Patient Aesthetic Satisfaction with Timing of Nasal Fracture Manipulation

Introduction. To determine patient cosmetic satisfaction following nasal fracture manipulation under general anaesthetic when offered at different time intervals after injury. Materials and Methods. Prospective chart review of adult patients with nasal fractures treated by closed reduction at a busy district general hospital in Greater London over a 10-month period. Patients were asked by a standardised telephone interview about satisfaction with nasal cosmesis pre- and postoperatively using a Likert scale. Results. Seventy-six of 106 patients presented for nasal manipulation at up to 9 weeks after injury and were successfully contacted (72%) postoperatively. Forty-nine patients (64%) reported that they still would have had the surgery in retrospect. Those done within 1-2 weeks after injury resulted in the highest mean satisfaction score ( ). There was a negative correlation between patient satisfaction and timing of surgery ( , ). Of the patients satisfied or very satisfied with their procedure, 96% had it done within 4 weeks. Conclusion. The majority of patients treated with closed reduction of nasal fractures under general anaesthetic are satisfied with the cosmetic outcome and would still have undergone surgery in retrospect. Increasing time of surgery after 2 weeks resulted in lower patient satisfaction. 1. Introduction Nasal bone fractures are the most common type of facial bone fractures and indeed are one of the most common reasons for patients being referred to ENT surgeons. As the nose is the most prominent part of the face, it is the most susceptible to damage from facial trauma; Illum et al. noted that 39% of facial trauma involves the nose [1]. Nasal fractures are commonly caused by assaults, sports injuries, and road accidents. As they are often associated with multiple trauma, frequently nasal fractures are not promptly diagnosed and treated, leading to secondary nasal deformities and chronic obstruction, requiring more extensive procedures including septorhinoplasty [2]. Whilst there is published literature regarding the management of nasal fractures, there is no uniform policy or protocol for the management of this condition [3]. Standard practice in the United Kingdom is closed reduction within approximately 2 weeks of the injury [4]. However, increasing evidence shows persistent aesthetic concerns regarding cosmetic outcome and obstructive symptoms [5]. The aim of our study was to evaluate the cosmetic satisfaction of nasal fracture manipulation under general anaesthetic relative to the timing of surgery after injury. 2. Material and