The Use of Mesh Microplates in Management of Comminuted Nasal Bone Fracture

ABSTRACT

The majority of nasal fractures have been managed by using closed reduction, intranasal packing and external splinting. However, in comminuted nasal bone fractures, the conventional closed reduction may be inadequate to reduce the fracture segments accurately, and insufficient to prevent secondary nasal deformity. In these cases, open reduction and interfragment wire fixation was recommended for accurate reduction, and has been mainstay of treatment modality. Furthermore, in nasoethmoid orbital fractures, anatomic reduction of fractured nasal bone, medial and inferior orbital rim segments to reconstruct nasofrontal buttress and transnasal wiring to prevent telecanthus were essential. But, the interfragment wire fixation is difficult and time-consuming procedure. The care must be taken to fix small fracture segments. It is also difficult to obtain bony support due to extensive dissection of periosteum, and to achieve rigid fixation on three- dimensional space, causing depression of bony contour. From April 1998 to August 1999, we used malleable mesh microplates for treatment of 3 comminuted nasal bone fractures and 3 nasoethmoid orbital fractures. During the follow up period of 8 months to 24 months, all of six patients had successful cosmetic result without complications. There was no recurrent depression of bony contour, no secondary nasal deformity, no displacement of microplates and no palpable, externally shown hardwares. The use of mesh microplates is reliable and useful method for the treatment of comminuted nasal fractures because it is relatively simple procedure and achieves rigid fixation on three-dimensional space without postoperative temporary nasal packing which may cause patient's discomfort. Furthermore, in nasoethmoid orbital fractures, correction of telecanthus can be done without application of transnasal wiring.