8.26.24
Quick Review #214 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental #closedreduction #nasalbone #fracture #nasalbonefracture
Closed Reduction of Bilateral Nasal Bone Fractures is a common treatment for nasal bone fractures, particularly when there is no severe comminution or displacement that requires open surgical intervention:
Indications:
1. Non-Comminuted Fractures: Appropriate for fractures without extensive comminution or with minimal displacement.
2. Cosmetic Deformity: Used when there is external nasal deformity or deviation needing correction.
3. Nasal Obstruction: Indicated if the fracture causes significant nasal airway obstruction.
4. Timing: Best performed within 7-10 days after injury, before significant callus formation.
5. Patient Preference: Chosen when the patient prefers a less invasive procedure and accepts potential minor residual deformity.
Advantages:
1. Minimally Invasive: Avoids surgical incisions, reducing infection risk and scarring.
2. Shorter Recovery: Patients typically recover faster with less downtime than with open reduction.
3. Outpatient Procedure: Often done under local anesthesia, reducing hospital stay and costs.
4. Reduced Morbidity: Lower risk of complications such as infection, septal perforation, and external scarring.
5. Cost-Effective: Lower overall cost due to reduced operative time, anesthesia, and hospital resources.
Techniques & Instruments:
1. Digital Manipulation:
• Uses fingers to manually realign the nasal bones.
• Pressure is applied to move the bones back into position.
2. Asch Forceps: Used to elevate depressed nasal bones by inserting forceps into the nasal cavity and prying fractured segments into alignment.
3. Walsham Forceps: Grabs and manipulates the nasal bones externally. The forceps are applied over the nasal bridge, and bones are maneuvered back into place.
4. Boies Elevator: Elevates depressed nasal bone fragments. The elevator is placed inside the nasal cavity to lift segments into alignment.
5. External Splinting: An external splint (e.g., thermoplastic or aluminum) is applied post-reduction to maintain bone position. Internal splints or nasal packing may also be used.
6. Nasal Packing: Supports the realigned bones internally, with packs placed inside the nasal cavity to maintain position and reduce swelling and bleeding.
References:
1. Fusetti, S., Cornelius, C.-P., Gellrich, N., Hillerup, S., Kusumoto, K., & Schubert, W. (n.d.). Closed reduction: Nasal bone. AO Surgery Reference.
2. Kocak, A., & Yucesoy, C. A. (2019). Management of nasal bone fractures. Plastic Surgery, 5(1), 32-39.
3. Rohrich, R. J., Adams, W. P., & Gunter, J. P. (2000). Nasal fractures: The role of closed and open reduction. Plastic and Reconstructive Surgery, 106(5), 942-949.
4. ChatGPT.2024
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