Research Article
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Nasal fractures and anesthetic applications

Year 2022, Volume: 35 Issue: 1, 107 - 114, 31.01.2022
https://doi.org/10.5472/marumj.1065843

Abstract

Objective: The aim of this study was to review and compare the demographic characteristics, radiological findings, pain scores
and the level of satisfaction of patients who underwent nasal fracture reduction (NFR) under sedation anesthesia (SA), infiltrative
anesthesia (IA) or topical anesthesia (TA).
Patients and Methods: Sixty patients were included in the study according to the types of anesthesia applied: SA group , IA group and
TA group. Demographic data (age, gender, etiology, duration and time to NFR), radiological findings (presence of septal fracture,
hematoma), pain scores, nasal patency and cosmetic satisfaction levels were analyzed.
Results: The mean age of patients was 23.8 ± 19.3. The mean age of females was 23 (38.3%) and mean age of males was 37 (61.7%). The
mean age of the SA group was 6.1±4. The most common etiology was falls, (39 patients 65%). Duration of the operation was higher in
patients (TA group) who had closed reduction. Pain score was lowest at 0 hour in the IA group (open reduction), while it was lowest
at 48 hours in the TA group. Cosmetic satisfaction level was high in the SA group (p<0.05). Septal fracture was detected in 95% of the
patients and septal hematoma in 36% of the patients in tomographic evaluation.
Conclusion: Sedation anesthesia was applied mostly to children, whereas, IA and TA were mostly applied to adult patients due
to patient compliance. Short operation time and immediate pain control were advantages of IA.TA was preferred when cosmetic
expectations were low in adults. Septal fracture and hematoma that cause nasal deformations, frequently seen in nasal fracture, may
be missed by physical examination but can easily be detected by tomographic examination, but the risks of tomography should be
noted.

