Overcorrection of Nasal Bone Fracture Reduction Can Be Minimized by Packing Removal

Abstract

but also in groups 2 and 3. In our case, the bone defect involved both the periosteum and dura mater, which could not be separated. Therefore, the bone graft could not be transplanted under the periosteum, so was transplanted onto the periosteum, which might explain why the grafted bone developed osteolysis and no osteogenesis occurred. The grafted bone, which was put back into the donor site on the dura and under the periosteum, subsequently returned to the same thickness as that measured before harvest.Large skull defects have various causes in children and require cranioplasty at a relatively young age to protect the brain and for cosmetic purposes. Although autologous bone should be used for cranioplasty in children whenever possible, other cranioplasty materials, such as artificial bone or a frozen bone allograft, may be used. In our patient, we considered that prolonged waiting was not in the interests of day-to-day safety. Given that we could not identify the cause of autologous bone resorption after the first surgery and needed to avoid resorption after a second surgery, we chose artificial bone as the material for cranioplasty. The patient is progressing well and no complications have arisen as a result of use of artificial bone. CONCLUSIONSWe have encountered a case of short-term resorption of grafted bone after split calvarial bone grafting for an occipital skull defect in a patient with multisystem LCH. To our knowledge, this is the first report of such a case. We considered 2 possible explanations for resorption of the autologous bone graft in this patient. The first possibility is that the recipient site may have contained an active lesion. In a case of LCH, even if the clinical and imaging findings indicate that the disease is in remission, treatment should proceed, whereas keeping in mind the possibility of a locally active lesion. A rapid intraoperative pathologic assessment or preoperative biopsy may need to be considered to confirm whether the lesion is active. The second possibility is that bone resorption occurred because the bone graft was placed onto the periosteum. The bone graft should be placed beneath the periosteum whenever possible.

The Efficacy of Sequential Intranasal Packing Removal in Overcorrected Nasal Bone Fracture: Evaluation With Computed Tomography

“…We experienced 6 cases of overcorrected nasal bone fracture with a closed reduction based on our retrospective medical chart reviews, including routine preoperative and postoperative CT scans. To our knowledge, only one study by Hwang et al 1 suggested that overcorrection of nasal bone fracture reduction can be minimized by packing removal.…”

Analysis of Nasal Bone Fractures: A 17-year Study of 3785 Patients

“…In our previous paper, re-exploration was performed in 1.36% of patients who underwent closed reduction, about 7.78 days after initial surgery. The indications for re-exploration were undercorrection or deviation of the reduced nasal bone 9 …”