Surgical treatment of nasal fractures may benefit from intraoperative 3D imaging

Available online 28 April 2024

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This retrospective study aimed to assess the effects of the use of intraoperative three-dimensional (3D) imaging on outcomes in surgical treatment of nasal fractures. Furthermore, we investigated whether the use of intraoperative imaging improves outcomes and decreases the frequency of corrective surgeries compared to published literature. This retrospective descriptive study included patients who underwent operative treatment for nasal fractures with the use of intraoperative 3D imaging between January 2015 and January 2020 at a University Hospital. The primary outcome measure was patient satisfaction, which was assessed through patient charts about subjective esthetic problems and nasal obstruction. The secondary outcome measures were the number of intraoperative images and necessity of intra- and postoperative revisions. All the outcomes were evaluated using regression analysis. Of the 172 patients, secondary rhinoplasty and intraoperative revision were performed in 10 (6 %) and 93 (54 %) patients, respectively. Postoperatively, 19 (11 %) and 12 (7 %) patients complained of subjective esthetic problems and nasal obstruction, respectively. The intraoperative revision rate in patients undergoing surgical treatment of nasal fractures with intraoperative 3D imaging was >50 %. However, the incidence of postoperative secondary revision, nasal obstruction, and subjective esthetic problems was lower than that reported in the literature not having an intraoperative imaging. Our findings suggest that prompt quality control of the operative result enables immediate correction and prevents postoperative revision.

Section snippetsINTRODUCTION

Nasal-bone fractures are the most common facial fracture and are often caused by violence, sports and traffic accidents, or falls (Rohrich and Adams, 2000; Rubinstein and Bradley Strong, 2000; Rhee et al., 2004; Yabe et al., 2004; Mondin et al., 2005; Hwang et al., 2017a; Lu et al., 2017; Epstein and Ettinger, 2021). Nasal fractures are often underestimated and undertreated, resulting in secondary nasal deformities and chronic nasal obstruction (Simmen, 1998; Mondin et al., 2005; Chan and Most,

Study design

This retrospective descriptive study was approved by the Institutional Review Board of the state (ref. no. 2019-01453). The study included patients with nasal fractures who underwent reduction surgery with intraoperative 3D imaging in the Department of Oral and Maxillofacial Surgery at a University Hospital between January 2015 and January 2020 and had signed an informed consent for further use of their data. The exclusion criteria were missing clinical or radiological data, age <16 years.

The

RESULTS

A total of 172 patients (mean age, 44.9 years; SD, 20.3 years) who met the inclusion criteria were enrolled. Of these, 136 (79 %) were men.

The most common cause of nasal fractures was violence in 49 cases (28 %), followed by falls from <3 m (47 [27 %]), non-motorized-vehicle accidents (34 [20 %]), sports accidents (14 [8 %]), motorized-vehicle accidents (11 [6 %]), work accidents (9 [5 %]), and falls from >3 m (5 [3 %]).

Isolated nasal fractures (i.e., nasal bone fracture or nasal complex

DISCUSSION

This retrospective study investigated the effect of intraoperative 3D imaging on the surgical treatment of nasal fractures, such as intraoperative and postoperative revisions, subjective esthetic problems, nasal obstruction, and the number of images required.

In this study, only 19 (11 %) and 12 (7 %) patients reported subjective esthetic problems, and nasal obstruction, respectively. The reported incidence in previous studies is 14–35 % for esthetic problems and 13–35 % for nasal obstruction,

CONCLUSION

In this study, intraoperative 3D imaging during closed reduction of nasal fractures resulted in a high intraoperative revision rate of >50 %. However, the incidence of postoperative secondary revision, nasal obstruction, and subjective esthetic problems is lower compared to those reported in previous studies. Prompt quality control of surgical outcomes enables immediate correction and prevents postoperative revisions.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author contributionss

Jan Hafner: Writing – original draft

Maximilian Eberhard Wagner: Writing - review & editing

Priska Heinz: Formal analysis

Daphne Schönegg: Writing - review & editing

Harald Essig: Writing - review & editing

Michael Blumer: Conceptualization, methodology, writing - review & editing

Surgical treatment of nasal fractures may benefit from intraoperative 3D imaging

Data Availability

Study participants were ensured in the informed consent that the encoded data remains confidential and would not be shared.

Uncited reference

Basheeth et al., 262015; Chan, 2008; Rubinstein and Strong, 2000; Team RC.

Declaration of Competing Interest

None.

Acknowledgements

We would like to thank Editage (www.editage.com) for English language editing.

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