BACKGROUND: Prophylactic antibiotic administration after surgery for a nasal bone fracture is performed due to concerns about infection-related complications, such as, toxic shock syndrome. To evaluate the validity and efficacy of antibiotic use, we compared the results obtained and the bacterial profiles of nasal packing materials in patients that underwent closed reduction for a nasal bone fracture with or without prophylactic antibiotic administration. METHODS: Thirty consecutive patients with a nasal bone fracture, but without an open wound, that underwent closed reduction during March to August 2017 were included in the present study. Fifteen of these 30 patients were randomly assigned to a control group, members of were administered postoperative intravenous antibiotics once at the day of surgery and then oral antibiotics for 4 days. The other 15 patients were assigned to an experimental group and not administered any antibiotic postoperatively. Antibiotic ointment was not applied to nasal packing in either group. Nasal packing was removed on postoperative day 4 in all cases. Removed nasal gauze packings were culture tested and strains identified in the two groups were compared. RESULTS: Bacterial strain types cultured from packings were similar in the experimental and control groups and no patient showed signs of clinically significant infection. CONCLUSION: The findings of this study suggest postoperative prophylactic antibiotic use is not clinically required after closed reduction of a nasal bone fracture. Furthermore, the non-use of postoperative antibiotics is biologically beneficial, as it reduces the occurrence of resistant strains and medical costs, and is more convenient for patients.
Anti-Bacterial Agents ; Fractures, Bone ; Humans ; Nasal Bone ; Prospective Studies ; Shock, Septic ; Wounds and Injuries

BACKGROUND: Nasal bone fractures occur frequently because the nasal bone is located at the forefront of the face. The goal of this study was to examine the cause, change in severity, change in incidence, and demographics of nasal bone fracture according to today's lifestyle. METHODS: A total of 2,092 patients diagnosed as having nasal bone fractures at our department between 2002 and 2017 were included in this study. We retrospectively examined patients' medical records to extract information regarding age, sex, cause of injury, combined facial bone fractures, and related injuries such as skull base fracture, spinal cord injury, brain hemorrhage, and other bone fractures. Fracture severity was classified by nasal bone fracture type. RESULTS: No statistically significant difference was found in annual number of patients treated for nasal bone fracture. The proportion of patients who underwent closed reduction was significantly decreased over time for those with nasal bone fractures caused by traffic accidents. However, it was not significantly changed for those with nasal bone fractures due to other causes. The number of patients with combined facial bone fractures increased over time. Incidences of severe nasal bone fracture also increased over time. CONCLUSION: The study suggested that there is a decrease in the frequency and increase in the severity of nasal bone fracture due to traffic accident. Many protective devices prevent nasal bone fractures caused by a small amount of external force; however, these devices are not effective against higher amounts of external force. This study highlights the importance of preoperative thorough evaluation to manage patients with nasal bone fractures due to traffic accident.
Accidents, Traffic ; Brain Injuries ; Demography ; Facial Bones ; Fractures, Bone ; Hemorrhage ; Humans ; Incidence ; Life Style ; Medical Records ; Nasal Bone* ; Nasal Surgical Procedures ; Nose ; Protective Devices ; Retrospective Studies ; Skull Base ; Spinal Fractures

Pentastomiasis, a zoonotic parasite infection, is typically found in the respiratory tract and viscera of the host, including humans. Here, we report for the first time an extremely rare case of intraosseous pentastomiasis in the human maxilla suffering from medication related osteonecrosis of the jaw (MRONJ). A 55-year-old male had continuously visited the hospital for MRONJ which had primarily developed after bisphosphonate and anti-neoplastic administration for previous bone metastasis of medullary thyroid cancer. Pain, bone exposure, and pus discharge in the right mandible and left maxilla were seen. Osteolysis with maxillary cortical bone perforation at the left buccal vestibule, palate, nasal cavity, and maxillary sinus was observed by radiologic images. A biopsy was done at the left maxilla and through pathological evaluation, a parasite with features of pentastome was revealed within the necrotic bone tissue. Further history taking and laboratory evaluation was done. The parasite was suspected to be infected through maxillary open wounds caused by MRONJ. Awareness of intraosseous pentastomiasis should be emphasized not to be missed behind the MRONJ. Proper evaluation and interpretation for past medical history may lead to correct differential diagnosis and therapeutic intervention for parasite infections.
Biopsy ; Bone and Bones ; Diagnosis, Differential ; Humans ; Jaw ; Male ; Mandible ; Maxilla* ; Maxillary Sinus ; Middle Aged ; Nasal Cavity ; Neoplasm Metastasis ; Osteolysis ; Osteonecrosis ; Palate ; Parasites ; Pentastomida ; Respiratory System ; Suppuration ; Thyroid Gland* ; Thyroid Neoplasms* ; Viscera ; Wounds and Injuries

