title: Nasal fractures in children and adolescents: Mechanisms of injury and efficacy of closed reduction.
abstract: OBJECTIVE
  To determine the most common mechanisms of traumatic nasal deformity referred to pediatric otolaryngology. To examine the efficacy of closed reduction of nasal fractures in children and adolescents based on the parents' and surgeons' ratings of post-reduction nasal symmetry.
  
  
  METHODS
  Case series and chart review within an urban, tertiary pediatric otolaryngology practice.
  
  
  RESULTS
  100 cases of traumatic nasal deformity met inclusion criteria over a 3-year study period. The mean age at presentation was 13 years (4 weeks-18 years); 55% were male and 70% were over the age of 12 years. The most common mechanism of injury was sports-related trauma (28%), followed by accidental trauma (21%), interpersonal violence (10%), motor vehicle collision (6%) and alcohol-related (2%). Of these 100 cases, 22% underwent closed reduction within a 14-day period following injury. All patients achieved symmetry in the operating room immediately following reduction. 21 of 22 post-reduction patients were assessed for nasal symmetry at the postoperative visit (7-10 days following surgery). The operating surgeon was satisfied with nasal symmetry in 43% of cases and the parent(s) satisfied in 81% of cases. Both parent and surgeon were satisfied with post-reduction symmetry 33% of the time.
  
  
  CONCLUSIONS
  The most common sources of traumatic nasal deformity in children and adolescents vary by age. In cases meriting operative intervention, parents appear to be satisfied with early postoperative results following closed reduction in approximately 80% of cases, however a result in which both parent and surgeon agree with successful re-establishment of symmetry occurs in only one-third of cases.
authors.affiliation: Department of Otolaryngology, Tufts University School of Medicine, Boston, MA, United States.
authors.forename: Clive
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Otolaryngology, Tufts University School of Medicine, Boston, MA, United States.
authors.forename: Alex T
authors.initials: AT
authors.lastname: Legocki
authors.affiliation: The University of Chicago, Chapin Hall, Chicago, IL, United States.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Mader
authors.affiliation: Division of Pediatric Otolaryngology and Facial Plastic Surgery, Department of Otolaryngology - Head & Neck Surgery, Floating Hospital for Children - Tufts Medical Center, Boston, MA, United States. Electronic address: ascott@tuftsmedicalcenter.org.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Scott
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D001265:Athletic Injuries / Q000150:complications; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009295:Nasal Bone / Q000293:injuries*; D009667:Nose Deformities, Acquired / Q000209:etiology*; D010290:Parents / Q000523:psychology; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012887:Skull Fractures / Q000209:etiology* / Q000628:therapy*; D016896:Treatment Outcome; D014754:Violence
keywords: Closed reduction; Efficacy; Mechanisms of injury; Nasal fracture; Pediatric; Satisfaction