References

  • Al-Moraissi EA, Ellis E III. Local versus general anesthesia for the management of nasal bone fractures: a systematic review and meta-analysis. J Oral Maxillofac Surg 2015 ;73:606-15. doi: 10.1016/j.joms.2014.10.013.
  • Cohn JE, Othman S, Toscano M, Shokri T, Bloom JD, Zwillenberg S. Nasal bone fractures: Differences amongst sub-specialty consultants. Ann Otol Rhinol Laryngol 2020; 129:1120-8. doi: 10.1177/000.348.9420931562.
  • Lu GN, Humphrey CD, Kriet JD. Correction of nasal fractures. Facial Plast Surg Clin North Am 2017 ;25:537-46. doi: 10.1016/j.fsc.2017.06.005.
  • Ichida M, Komuro Y, Koizumi T, Shimizu A, Yanai A. A repositioning technique for nasal fracture using the little finger. J Craniofac Surg 2008 ;19:1512-7. doi: 10.1097/ SCS.0b013e31818b37e0.
  • Ondik MP, Lipinski L, Dezfoli S, Fedok FG. The treatment of nasal fractures: a changing paradigm. Arch Facial Plast Surg 2009 ;11:296-302. doi: 10.1001/archfacial.2009.65
  • Ortega A, Gauna F, Munoz D, Oberreuter G, Breinbauer HA, Carrasco L. Music therapy for pain and anxiety management in nasal bone fracture reduction: Randomized controlled clinical trial. Otolaryngol Head Neck Surg 2019 ;161:613-9. doi: 10.1177/019.459.9819856604.
  • Coté CJ, Wilson S. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatr Dent 2019; 41:26E-52E.
  • Kyung H, Choi JI, Song SH, Oh SH, Kang N. Comparison of postoperative outcomes between monitored anesthesia care and general anesthesia in closed reduction of nasal fracture. J Craniofac Surg 2018 ;29:286-8. doi: 10.1097/ SCS.000.000.0000004084.
  • Park KS, Kim SS, Lee WS, Yang WS. The Algorithm-oriented management of nasal bone fracture according to stranc’s classification system. Arch Craniofac Surg 2017 ;18:97-104. doi: 10.7181/acfs.2017.18.2.97.
  • Butterworth JF, Mackey D C, Wasnick J D, (Eds). Morgan and Michail’s Clinical Anesthesiology, 5e.New York: McGraw-Hill, 2013.
  • Hwang K, Ki SJ, Ko SH. Etiology of nasal bone fractures. J Craniofac Surg 2017 ;28:785-8. doi: 10.1097/ SCS.000.000.0000003477.
  • Chadha NK, Repanos C, Carswell AJ. Local anaesthesia for manipulation of nasal fractures: systematic review. J Laryngol Otol 2009 ;123:830-6. doi: 10.1017/S002.221.510900560X.
  • Yu H, Jeon M, Kim Y, Choi Y. Epidemiology of violence in pediatric and adolescent nasal fracture compared with adult nasal fracture: An 8-year study. Arch Craniofac Surg 2019; 20:228-32. doi: 10.7181/acfs.2019.00346.
  • Cook JA, Murrant NJ, Evans K, Lavelle RJ. Manipulation of the fractured nose under local anaesthesia. Clin Otolaryngol Allied Sci 1992 ;17:337-40. doi: 10.1111/j.1365-2273.1992. tb01008.x.
  • Kim HS, Lee HK, Jeong HS, Shin HW Decreased postoperative pain after reduction of fractured nasal bones using a nerve block of the anterior ethmoidal nerve. Int J Oral Maxillofac Surg 2013 ;42:727-31. doi: 10.1016/j.ijom.2013.01.017.
  • Mohammadi A, Ghasemi-Rad M. Nasal bone fracture— ultrasonography or computed tomography? Med Ultrason 2011 ;13:292-5. PMID: 22132401.
  • Rhee SC, Kim YK, Cha JH, Kang SR, Park HS. Septal fracture in simple nasal bone fracture. Plast Reconstr Surg 2004; 113:45-52. doi: 10.1097/01.PRS.000.009.6705.64545.69
  • Sayin I, Yazici ZM, Bozkurt E, Kayhan FT. Nasal septal hematoma and abscess in children. J Craniofac Surg 2011; 22:e17-9. doi: 10.1097/SCS.0b013e31822ec801.
  • Ayatollahi V, Vafaiyan M, Hatami M, Behdad S. Two different concentrations of ketofol for procedural sedation and analgesia in closed reduction of nasal fracture. J Craniofac Surg 2016; 27:996-1000. doi: 10.1097/SCS.000.000.0000002660.
  • Atighechi S, Baradaranfar MH, Akbari SA. Reduction of nasal bone fractures: a comparative study of general, local, and topical anesthesia techniques. J Craniofac Surg 2009 ;20:382- 4. doi: 10.1097/SCS.0b013e31819b945f.
  • Sclafani AP, Kim M, Kjaer K, Kacker A, Tabaee A. Postoperative pain and analgesic requirements after septoplasty and rhinoplasty. Laryngoscope. 2019 ;129:2020-5. doi:10.1002/ lary.27913.
  • Zhu J, Liu J, Shen G, Zhong T, Yu X. Comparison of efficacy outcomes of lidocaine spray, topical lidocaine injection, and lidocaine general anesthesia in nasal bone fractures surgeries: A randomized, controlled trial. Med Sci Monit 2018 ;24:4386- 94. doi:10.12659/MSM.908468.
  • Ridder GJ, Boedeker CC, Fradis M, Schipper J. Technique and timing for closed reduction of isolated nasal fractures: a retrospective study. Ear Nose Throat J 2002;81:49-54.
  • Hung T, Chang W, Vlantis AC, Tong MC, van Hasselt CA. Patient satisfaction after closed reduction of nasal fractures. Arch Facial Plast Surg 2007;9:40-3 doi: 10.1001/archfaci.9.1.40.
  • Yilmaz MS, Guven M, Varli AF. Nasal fractures: is closed reduction satisfying? J Craniofac Surg 2013; 24:e36-8. doi: 10.1097/SCS.0b013e3182688ea1.
  • Rajapakse Y, Courtney M, Bialostocki A, Duncan G, Morrissey G. Nasal fractures: a study comparing local and general anaesthesia techniques. ANZ J Surg 2003 ;73:396-9. doi: 10.1046/j.1445-2197.2003.t01-1-02615.x.
  • Vilela F, Granjeiro R, Maurício C Júnior, Andrade P. Applicability and effectiveness of closed reduction of nasal fractures under local anesthesia. Int Arch Otorhinolaryngol 2014; 18:266-71. doi: 10.1055/s-0034.136.8138.
Year 2022, Volume: 35 Issue: 1, 107 - 114, 31.01.2022
https://doi.org/10.5472/marumj.1065843

