ACCORDANCE BETWEEN CLINICAL AND RADIOLOGIC FINDINGS OF NASAL BONE FRACTURE

Year 2017, Volume: 80 Issue: 1, 33 - 37, 31.03.2017

Mehmet Çelik , Said Sönmez Mehmet Melih Çiçek Levent Aydemir Mehmet Serkan Alpaslan Şenol Çomoğlu

https://doi.org/10.18017/iuitfd.309229

Abstract

Objective: The goal of our study was to compare physical
examination with plain X-ray findings in patients with a suspected nasal bone
fracture (NBF).

Methods: The study included 403 patients who received a
suspected NBF between 2014 and 2016; the files of these patients were
retrospectively reviewed. In our tertiary hospital, patients with nasal bone
trauma are principally admitted to the trauma and emergency department.
Patients are first examined by a general surgeon for suspected NBF. Afterwards,
lateral nasal radiography and otorhinolaryngology (ORL) consultations are
requested. Presence of crepitation, radiologic findings, swelling, deviation of
nasal axis, septal hematoma/fracture, and cause of trauma are all
documented. 
Results: The 403 patients who
presented to the trauma and emergency department for suspected NBF included 274
males and 129 females, the median age was 25±18.7 years (range, 2-106 years).
When the correlation between positive clinical and radiologic findings was analyzed,
crepitation was correlated with radiologic data in 155/156 (99.3%) cases,
deviation of nasal axis in 135/142 (95%), septal hematoma 4/5 (80%), swelling
in 103/134 (76.8%), laceration in 60/93 (64.5%), and epistaxis in 7/14 (50%).
The correlation of crepitation, deviation of nasal axis, and swelling with
radiologic evaluation were found statistically significant.

Conclusion: Crepitation of nasal bone, deviation of nasal axis
and swelling of the nasal dorsum were significantly correlated with plain X-ray
imaging that had a positive finding of fracture. We believe that these results
might have practical potential for diagnostic management and save time
especially in crowded emergency departments.

Keywords: Crepitation; epistaxis; nasal; nasal bone fracture;
plain X-ray; septal hematoma; trauma.

Keywords

Crepitation, epistaxis, nasal, nasal bone fracture, plain X-ray, septal hematoma, trauma

NAZAL KEMİK KIRIĞININ KLİNİK VE RADYOLOJİK BULGULARI ARASINDAKİ UYUMU

Abstract

Amaç:
Çalışmamızın amacı nazal kemik kırığı (NKK) olan hastalarda fizik muayene ile
düz grafi bulgularını karşılaştırmaktı.

Yöntem:
Çalışmada, 2014-2016 yılları arasında şüpheli nazal kemik fraktürü tanısı alan
403 hastanın dosyaları retrospektif olarak incelendi. Üçüncü basamak
hastanemizde, burun kemiği travması olan hastalar Travmatoloji ve Acil Cerrahi
başvurusunun ardından, NKK şüphesiyle lateral burun radyografisi ile Kulak
Burun Boğaz Servisi’ne konsülte edilmektedir. Hastaların bulguları krepitasyon,
şişlik, aks devisyonu ve septal hematom/kırık varlığına; radyolojik bulgulara
ve travmanın nedenine göre kategorize edildi.

 Bulgular: Nazal kemik kırığı şüphesi
nedeniyle değerlendirilen 403 hastanın 274 ü erkek ve 129 u kadın olup; medyan
yaş 25 ± 18.7 idi. (aralık; 2-106 yaş) Pozitif klinik ve radyolojik bulgular
arasındaki korelasyonu analiz ettiğimizde radyolojik verilerde; krepitasyon
155/156 (% 99.3), aks deviasyonu 135/142 (%95), septal hematom 4/5 (% 80),
şişlik 103/134 (% 76.8), laserasyon 60/93 (%64.5) ve burun kanaması 7/14(% 50)
oranında tespit edildi.

Krepitasyon, aks
deviasyonu ve şişlik ile radyolojik değerlendirme arasındaki korelasyon
istatistiksel olarak anlamlı bulundu.

Sonuç: Fizik muayene ile burun kemiğinin krepitasyonu, aks deviasyonu ve
burun dorsumunun şişmesi ile kırık bulgusu pozitif olan düz X-ray görüntüleme
arasında anlamlı korelasyon göstermiştir. Bu sonuçların, özellikle kalabalık
acil servislerde tanı yöntemleri için pratik bir potansiyele sahip
olabileceğine ve zaman kazandıracağına inanıyoruz.

