Published online Sep 26, 2023. doi: 10.12998/wjcc.v11.i27.6374
Peer-review started: June 6, 2023
First decision: July 17, 2023
Revised: July 28, 2023
Accepted: August 23, 2023
Article in press: August 23, 2023
Published online: September 26, 2023
Among facial bones, the nasal bone is located at the center of the facial bones. It is the most protruding and thus, the weakest bone. It has a high frequency of damage, which often leads to secondary deformation, as well as dysfunction of the nose due to fracture and dislocation of the septum. The current practices have had little consideration towards anatomical structures such as the nasal cavities, which often involve airway obstruction and olfactory disturbances due to fractures or efforts to objectify patient's subjective or temporary symptoms.
In order to improve functional problems, inferior turbinate outward osteotomy and septal curvature have been mainly performed in the field of otolaryngology, while studies involving such structures have been rare in the field of plastic surgery. Therefore, our study investigated the effect of the anatomical structure of the inferior turbinate on the function of the nose in nasal bone fractures through the changes of the nasal cavity, determined by subjects’ pre- and post-operative symptoms, computed tomography (CT) analysis, and pre- and postoperative acoustic nasal airway examination.
The article demonstrates a satisfactory result in the appearance and function of the nose, subjective and objective, after inferior turbinate outward osteotomy and a concurrent closed reduction in patients with nasal bone fractures.
From January to December 2010, pre-operative radiological examination and acoustic rhinometry were performed on nasal bone fracture patients with nasal obstruction symptoms prior to receiving closed reduction. Questionnaires on the patients’ symptoms were conducted before surgery, and two weeks, four weeks, and eight weeks after surgery. Nasal bone fractures were classified according to the Stranc classification system using CT performed for diagnosis and nasal obstruction was objectively measured using an acoustic rhinometry. Closed reduction and out-fracture of both inferior turbinates performed by the same surgeon. Treatment outcomes were assessed by comparing changes in the nasal airway volume measured using acoustic rhinometry before and after surgery. The minimal cross-sectional area (MCA) was also analyzed based on the fracture classification.
The mean MCA for all cases before reduction was 0.59 ± 0.06 cm2, which was a 11% decrease compared to that in the average of a Korean adult (0.65 ± 0.03 cm2). The MCA were 0.60 ± 0.02 cm2 for frontal impact, and 0.58 ± 0.03 cm2 for lateral impact. The MCA improved up to 0.64 ± 0.04 cm2 after reduction with inferior turbinoplasty.
The results of this study suggest that out-fracture of the inferior turbinoplasty is more helpful to prove nasal obstruction.
Our study proved that a simple and easy inferior turbinate outward osteotomy is more advantageous in improving the symptoms of nasal obstruction at an early stage. Out-fracture of the inferior turbinate is an effective and durable technique, which can be performed easily to enlarge the nasal airway with minimal morbidity.