Abstract

References

  • Al-Moraissi EA, Ellis E III. Local versus general anesthesia for the management of nasal bone fractures: a systematic review and meta-analysis. J Oral Maxillofac Surg 2015 ;73:606-15. doi: 10.1016/j.joms.2014.10.013.
  • Cohn JE, Othman S, Toscano M, Shokri T, Bloom JD, Zwillenberg S. Nasal bone fractures: Differences amongst sub-specialty consultants. Ann Otol Rhinol Laryngol 2020; 129:1120-8. doi: 10.1177/000.348.9420931562.
  • Lu GN, Humphrey CD, Kriet JD. Correction of nasal fractures. Facial Plast Surg Clin North Am 2017 ;25:537-46. doi: 10.1016/j.fsc.2017.06.005.
  • Ichida M, Komuro Y, Koizumi T, Shimizu A, Yanai A. A repositioning technique for nasal fracture using the little finger. J Craniofac Surg 2008 ;19:1512-7. doi: 10.1097/ SCS.0b013e31818b37e0.
  • Ondik MP, Lipinski L, Dezfoli S, Fedok FG. The treatment of nasal fractures: a changing paradigm. Arch Facial Plast Surg 2009 ;11:296-302. doi: 10.1001/archfacial.2009.65
  • Ortega A, Gauna F, Munoz D, Oberreuter G, Breinbauer HA, Carrasco L. Music therapy for pain and anxiety management in nasal bone fracture reduction: Randomized controlled clinical trial. Otolaryngol Head Neck Surg 2019 ;161:613-9. doi: 10.1177/019.459.9819856604.
  • Coté CJ, Wilson S. Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. Pediatr Dent 2019; 41:26E-52E.
  • Kyung H, Choi JI, Song SH, Oh SH, Kang N. Comparison of postoperative outcomes between monitored anesthesia care and general anesthesia in closed reduction of nasal fracture. J Craniofac Surg 2018 ;29:286-8. doi: 10.1097/ SCS.000.000.0000004084.
  • Park KS, Kim SS, Lee WS, Yang WS. The Algorithm-oriented management of nasal bone fracture according to stranc’s classification system. Arch Craniofac Surg 2017 ;18:97-104. doi: 10.7181/acfs.2017.18.2.97.
  • Butterworth JF, Mackey D C, Wasnick J D, (Eds). Morgan and Michail’s Clinical Anesthesiology, 5e.New York: McGraw-Hill, 2013.
  • Hwang K, Ki SJ, Ko SH. Etiology of nasal bone fractures. J Craniofac Surg 2017 ;28:785-8. doi: 10.1097/ SCS.000.000.0000003477.
  • Chadha NK, Repanos C, Carswell AJ. Local anaesthesia for manipulation of nasal fractures: systematic review. J Laryngol Otol 2009 ;123:830-6. doi: 10.1017/S002.221.510900560X.
  • Yu H, Jeon M, Kim Y, Choi Y. Epidemiology of violence in pediatric and adolescent nasal fracture compared with adult nasal fracture: An 8-year study. Arch Craniofac Surg 2019; 20:228-32. doi: 10.7181/acfs.2019.00346.
  • Cook JA, Murrant NJ, Evans K, Lavelle RJ. Manipulation of the fractured nose under local anaesthesia. Clin Otolaryngol Allied Sci 1992 ;17:337-40. doi: 10.1111/j.1365-2273.1992. tb01008.x.
  • Kim HS, Lee HK, Jeong HS, Shin HW Decreased postoperative pain after reduction of fractured nasal bones using a nerve block of the anterior ethmoidal nerve. Int J Oral Maxillofac Surg 2013 ;42:727-31. doi: 10.1016/j.ijom.2013.01.017.
  • Mohammadi A, Ghasemi-Rad M. Nasal bone fracture— ultrasonography or computed tomography? Med Ultrason 2011 ;13:292-5. PMID: 22132401.
  • Rhee SC, Kim YK, Cha JH, Kang SR, Park HS. Septal fracture in simple nasal bone fracture. Plast Reconstr Surg 2004; 113:45-52. doi: 10.1097/01.PRS.000.009.6705.64545.69
  • Sayin I, Yazici ZM, Bozkurt E, Kayhan FT. Nasal septal hematoma and abscess in children. J Craniofac Surg 2011; 22:e17-9. doi: 10.1097/SCS.0b013e31822ec801.
  • Ayatollahi V, Vafaiyan M, Hatami M, Behdad S. Two different concentrations of ketofol for procedural sedation and analgesia in closed reduction of nasal fracture. J Craniofac Surg 2016; 27:996-1000. doi: 10.1097/SCS.000.000.0000002660.
  • Atighechi S, Baradaranfar MH, Akbari SA. Reduction of nasal bone fractures: a comparative study of general, local, and topical anesthesia techniques. J Craniofac Surg 2009 ;20:382- 4. doi: 10.1097/SCS.0b013e31819b945f.
  • Sclafani AP, Kim M, Kjaer K, Kacker A, Tabaee A. Postoperative pain and analgesic requirements after septoplasty and rhinoplasty. Laryngoscope. 2019 ;129:2020-5. doi:10.1002/ lary.27913.
  • Zhu J, Liu J, Shen G, Zhong T, Yu X. Comparison of efficacy outcomes of lidocaine spray, topical lidocaine injection, and lidocaine general anesthesia in nasal bone fractures surgeries: A randomized, controlled trial. Med Sci Monit 2018 ;24:4386- 94. doi:10.12659/MSM.908468.
  • Ridder GJ, Boedeker CC, Fradis M, Schipper J. Technique and timing for closed reduction of isolated nasal fractures: a retrospective study. Ear Nose Throat J 2002;81:49-54.
  • Hung T, Chang W, Vlantis AC, Tong MC, van Hasselt CA. Patient satisfaction after closed reduction of nasal fractures. Arch Facial Plast Surg 2007;9:40-3 doi: 10.1001/archfaci.9.1.40.
  • Yilmaz MS, Guven M, Varli AF. Nasal fractures: is closed reduction satisfying? J Craniofac Surg 2013; 24:e36-8. doi: 10.1097/SCS.0b013e3182688ea1.
  • Rajapakse Y, Courtney M, Bialostocki A, Duncan G, Morrissey G. Nasal fractures: a study comparing local and general anaesthesia techniques. ANZ J Surg 2003 ;73:396-9. doi: 10.1046/j.1445-2197.2003.t01-1-02615.x.
  • Vilela F, Granjeiro R, Maurício C Júnior, Andrade P. Applicability and effectiveness of closed reduction of nasal fractures under local anesthesia. Int Arch Otorhinolaryngol 2014; 18:266-71. doi: 10.1055/s-0034.136.8138.
There are 27 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Research
Authors

