Reduction of Nasal Bone Fracture using Ultrasound Imaging during Surgery

Abstract

BackgroundMost nasal bone fractures are corrected using non-invasive methods. Often, patients are dissatisfied with surgical outcomes following such closed approach. In this study, we compare surgical outcomes following blind closed reduction to that of ultrasound-guided reduction.MethodsA single-institutional prospective study was performed for all nasal fracture patients (n=28) presenting between May 2013 and November 2013. Upon research consent, patients were randomly assigned to either the control group (n=14, blind reduction) or the experimental group (n=14, ultrasound-guided reduction). Surgical outcomes were evaluated using preoperative and 3-month postoperative X-ray images by two independent surgeons. Patient satisfaction was evaluated using a questionnaire survey.ResultsThe experimental group consisted of 4 patients with Plane I fracture and 10 patients with Plane II fracture. The control group consisted of 3 patients with Plane I fracture and 11 patients with Plane II fracture. The mean surgical outcomes score and the mean patient dissatisfaction score were found not to differ between the experimental and the control group in Plane I fracture (p=0.755, 0.578, respectively). In a subgroup analysis consisting of Plane II fractures only, surgeons graded outcomes for ultrasound-guided reduction higher than that for the control group (p=0.007). Likewise, among the Plane II fracture patients, those who underwent ultrasound-guided reduction were less dissatisfied than those who underwent blind reduction (p=0.043).ConclusionOur study result suggests that ultrasound-guided closed reduction is superior to blind closed reduction in those patients with Plane II nasal fractures.

A Method for Precise Reduction of Facial Bone Fractures Using Intraoperative Ultrasound With a Solid Gel Pad as a Coupling Medium

“…The reduction of the nasal bone and zygomatic arch fractures typically entails closed reduction, a process that hinges significantly on the surgeon’s technique and experience. Concurrently, to circumvent the limitations concomitant with this blind technique, numerous surgeons have incorporated the use of intraoperative ultrasound, as supported by previous studies 2,3,8 . Nevertheless, the complex 3-dimensional curvature of the nose and zygomatic arch presents challenges when scanning the adjacent facial bones.…”

“…Concurrently, to circumvent the limitations concomitant with this blind technique, numerous surgeons have incorporated the use of intraoperative ultrasound, as supported by previous studies. 2,3,8 Nevertheless, the complex 3-dimensional curvature of the nose and zygomatic arch presents challenges when scanning the adjacent facial bones. We applied a solid gel pad to augment the visualization of ultrasound images during surgery, thereby granting the surgeon better visual feedback and real-time video monitoring.…”

“…However, this blind technique has limitations, prompting intraoperative ultrasound to enhance surgical outcomes. While ultrasound-assisted closed reduction offers benefits, 2,3 scanning the relationship with surrounding facial bones poses a technical challenge due to the 3-dimensional curvature of the facial bones. The curved nature of these structures makes it difficult to perform an ultrasound scan using a linear probe.…”

Intraoperative Use of Ultrasonography in the Reduction of Zygomatico-Maxillary Complex Fractures

“…The main advantage of ultrasonography is it’s “real time” imaging, accuracy, nil radiation exposure and reduced operative time. 13,14 However, the surgeon needs to have good technical skill or guided by a radiologist for accurate scanning and interpretation.…”

Precisely Closed Reduction of Nasal Bone Fracture Assisted With Plain Film Measurements Under the Picture Archiving and Communication System

“…However, as reduction is not conducted via a direct gross observation of the fracture site, it is difficult to obtain a satisfactory result. Some methods can be used to perform closed reduction, which include C-arm guide, 8 USG-assisted visual inspection, 9,10 and surgical navigation for identifying fracture locations and guiding closed reduction. 11 If closed reduction is conducted for nasal bone fractures using C-arm, an accurate result can be obtained by observing the fractured bone indirectly with continuous imaging during surgery.…”