Management of Acute Nasal Bone Fractures in Adults: Systematic Review and Meta-Analysis

Abstract

Background: The optimal timing, patient selection, andsurgical technique for the management of nasal trauma are notyet clearly established. The choice of surgical technique alsovaries depending on the severity of the injury, the patient’s individualanatomy, surgeon selection and expertise.Objective: To review previous studies discussing the treatmentof acute nasal fractures in adults.Methods: A systematic review and meta-analysis was conductedin March 2022 for papers published between 2002 and2022. To compare the outcomes of closed nasal bone reduction,septal reduction to other treatments as open reduction, limitedseptoplasty, septorhinoplasty, and delayed rhinoplasty for nasalbone fractures. Also, to assess how reduction type, type ofanesthesia, presence of septal fractures and the time intervalbetween injury and treatment could affect patient satisfactionpost operatively, rate of complications, revisional surgeries andolfactory dysfunction.Results: A meta-analysis of 19 studies found that reductiontype and timing interval between injury and treatment had a significantimpact on patient satisfaction. Reduction type and thetype anesthesia also had a significant impact on post-operativecomplication rates.Conclusion: Open nasal reduction (ONR) is associated withhigher patient satisfaction, however, closed nasal reduction maybe safer. Patients with septal fractures are less satisfied withtheir results. General anesthesia has higher satisfaction rates andlower complication rates than local anesthesia. Early surgicalintervention within 2 weeks of trauma is recommended.