Neslihan Sarı This is me 0000-0001-7164-3933

Publication Date January 31, 2022
Published in Issue Year 2022 Volume: 35 Issue: 1

Cite

APA Sarı, N. (2022). Nasal fractures and anesthetic applications. Marmara Medical Journal, 35(1), 107-114. https://doi.org/10.5472/marumj.1065843
AMA Sarı N. Nasal fractures and anesthetic applications. Marmara Med J. January 2022;35(1):107-114. doi:10.5472/marumj.1065843
Chicago Sarı, Neslihan. “Nasal Fractures and Anesthetic Applications”. Marmara Medical Journal 35, no. 1 (January 2022): 107-14. https://doi.org/10.5472/marumj.1065843.
EndNote Sarı N (January 1, 2022) Nasal fractures and anesthetic applications. Marmara Medical Journal 35 1 107–114.
IEEE N. Sarı, “Nasal fractures and anesthetic applications”, Marmara Med J, vol. 35, no. 1, pp. 107–114, 2022, doi: 10.5472/marumj.1065843.
ISNAD Sarı, Neslihan. “Nasal Fractures and Anesthetic Applications”. Marmara Medical Journal 35/1 (January 2022), 107-114. https://doi.org/10.5472/marumj.1065843.
JAMA Sarı N. Nasal fractures and anesthetic applications. Marmara Med J. 2022;35:107–114.
MLA Sarı, Neslihan. “Nasal Fractures and Anesthetic Applications”. Marmara Medical Journal, vol. 35, no. 1, 2022, pp. 107-14, doi:10.5472/marumj.1065843.
Vancouver Sarı N. Nasal fractures and anesthetic applications. Marmara Med J. 2022;35(1):107-14.