Anahtar kelimeler: Burun; krepitasyon;
epistaksis; nazal; nazal kemik kırığı; direk grafi; septal hematom; travma.

Keywords

Burun, krepitasyon, epistaksis, nazal, nazal kemik kırığı, direk grafi, septal hematom, travma

References

• 1. Rhee SC, Kim YK, Cha JH, Kang SR, Park HS. Septal fracture in simple nasal bone fracture. Plastic and reconstructive surgery 2004; 113:45-52.
• 2. Murray JA, Maran AG, Mackenzie IJ, Raab G. Open v closed reduction of the fractured nose. Arch Otolaryngol 1984; 110:797-802.
• 3. Carvalho TB, Cancian LR, Marques CG, Piatto VB, Maniglia JV, Molina FD. Six years of facial trauma care: an epidemiological analysis of 355 cases. Braz J Otorhinolaryngol 2010; 76:565-74.
• 4. Rohrich RJ, Adams WP, Jr. Nasal fracture management: minimizing secondary nasal deformities. Plastic and reconstructive surgery 2000; 106:266-73.
• 5. SCHULTZ RC, TREMOLET deVILLERS Y. NASAL FRACTURES. Journal of Trauma and Acute Care Surgery 1975;15:319-27.
• 6. Gurkov R, Clevert D, Krause E. Sonography versus plain x rays in diagnosis of nasal fractures. Am J Rhinol 2008; 22:613-6.
• 7. Holt GR. Immediate open reduction of nasal septal injuries. Ear Nose Throat J 1978;57:343-54.
• 8. Perkins SW, Dayan SH. Management of nasal trauma. Aesthetic Plast Surg 2002; 26(1):3.
• 9. Basheeth N, Donnelly M, David S, Munish S. Acute nasal fracture management: A prospective study and literature review. The Laryngoscope 2015;125:2677-84.
• 10. Oluwasanmi AF, Pinto AL. Management of nasal trauma--widespread misuse of radiographs. Clinical performance and quality health care 2000;8:83-5.
• 11. Cil Y, Kahraman E. An analysis of 45 patients with pure nasal fractures. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES 2013; 19:152-6.
• 12. Remmler D, Denny A, Gosain A, Subichin S. Role of three-dimensional computed tomography in the assessment of nasoorbitoethmoidal fractures. Annals of plastic surgery 2000; 44:553-62; discussion 562-53.
• 13. Yabe T, Ozawa T, Sakamoto M, Ishii M. Pre- and postoperative x-ray and computed tomography evaluation in acute nasal fracture. Annals of plastic surgery 2004; 53:547-53.
• 14. Liu C, Legocki AT, Mader NS, Scott AR. Nasal fractures in children and adolescents: Mechanisms of injury and efficacy of closed reduction. International journal of pediatric otorhinolaryngology 2015; 79:2238-42.
• 15. Gharehdaghi J, Samadi Rad B, Ghatreh Samani V, Kolahi F, Khatami Zonoozian A, Marashian SM. Comparison of physical examination and conventional radiography in diagnosis of nasal fracture. Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India 2013; 65:304-7.
• 16. Higuera S, Lee EI, Cole P, Hollier LH, Jr., Stal S. Nasal trauma and the deviated nose. Plastic and reconstructive surgery 2007;120:64-75.
• 17. Hampson D. Facial injury: a review of biomechanical studies and test procedures for facial injury assessment. Journal of biomechanics 1995; 28:1-7.
• 18. Dingman R, Converse J. The clinical management of facial injuries and fractures of the facial bones. Reconstructive plastic surgery, WB Saunders, Philadelphia 1977:599-747.
• 19. Owen G, Parker A, Watson D. Fractured-nose reduction under local anaesthesia. Is it acceptable to the patient? Rhinology 1992; 30:89-96.
• 20. Stranc MF, Robertson GA. A classification of injuries of the nasal skeleton. Annals of plastic surgery 1979; 2:468-74.
• 21. Fomon S. The Surgery of Injury and Plastic Repair. Annals of Surgery 1940; 111:511.
• 22. Hwang K, You SH, Kim SG, Lee SI. Analysis of nasal bone fractures; a six-year study of 503 patients. The Journal of craniofacial surgery 2006; 17:261-4.