Technique and timing for closed reduction of isolated nasal fractures: a retrospective study

Isolated fractures of the nasal pyramid are among the most common facial injuries. Nevertheless, studies of therapeutic results following closed reduction of nasal fractures are rare. We conducted a retrospective clinical review of 187 patients who were evaluated for nasal trauma (including nondislocated fractures, dislocated fractures, and contusions) at our otolaryngology department during 1997 and 1998. Of this group, 96 fractures were treated with closed reduction--either under local anesthesia (n = 68), under general anesthesia (n = 21), or with concomitant septoplasty under general anesthesia (n = 7). At follow-up, which ranged from 1 to 2 years, 91 of the 96 patients (94.8%) expressed satisfaction with their results. Prior to deciding on a course of action, the surgeon must conduct a careful physical examination because the decision as to whether treatment is required, which technique to use (open vs closed reduction), and which type of anesthesia is appropriate (local vs general) all depend on the clinical findings, such as the degree of deviation and airflow obstruction. We also suggest that all patients receive both a Waters' view and a lateral view x-ray. In our opinion, closed reduction is a safe procedure for isolated nasal fractures and can be performed with local anesthesia in most adult patients. Morbidity is minimal in the hands of an experienced ENT surgeon.