Postoperative Satisfaction in Nasal Bone Fracture Patients Who Had Rhinoplasty.

PURPOSE: Nasal bone fracture is the most common type of facial bone fracture. There are 2 main reduction methods for treating nasal bone fractures: open reduction and closed reduction. A secondary operation was required when there was a deviation of shape after the operation, so there have been many studies conducted on patient satisfaction after reduction. However, there was few study on the satisfaction of nasal bone fracture patients with rhinoplasty depending on treatment modality. This study focused on the characteristics of nasal bone fracture rhinoplasty patients and on the satisfaction of patients who had previous rhinoplasty and their satisfaction after closed fracture reduction. METHODS: The 22 patients, who had previously undergone augmentation rhinoplasty using silicone implants, visited Sanggye Paik Hospital from 2009 to 2014 for isolated nasal bone fractures. A satisfaction survey was conducted by telephone. The patients were asked of their subjective satisfaction after rhinoplasty, after the nasal bone fracture, and after the closed or open reduction. The satisfaction scores were recorded on a 5-point numerical scale. As the control group, 149 nasal bone fracture patients who were operated in the year 2013 were selected, and a phone survey was performed. Also, all facial three-dimensional computed tomography scans were reviewed to analyze characteristics of nasal bone fractures in the previously augmented rhinoplasty patients. Satisfaction and other characteristics of the 2 groups were evaluated with the independent t test and χ test using SPSS software (Version 18.0; SPSS Inc, Chicago, IL). RESULT: Seven patients of 22 were able to complete the phone questionnaire (31.8%). Six of the 7 participants went through closed reduction and 1 had open reduction. Before plastic surgery, patient satisfaction was 2.333; after rhinoplasty it increased to 3.833. After the nasal bone fracture, patient satisfaction was 2.25, and after the reduction, it improved to 3.167. Of the 149 patients of the control group, 87 were able to complete the phone survey (58.3%). Before the injury, patient satisfaction was 3.512, whereas after the fracture it was 2.314. After closed reduction, the satisfaction was 3.326. There were no statistical significance on before trauma (P value >0.05), before reduction (P value >0.05), after reduction (P value >0.05). The rhinoplasty group and the control group were similar in terms of broad characteristics. However, the rhinoplasty group demonstrated a lower diagnostic rate by simple x-ray (40.9%) than the control group (68.5%), a difference that was statistically significant (P value = 0.012). CONCLUSION: Because there was no significant difference between 2 groups, the closed reduction method is more helpful in patients without deviation, exposure, or destruction of the implant. Also, in rhinoplasty patients who have sustained nasal trauma, the authors suggest facial three-dimensional computed tomography to prevent misdiagnosis.

Primary Infraorbital Foramen Decompression for the Zygomaticomaxillary Complex Fracture: Is It Essential?

PURPOSE: The frequency of zygomaticomaxillary fracture is second only to nasal bone fracture. Up to 30% to 80% of zygomaticomaxillary fracture patients complain of sensory disturbance results from infraorbital nerve injury. The objective of this study was to detect what factors are related to infraorbital nerve recovery and specifically to investigate decompression of infraorbital foramen improves sensory recovery. PATIENTS AND METHODS: A total of 257 patients were assessed with unilateral zygomaticomaxillary complex fracture, treated with open reduction and internal fixation with orbital floor reconstruction. Of these, 166 patients followed up over 6 months were included in this study. The data collected included age, sex, pre, and postoperative sensory score measured by visual analogue scale (range: 0-10). Sensory score was measured at the infraorbital nerve innervation. The impact of decompression operation on the change of sensory score was compared. Statistical analysis was performed using SPSS 18.0 software (SPSS Inc, Chicago, IL). RESULTS: In patients with preoperative hypoesthesia, difference between postoperative and preoperative sensory score was 3.2 (decompression group), 4.4 (nondecompression group), respectively, but not significant (P > 0.05). In patients without preoperative hypoesthesia, difference between postoperative and preoperative sensory score was -0.2 (decompression group), -0.3 (nondecompression group), respectively, and did not show significant association (P > 0.05). DISCUSSION: Based on this result, in patients with preoperative hypoesthesia, infraorbital decompression operation is not useful for sensory recovery. This result indicates infraorbital sensory disturbance occurs from not only pinched nerve injury at the infraorbital foramen but also traction nerve injury at the other part of the nerve.