Optimizing treatment of nasal fractures.

Abstract

A graduated protocol involving closed reduction, septoplasty, osteotomies, upper lateral cartilage release, anterior perpendicular plate fracture, and camouflaging cartilage grafts yields a higher percentage of straight noses in cases of acute fracture than treatment with closed reduction alone. Retrospective chart and literature review followed by a prospective, non-randomized sequential trial. Closed reduction was performed on 26 cases of acute nasal fracture and the results were compared with a subsequent series of 79 cases treated using a more complete protocol. The cases treated with the more complete protocol yielded straighter noses. The difference was statistically significant using Wilcoxon rank sum analysis at the P=.028 level. Treatment of the acutely fractured nose involving an individually tailored protocol of closed reduction, septoplasty, osteotomies, release of the upper lateral cartilages, fracture of the anterior extension of the perpendicular plate of the ethmoid, and camouflaging cartilage grafts yields straighter noses than treatment by closed reduction alone.