Nasal Fractures in Children and Adolescents: Mechanisms of Injury and Efficacy of Closed Reduction

Abstract

Objectives: (1) Determine the most common causes of traumatic nasal deformities referred to pediatric otolaryngology. (2) Examine the efficacy of closed reduction of nasal fractures in children and adolescents based on the parents’ and surgeon’s ratings of post-reduction nasal symmetry. Methods: Case series and chart review within an urban pediatric otolaryngology practice. Results: One hundred 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, 21% underwent closed reduction within a 14-day period following injury. All patients achieved symmetry in the operating room immediately following reduction. 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) was satisfied in 81% of cases. Both parent and surgeon were satisfied with postreduction symmetry 33% of the time. Conclusions: The most common source of traumatic nasal deformity in children and adolescents differs from the most frequent mechanisms of nasal trauma in adults. 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 1/3 of cases.

An Initial Survey of Septorhinoplasty in Crooked Nose Deformities

“…This may be related to the finding that the most common etiology of this deformity was trauma, most frequently due to physical violence, followed by sports related injuries, both of which more commonly involve males. 7 These data are consistent with results of previous demographic and epidemiologic studies on the Asian nose. 6 One of the patients had acquired the deformity from a previous rhinoplasty.…”

“…Together with the spreader graft, the camouflage graft, and the alar batten graft, the tip plasty done corrected the collapsed nostril and nasal ala present in the cleft lip-nose deformity. 7 Two patients had both a lower third level deviation and a middle level deviation. This includes the patient whose deformity was from a previous rhinoplasty.…”

Comparison of postoperative outcomes between early and delayed surgery for pediatric nasal fractures

“…In cases of greenstick fractures, the fracture segment is often not clearly identified; however, the condition of the fracture can be evaluated by checking abnormal bending or asymmetric bending on CT scans converted from two-dimensional to three-dimen- sional views. Greenstick fractures develop due to immature, soft, and resilient bone with thick and fibrous periosteum, and they may lead to incomplete repositioning of bone fragments or under-correction [8,17]. Four cases of typical greenstick or imprinted fractures were found in this study, all of which demonstrated incomplete repositioning of fracture segments into the pre-traumatic position regardless of the timing of reduction (Fig.…”

“…Previous studies of pediatric nasal fractures have investigated the incidence, etiology, treatment options, and outcomes [3,[6][7][8], but few reports have analyzed the time interval between in-…”