In a small series of patients who underwent closed reduction, the standard procedure to repair a broken nose, nearly one-third reported dissatisfaction with the outcome and about one-third said they would consider further surgery to correct their nasal deformities, according to a report in the January/February issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.
Closed reduction involves repositioning nasal bones without an open surgical incision. It is typically performed within seven days of nasal fracture for children and within 10 days for adults, according to background information in the article. “This method, although simple, fails to address deformities of the cartilaginous framework and the nasal septum caused by the injury,” the authors write. “Increasing evidence shows that patients have persistent aesthetic concerns about the outcome and obstructive symptoms after closed reductions.”
Terry Hung, M.B.Chir., F.R.C.S., and colleagues at The Chinese University of Hong Kong, Prince of Wales Hospital, interviewed 62 patients who underwent a closed reduction between July 1, 2002, and June 30, 2005. The interviews assessed patients’ satisfaction and the severity of their deformity aesthetically and functionally both before and after the procedure. Satisfaction and severity were assessed on a scale from one to five, with one being very satisfied or least severe and five being very dissatisfied and most severe.
Fifty patients (81 percent) were male and 12 (19 percent) were female, and they had an average age of 27.7 years. Forty-five percent of nasal fractures were caused by sports injuries, 23 percent by physical altercations or assaults and 10 percent by motor vehicle crashes. The average score for nasal deformity was 3.08 before surgery and 1.62 after surgery, the average score for aesthetic concern was 2.97 before surgery and 1.54 following, and the average score for nasal obstruction was 2.03 before surgery and 1.36 after surgery. Following the closed reduction, eight patients (13 percent) reported dissatisfaction with their nasal deformity, seven (11 percent) were dissatisfied with the aesthetic appearance as a result of nasal deformities and 13 (21 percent) were dissatisfied because of nasal obstruction.
“Eighteen patients (29 percent) indicated that they would like revision surgery to correct an aesthetic and/or nasal airway problem,” the authors write. “Of those who requested revision surgery, four (24 percent) wanted surgery for both cosmetic and functional reasons, six (35 percent) wanted surgery for nasal obstruction alone and eight (47 percent) wanted surgery for aesthetic reasons alone.”
Although many of the patients reported improvements in nasal structure and function following surgery, the large number of dissatisfied patients suggests that alternative procedures might work better for some, the authors continue. “A stringent preoperative assessment is paramount, before patients are advised to undergo a closed reduction of a nasal fracture,” they conclude. “A septorhinoplasty may be offered as a definitive and/or elective procedure when the post-injury assessment suggests that a closed reduction of the nasal fracture may be inadequate to address all the deformities.”