title: Repair of nasal complex fractures and the need for secondary septo-rhinoplasty.
abstract: OBJECTIVE
  This study was undertaken to evaluate the efficacy of closed reduction of nasal fractures and determine the incidence of the need for post-traumatic septo-rhinoplasty in the management of residual nasal deformities.
  
  
  METHODS
  Medical records of all patients with nasal fractures evaluated and treated by the Division of Oral and Maxillofacial Surgery at the University of Florida Health Science Center, Jacksonville, FL between January 2001 and October 2004 were retrospectively evaluated. Out of a total of 344 patients, 50 patients met the inclusion criteria. Forty-four patients (group A) underwent closed reduction of nasal bones and septum along with a septoplasty if needed within 2 weeks of initial injury. Six patients (group B) could not tolerate any surgical intervention because of multisystem injury or comorbidities. All 50 patients were then followed up in the Division of Oral and Maxillofacial Surgery to determine overall efficacy of the initial treatment modality, as well as the need for secondary post-traumatic septo-rhinoplasty. Group A was then further subdivided into groups A1 and A2. Group A1 consisted of patients who underwent a closed reduction of their nasal complex fracture without a residual deformity or the need for a secondary post-traumatic septo-rhinoplasty. Group A2 consisted of patients who underwent a closed reduction of their nasal complex fracture and developed a secondary nasal deformity significant enough to require a septo-rhinoplasty.
  
  
  RESULTS
  The follow-up period ranged from 1 week to 12 months. Nine patients in group A were lost to follow-up. Patients in group A1 (31 patients) were pleased with their results and did not require a secondary surgery. Four patients developed a post-traumatic nasal deformity requiring a post-traumatic septo-rhinoplasty (group A2). All patients in group B required post-traumatic septo-rhinoplasty.
  
  
  CONCLUSIONS
  Closed reduction of nasal fractures appears to be an effective method of treatment as long as careful attention is paid to the key regions in the nasal complex, including the septum at the initial time of treatment. Ideal results are obtained when surgery is performed within 2 weeks of initial injury. Factors such as timing of surgery, the status of the nasal septum, delay in treatment, and other associated injuries may influence the overall result.
authors.affiliation: Division of Oral and Maxillofacial Surgery, University of Florida, Jacksonville, FL, USA. Tirbod.Fattahi@jax.ufl.edu
authors.forename: Tirbod
authors.initials: T
authors.lastname: Fattahi
authors.forename: Barry
authors.initials: B
authors.lastname: Steinberg
authors.forename: Rui
authors.initials: R
authors.lastname: Fernandes
authors.forename: Maneesh
authors.initials: M
authors.lastname: Mohan
authors.forename: Erik
authors.initials: E
authors.lastname: Reitter
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation; D050724:Fractures, Cartilage / Q000150:complications / Q000601:surgery*; D005596:Fractures, Closed / Q000601:surgery; D006801:Humans; D008297:Male; D009295:Nasal Bone / Q000293:injuries* / Q000601:surgery; D009300:Nasal Septum / Q000293:injuries* / Q000601:surgery; D020380:Needs Assessment; D009667:Nose Deformities, Acquired / Q000601:surgery*; D012189:Retrospective Studies; D012225:Rhinoplasty; D012887:Skull Fractures / Q000150:complications / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome