The effect of a new topographic classification on determining the prognosis of nasal fracture and treatment modality

Abstract

Background: Classifications of nasal fracture are based on clinical findings or radiological findings. The classification systems of nasal fracture usually determine the type of nasal fracture. It is important that a classification gives information about treatment modality and prognosis rather than determining the type of fracture. The objective of this study was to show the effect of the new topographic classification on determining the parameters of prognosis and deciding on treatment modality of the nasal fracture.

Methods: We reviewed patients with nasal fracture that was referred from emergency department between December 2018 and September 2020. The views of lateral nasal radiography, the facial view of computed tomography (CT), and/or the views of three-dimensional CT were examined to analyze 120 patients with nasal bone fractures. The length of the nasal bone from the top to the base was divided into equal three levels by two lines perpendicular to the length of the nose. The location of fracture was determined as level I, II, and III, respectively, from caudal part to cranial part of the nasal bone. The demographic features of patients, the side of the fracture, the pattern of fracture, accompanying fractures, and the treatment modality were noted.

Results: The frequencies of location of nasal fractures were 44%, 28%, and 27% at level I, level II, and level III, respectively, in 120 cases. It was an expected result that the frequency of fractures was low in parts with the thick bone. Considering the rates of being bilateral or unilateral, it was found that the frequency of unilateral was higher in group of level I, where the thickness of nasal bone was thin, but it was less in group of level III (p<0.05). Non-depressed/minimal-depressed pattern of fracture in group of level I accounted for 92.6% which was the highest frequency (p<0.05). Depressed/elevated fracture patterns were more common in group of level II (p<0.05). Comminuted pattern was mostly observed in group of level III. The rate of accompanying fractures and the applied treatment modality was consistent with anatomic feature of fracture's level.

Conclusion: We believe that the new topographic classification evaluates the parameters of clinical prognosis such as accompanying fracture, site of fracture and pattern of fracture, and also requirement of closed or open reduction better than other classifications.

Figure 1

The length of the nasal bone from the cranial part to the caudal part was divided into equal three levels by two lines perpendicular to the length of the nose (LI: Level I, LII: Level II, and LIII: Level III).

Figure 2

Distribution of age group and gender is shown by bar chart.

Figure 3

A 54-year-old man with unilateral and non-depressed isolated nasal fracture at level I (Images of radiography, axial plane of maxillofacial computed tomography, and three-dimensional computed tomography).

Figure 4

A 35-year-old man with bilateral, depressed nasal fracture at level II and orbital fracture (Images of radiography, axial plane of maxillofacial computed tomography, and three-dimensional computed tomography).

Figure 5

A 48-year-old man with bilateral, comminuted nasal fracture at level III and accompanying fractures orbital, zygoma, maxilla fracture (Images of radiography, axial plane of maxillofacial computed tomography, and three-dimensional computed tomography).