title: Improving Results in Closed Nasal Reduction: A Protocol for Reducing Secondary Deformity.
abstract: BACKGROUND
  Nasal fractures are the most common facial fracture. Improper reduction is a common occurrence, resulting in a residual deformity that requires secondary surgery. A treatment protocol for nasal fracture management is presented with the aim of reducing secondary deformities requiring corrective surgery.
  
  
  METHODS
  After institutional review board approval, a retrospective review of all closed nasal reductions performed by a single surgeon between 2006 and 2015 was conducted. Patient age, sex, presence of secondary deformity, and need for a correctional operation were recorded. Clinical records were analyzed for evidence of postoperative deformity and need for subsequent manipulation or surgery.
  
  
  RESULTS
  A total of 90 patients with nasal bone fractures who underwent closed nasal reduction were identified. The mean age of patients was 24.9 years. The male-to-female ratio was 2.2:1. Postoperative deformity was reported in 14 patients (15.6 percent). Four of the 90 patients (4.4 percent) were found to have avulsion of their upper lateral cartilage from the nasal bone. Nine of the 14 subjects (64.3 percent) presenting with secondary deformity were managed with external manipulation, avoiding a secondary operation. Five patients (5.5 percent) from the original cohort of 90 underwent revision surgery.
  
  
  CONCLUSIONS
  By using the described protocol to treat nasal fractures, we have seen a low rate of postreduction deformity and a small percentage of need for secondary operation. The overall success rate of closed nasal reduction with postoperative manipulation (when necessary) was identified to be 94.5 percent. Using this protocol, surgeons may see a decrease in secondary deformities following closed nasal reduction procedures.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: St. Louis, Mo.|From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: Farber
authors.affiliation: St. Louis, Mo.|From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine.
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Nguyen
authors.affiliation: St. Louis, Mo.|From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine.
authors.forename: Rajiv P
authors.initials: RP
authors.lastname: Parikh
authors.affiliation: St. Louis, Mo.|From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine.
authors.forename: Judy L
authors.initials: JL
authors.lastname: Jang
authors.affiliation: St. Louis, Mo.|From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine.
authors.forename: Albert S
authors.initials: AS
authors.lastname: Woo
mesh_terms: D000328:Adult; D000465:Algorithms; D002985:Clinical Protocols; D000070628:Closed Fracture Reduction / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009295:Nasal Bone / Q000293:injuries*; D009667:Nose Deformities, Acquired / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012887:Skull Fractures / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome