly projecting facial structure and the forces required to cause significant injury are less than those required for other facial fractures. But NBF is usually considered a minor problem because it involves small bones that are treated with a simple procedure under local anesthesia usually resulting in good results with low number of complications.
The diagnosis of nasal fractures requires a thorough history and physical examination. Patients with nasal fractures usually present with some combination of epistaxis, ecchymosis, deformity, tenderness, edema, instability, and crepitation; however, these symptoms and signs may not be present or may be transient with low sensitivity and specificity.[
3] In addition, NBF diagnosis is based on radiology, but the usefulness of simple X-rays in the clinical decision making of nasal trauma is highly controversial.[
4,
5,
6,
7] Since its first description in the Edwin Smith papyrus 5,000 years ago, closed nasal reduction has been considered the standard of care as a relatively short, simple, and effective procedure.[
8] Unfortunately, patient and surgeon satisfaction after close nasal reduction is very low,[
9] and postreduction nasal deformities requiring rhinoplasty or rhinoseptoplasty ranges from 14 to 50%.[
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10,
11,
12,
13,
14]
Considering all the aforementioned points, it seems that NBF is not a minor problem with a simple solution. In the literature, just a few studies have tried to understand the reasons for these difficulties and poor outcomes.[
8,
15,
16,
17] There are still many unresolved questions like timing for nasal bone reduction, treatment of the septum, and postoperative assessment in this group of patients. The purpose of this study was to assess the outcomes of closed nasal reduction in a large retrospective cohort during a long period of time and determine factors influencing treatment and outcomes in patients with nasal trauma.
Patients and Methods
Patients and Design
A retrospective cohort study was conducted that included all patients who were attended at the Maxillofacial Surgery Department outpatient clinic of the Hospital del Trabajador de Santiago-Chile for nasal trauma between January and December 2010. Patients consulting after 30 days of nasal trauma, or treatedbyanother specialty (ENTof plastic surgery), or not considered as a working accident (private patients) were excluded from the study. A total of 220 patients consulted over the above-mentioned period met the inclusion criteria and were included in the investigation. The ethical committee of our hospital approved the completion of this work.
Follow-Up
In December 2015, the medical records of nasal trauma patients were thoroughly reviewed. This revision included patient demographic data, comorbidities, trauma history, clinical presentation, presence of other fractures in the head and neck region, presence of other lesions in the body, and radiologic reports. Indications for surgery, time elapsed between the accident and surgery, surgical records, presence of complications, and reoperations were also reviewed. If the patient did not have an office visit during 2016, he/she was contacted by thehospital nurse coordinator to arrange another visit. If the patient was not able to cometo the visit, a telephone interview was performed and pictures were asked by e-mail. If it was not possible to contact the patient or his/her family, the last office visit registered in the clinical chart was considered his final follow-up. If the patient was not traceable and had less than 6 months of follow-up, was considered as a lost patient. The closing date for the study was July 2016.
Statistics
Continuous variables are described as mean and standard deviation, ordinal variables as mean and interquartile range, and categorical variables as percentages. A univariate analysis between complications and risk factors was performed using the chi-squared or Fisher’s exact test when the sample was small (n < 5) for categorical variables, and a t-test for continuous variables. For the multivariate analysis, a logistic regression model was used to explore the prognostic role of the variables considered to have clinical relevance and to estimate the odds ratio for the occurrence of postoperative complications. A two-tailed p-value <0.05 was considered statistically significant and all confidence intervals are reported in the 95% range. All calculations were performed using SPSS for Windows, version 14.0 (Chicago, IL).