OBJECTIVES: Submental intubation has been advocated as an alternative to classical tracheostomy for certain indicated panfacial trauma surgeries. Surgeons should have various options for airway management in maxillofacial trauma patients. Most maxillofacial injuries involve occlusal derangements, which might require intraoperative occlusal corrections; hence, orotracheal intubation is not ideal. Maxillofacial surgeons generally prefer nasotracheal intubation; however, in cases with concomitant skull base fracture or nasal bone fracture, nasotracheal intubation might not be suitable; in these situations, tracheostomy is typically performed. However, the possible complications of tracheostomy are well known. Due to trauma situations and to avoid the complications of tracheostomy, submental intubation would be an ideal alternative procedure in selected maxillofacial trauma surgery patients. This study aimed to evaluate the safety and usefulness of a submental intubation technique for panfacial trauma surgery. Moreover, we intended to share our experience of submental intubation and to recommend this simple, safe procedure for certain panfacial trauma surgeries. MATERIALS AND METHODS: In five panfacial trauma patients, we performed submental intubation for airway management; the mean time required for the procedure was only eight minutes. RESULTS: We were able to execute this procedure safely in a short time without any intraoperative or postoperative complications. CONCLUSION: Submental intubation is a safe and simple technique for airway management in indicated panfacial trauma surgery patients.
Airway Management ; Humans ; Intubation* ; Maxillofacial Injuries ; Nasal Bone ; Postoperative Complications ; Skull Base ; Tracheostomy

OBJECTIVES: To explore the characteristics of nasal bone fracture caused by blunt instrument, including the fracture types, the fracture repair, and the difference of manifestations between X-ray and CT. To provide reference for the identification. METHODS: The information of basic situation, fracture site, injury manner, diagnosis method, expert opinion of 95 adult nasal fracture cases caused by blunt object, which occurred in Gutian county of Fujian province from January 1999 to December 2013, were analyzed by descriptive statistics. The identification conclusions of different injuries were compared according to new and old standards as well. RESULTS: There were total 95 adults including 87 male and 8 female. The fracture site and quantity have significant correlation with the nasal bone anatomical relations and the direction and size of the force. Compound fracture was most common. The fracture that could not be determined by X-ray could be clearly diagnosed by CT examination. According to new and old standards, different fracture types have different identification conclusions. CONCLUSIONS There are gender differences in nasal bone fracture cases. Larger external force is easy to cause compound fracture. CT examination is significantly better than X-ray examination.
Adult ; Female ; Humans ; Male ; Nasal Bone/injuries* ; Radiography ; Reference Standards ; Sex Factors ; Skull Fractures/diagnostic imaging* ; Tomography, X-Ray Computed

The bony naso-orbital-ethmoid (NOE) complex is a 3-dimensional delicate anatomic structure. Damages to this region may result in severe facial dysfunction and malformation. The management and optimal surgical treatment strategies of NOE fractures remain controversial. For a patient with NOE trauma, doctors should perform comprehensive clinical examination and radiographic analysis to assess the type and extent of fracture. The results of assessment will assist doctors to make a patientspecific program for the sake of reducing post-operation complications and restoring normal appearance and function as much as possible. This review focuses on the advancement of management of NOE fractures including symptoms, classifications, diagnosis, approaches, treatment and new techniques in this field.
Ethmoid Bone ; diagnostic imaging ; injuries ; surgery ; Fracture Fixation ; Humans ; Nasal Bone ; diagnostic imaging ; injuries ; surgery ; Orbital Fractures ; diagnostic imaging ; surgery ; Postoperative Complications ; prevention & control ; Reconstructive Surgical Procedures ; Surgery, Computer-Assisted ; Tendons ; surgery ; Tomography, X-Ray Computed

OBJECTIVES: The facial bones are the most noticeable area in the human body, and facial injuries can cause significant functional, aesthetic, and psychological complications. Continuous study of the patterns of facial bone fractures and changes in trends is helpful in the prevention and treatment of maxillofacial fractures. The purpose of the current clinico-statistical study is to investigate the pattern of facial fractures over a 4-year period. MATERIALS AND METHODS: A retrospective analysis of 1,824 fracture sites was carried out in 1,284 patients admitted to SMG-SNU Boramae Medical Center for facial bone fracture from January 2010 to December 2013. We evaluated the distributions of age/gender/season, fracture site, cause of injury, duration from injury to treatment, hospitalization period, and postoperative complications. RESULTS: The ratio of men to women was 3.2:1. Most fractures occurred in individuals aged between teens to 40s and were most prevalent at the middle and end of the month. Fractures occurred in the nasal bone (65.0%), orbital wall (29.2%), maxillary wall (15.3%), zygomatic arch (13.2%), zygomaticomaxillary complex (9.8%), mandibular symphysis (6.5%), mandibular angle (5.9%), mandibular condyle (4.9%), and mandibular body (1.9%). The most common etiologies were fall (32.5%) and assault (26.0%). The average duration of injury to treatment was 6 days, and the average hospitalization period was 5 days. Eighteen postoperative complications were observed in 17 patients, mainly infection and malocclusion in the mandible. CONCLUSION: This study reflects the tendency for trauma in the Seoul metropolitan region because it analyzes all facial fracture patients who visited our hospital regardless of the specific department. Distinctively, in this study, midfacial fractures had a much higher incidence than mandible fractures.
Adolescent ; Facial Bones ; Facial Injuries ; Female ; Hospitalization ; Human Body ; Humans ; Incidence ; Male ; Malocclusion ; Mandible ; Mandibular Condyle ; Maxillofacial Injuries ; Nasal Bone ; Orbit ; Postoperative Complications ; Retrospective Studies* ; Seoul ; Zygoma

