Nasal fractures: the taming of the shrewd.

OBJECTIVE/HYPOTHESIS: Closed reduction of nasal fractures has not been a satisfactory approach. Graduated protocols yield better results. Because a significant proportion of these closed reduction patients refuse a second operation, would it be better to resort to a full septorhinoplasty at the first operation and therefore decrease the post first operation deformity rate?

STUDY DESIGN: Retrospective review of patients treated by the closed reduction technique and with a full septorhinoplasty approach.

METHODS: Thirty-four patients treated by the closed reduction technique were surveyed by telephone, and thus only patient satisfaction, which is usually higher in most studies, was allowed to influence the outcome. In another study, 52 patients treated with a full septorhinoplasty were reviewed by the surgeon.

RESULTS: Sixty-two percent of the closed reductions had esthetic or obstructive concerns. Of these with esthetic or obstructive concerns, 62% will not have a second operation for correction. Only 11.5% of those undergoing a full septorhinoplasty had esthetic concerns.

CONCLUSION: It may be necessary to adopt an early full septorhinoplasty approach in the initial treatment of nasal fractures to reduce the post first operation deformity/obstruction rates.