Predictors of functional and aesthetic failure following closed reduction of nasal fractures: a prospective cohort study

Shwetha C. Poojary

doi:10.18203/issn.2454-5929.ijohns20262357

Authors

Shwetha C. Poojary Department of ENT, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20262357

Keywords:

Nasal fracture, Closed reduction, NOSE scale, SCHNOS, Septorhinoplasty, Patient-reported outcome measures

Abstract

Background: Closed reduction (CR) is the standard intervention for nasal fractures, yet historically high failure rates persist. This prospective study aims to analyze clinical outcomes, complication rates, and predictors of surgical failure following CR utilizing validated patient-reported outcome measures (PROMs).

Methods: A prospective cohort study of 185 patients undergoing CR for isolated nasal bone fractures was conducted from May 2024 to May 2025. Outcomes were assessed pre-operatively and at 6 months using the nasal obstruction symptom evaluation (NOSE) and standardized cosmesis and health nasal outcomes survey (SCHNOS) scales. Surgical failure was defined as moderate-to-severe persistent obstruction (NOSE>30), significant aesthetic dissatisfaction (SCHNOS-C), or the necessity for secondary Septorhinoplasty. Multivariate logistic regression identified independent risk factors for failure.

Results: CR resulted in significant improvement in mean NOSE and SCHNOS scores at 6 months (p<0.001). However, the overall surgical failure rate was 14.59% (n=27), with 9.72% (n=18) requiring secondary septorhinoplasty within 12 months. Multivariate analysis revealed that intervention delay >7 days (aOR=2.45, p=0.04) and concomitant cartilaginous septal deviation (aOR=3.61, p=0.01) were robust independent predictors of functional and aesthetic failure. Complication rates were minimal (3.24%).

Conclusions: While CR is a safe primary treatment, prospective PROM integration reveals a failure rate of approximately 15%. Unaddressed cartilaginous septal trauma is a primary driver of these failures. Patients with endoscopic evidence of septal deviation should be counseled regarding the high risk of CR failure and considered for primary open reduction or early functional Septorhinoplasty.

References

Kelley BP, Downey CR, Stal S. Evaluation and reduction of nasal trauma. Semin Plast Surg. 2010;24(4):339-47.

Gassner R, Tuli T, Hächl O, Rudisch A, Ulmer H. Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries. J Craniomaxillofac Surg. 2003;31(1):51-61.

VandeGriend ZP, Hashemi A, Shkoukani M. Changing trends in adult facial trauma epidemiology. J Craniofac Surg. 2015;26(1):108-12.

Manninen IK, Klockars T, Mäkinen LK, Blomgren K. Epidemiology and aetiology of sport-related nasal fractures: Analysis of 599 Finnish patients. Clin Otolaryngol. 2023;48(1):70-4.

Verwoerd CD. Present day treatment of nasal fractures: closed versus open reduction. Facial Plast Surg. 1992;8(4):220-3.

Reilly MJ, Davison SP. Open vs closed approach to the nasal pyramid for fracture reduction. Arch Facial Plast Surg. 2007;9(2):82-6.

Mondin V, Rinaldo A, Ferlito A. Management of nasal bone fractures. Am J Otolaryngol. 2005;26(3):181-5.

Hoffmann JF. An Algorithm for the Initial Management of Nasal Trauma. Facial Plast Surg. 2015;31(3):183-93.

Fernandes SV. Nasal fractures: the taming of the shrewd. Laryngoscope. 2004;114(3):587-92.

Staffel JG. Optimizing treatment of nasal fractures. Laryngoscope. 2002;112(10):1709-19.

Hwang K, You SH, Kim SG, Lee SI. Analysis of nasal bone fractures; a six-year study of 503 patients. J Craniofac Surg. 2006;17(2):261-4.

Rhee SC, Kim YK, Cha JH, Kang SR, Park HS. Septal fracture in simple nasal bone fracture. Plast Reconstr Surg. 2004;113(1):45-52.

Rohrich RJ, Adams WP Jr. Nasal fracture management: minimizing secondary nasal deformities. Plast Reconstr Surg. 2000;106(2):266-73.

Choi MH, Cheon JS, Son KM, Choi WY. Long-term postoperative satisfaction and complications in nasal bone fracture patients according to fracture type, site, and severity. Arch Craniofac Surg. 2020;21(1):7-14.

Besmens IS, Shahrdar C, Fontein DBY, Knipper S, Giovanoli P, Lindenblatt N. Efficacy of closed reduction of nasal fractures-a retrospective analysis with focus on factors affecting functional and aesthetic outcomes. J Plast Reconstr Aesthet Surg. 2023;77:371-8.

Arnold MA, Yanik SC, Suryadevara AC. Septal fractures predict poor outcomes after closed nasal reduction: Retrospective review and survey. Laryngoscope. 2019;129(8):1784-90.

Atighechi S, Baradaranfar MH, Karimi G, Dadgarnia MH, Mansoorian HR, Barkhordari N, et al. Diagnostic value of ultrasonography in the diagnosis of nasal fractures. J Craniofac Surg. 2014;25(1):e51-3.

Kim KS, Lee HG, Shin JH, Hwang JH, Lee SY. Trend analysis of nasal bone fracture. Arch Craniofac Surg. 2018;19(4):270-4.

Wang W, Lee T, Kohlert S, Kadakia S, Ducic Y. Nasal Fractures: The Role of Primary Reduction and Secondary Revision. Facial Plast Surg. 2019;35(6):590-601.

Hung T, Chang W, Vlantis AC, Tong MC, van Hasselt CA. Patient satisfaction after closed reduction of nasal fractures. Arch Facial Plast Surg. 2007;9(1):40-3.

Younes A, Elzayat S. The role of septoplasty in the management of nasal septum fracture: a randomized quality of life study. Int J Oral Maxillofac Surg. 2016;45(11):1430-4.

Tota SM, Modi NR. Incidence, evaluation and management of nasal bone fracture: study of 60 cases. Int J Otorhinolaryngol Head Neck Surg. 2021;7(9):1478-81.

Ridder GJ, Boedeker CC, Fradis M, Schipper J. Technique and timing for closed reduction of isolated nasal fractures: a retrospective study. Ear Nose Throat J. 2002;81(1):49-54.

Hwang K, Yeom SH, Hwang SH. Complications of Nasal Bone Fractures. J Craniofac Surg. 2017;28(3):803-5.

Rubinstein B, Strong EB. Management of nasal fractures. Arch Fam Med. 2000;9(8):738-42.