OBJECTIVE: To evaluate the age, sex, etiology, diagnosis and treatment time of nasal bone fractures. METHOD: Clinical data of 202 cases with nasal bone fractures treated in the hospital were retrospectively analysed. RESULT: A total of 202 cases,163 men (80. 7%) and 39 women (19. 3%). Fifty-two patients had a relationship with alcohol consumption, and all of them were males. The most frequent reasons of the injury were fight 46. 5% (94 cases) followed by falling-down 21. 3% (43 cases), traffic accidents 19. 3% (39 cases), works related 6. 5% (13 cases), sport injuries 5. 9% (12 cases) and others 0. 5% (1 cases). Patients distribution in seasons were: spring 54 cases (26.7%), summer 42 cases (20.8%), autumn 58 cases (28.7%), winter 48 cases (23. 8%). Diagnosis of nasal bone fractures were made positively by x-ray films in 79. 7% of cases, but 100% by CT. Positive predictive value of CT was superior to that of X-ray films in the diagnosis of nasal bone fracture. CONCLUSION High morbidity of nasal bone fracture was seen in the age group of 20-29 years, and predominantly in male. Fight was found to be the main etiologic factor. We think that CT is necessary for diagnosing nasal bone fracture.
Adult ; Facial Bones ; Female ; Fractures, Bone ; complications ; epidemiology ; Humans ; Male ; Nasal Bone ; injuries ; Nose Diseases ; Retrospective Studies ; Risk Factors ; Seasons ; Skull Fractures ; complications ; epidemiology ; Violence ; Young Adult

OBJECTIVE: To investigate the classification and distribution of external nasal fracture, and its influence to the nasal septum. METHOD: We randomly chose 60 patients who received nasal CT scan because of nasal trauma and diagnosed as external nasal fracture. We reviewed their CT data in PACS system with computer. RESULT: Of the 60 cases of nasal trauma, 90 sides got external nasal fracture, among which 58 sides (64.4%) had only nasal bone fracture, 16 sides (17.8%) had only maxillary frontal process fracture, and 16 sides (17.8%) had both. Half of these 60 patients got unilateral external nasal fracture, among whom 14 patients (46.7%) had traumatic nasal septum deviation meanwhile. The other 30 patients suffered from bilateral external nasal fracture, among whom 26 patients (86.7%) had traumatic nasal septum deviation. The difference between these two groups was statistically significant (P < 0.01). Moreover, 24 patients got fracture of either nasal bone or maxillary frontal process, 11 of whom (45.8%) got traumatic nasal septum deviation at the same time. The other 36 patients suffered fracture of both these two bones, 29 of whom (80.6%) had traumatic nasal septum deviation. The difference between these two groups was statistically significant (P < 0.01). We classified the nasal bone fracture as below: 16 patients with only unilateral external nasal fracture belonged to Type I, of whom 15 patients (25.0%) were type Ia with nasal bone or maxillary frontal process fracture and 1 patient (1.7%) fell into type Ib with fracture occurred on both of these two bones at the same side. Four patients suffered bilateral external nasal fracture belonged to type II, among whom 2 patients (3.3%) belonged to type IIa with nasal bone or maxillary frontal process fracture and 2 patients fell into type IIb with fracture of both of these two bones at different sides. The other 40 patients (66.7%) belonged to Tpye III, who suffered external nasal fracture accompanied with traumatic nasal septum deviation. CONCLUSION Traumatic nasal septum deviation was extremely concomitant in patients with external nasal fracture. It will be better to perform external nasal reconstructive surgery and plasty of nasal septum deviation by using the endoscope within 1 month for the patients whose symptom were serious or who cared a lot about the appearance.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Female ; Fractures, Bone ; classification ; diagnostic imaging ; pathology ; Humans ; Male ; Middle Aged ; Nasal Bone ; injuries ; Nasal Septum ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVE: To investigate the feasibility and the efficacy of endoscopic three lines tension relaxing septorhinoplasty combined with nasal bone fracture correction for traumatic nasal septum deviation. METHOD: Clinical data of 45 cases with traumatic nasal septum deviation treated were retrospectively analysed. These patients were performed with three lines tension relaxing septorhinoplasty and nasal bone fracture correction under endoscopy 5 to 14 days after injury. RESULT: All patients were followed up for more than six months. They all achieved significant efficacy and no complications occurred. CONCLUSION Endoscopic three lines tension relaxing septorhinoplasty combined with nasal bone fracture correction can achieve satisfactory curative effect and can effectively prevent the occurrence of complications.
Adult ; Endoscopy ; Female ; Fractures, Bone ; surgery ; Humans ; Male ; Middle Aged ; Nasal Bone ; injuries ; surgery ; Nasal Septum ; injuries ; surgery ; Nose Deformities, Acquired ; surgery ; Retrospective Studies ; Rhinoplasty ; methods ; Treatment Outcome ; Young Adult