Lateral force compared with frontal impact nasal fractures: need for reoperation

Patient concern over the outcome of correction of nasal fractures is usually extremely high; often, a secondary procedure is necessary. Therefore, thorough consultation is mandatory. The clinical data of 50 patients who sustained nasal fractures was retrospectively reviewed to determine if there was any predictive value to classification of nasal fractures and the likelihood of a secondary surgical procedure. Using Stranc and Robertson's nasal fracture classification, 41 of 50 patients were described as lateral force fractures and 9 of 50 were frontal impact fractures. Five of 50 patients underwent a secondary surgical procedure, 4 from the frontal impact and 1 from the lateral force fracture group. The number of patients reoperated on approximately equaled the number who were dissatisfied with the result of the initial procedure (5 versus 6). However, objective assessment by the primary surgeon revealed 21 patients with an anatomic or functional defect. Of these, 15 were lateral force fractures (15 of 41, or 37%) and 6 were frontal impact fractures (6 of 9, or 67%). These results illustrate the difficulty in restoring preinjury nasal anatomy and function, especially in the more severe and complicated frontal impact types of nasal fracture. Using this information can aid in obtaining satisfactory informed patient consent.