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• W155173611 abstract "Nasal fractures are the most common facial injury, frequently associated with aesthetic, functional and psychological complications1. Closed reduction of fractured nasal bones is first line treatment commonly employed by Otolaryngologists and Plastic Surgeons, however some patients require open septorhinoplasty1.In our practice the incidence of fractured nasal bones appears to be rising from approximately 100 cases in 2008 to 170 cases in 2012. For 95 percent of cases closed reduction of fractured nasal bones led to satisfactory results. However an increasing numbers of patients are being seen, following closed reduction of fractured nasal bones, who are unsatisfied with the result and are requesting further surgical intervention. Our review of 700 patients from 2008 to 2012 has shown a rise in those undergoing either rhinoplasty or septorhinoplasty from 1.9 percent to 8.4 percent.Seventy percent of patients with fractured nasal bones were male with an average age of 31 years, of which approximately 50 percent sustained nasal injury secondary to alleged assault. SIMON (Single, Immature, Male, Overly expectant and Narcissistic) is an acronym commonly used to identify patients who are likely to be unsatisfied with the outcome of nasal surgery2. We appear to be seeing an increasing number of patients fitting the SIMON criteria who are ‘unsatisfied’ with the outcomes of a procedure that in general provides satisfactory results. Alternatively there maybe a legal motivation for those pursuing open surgery considering that almost half of our patients reported injury secondary to alleged assault3.Complex nasal injuries are frequently associated with high failure rates, following closed reduction of fractured nasal bones. These include grade III fractures involving the nasal septum and patients with previous nasal fractures1, 4, 5. Septal involvement is frequently underestimated by physicians when assessing and managing nasal fractures1, 4, 5. Our study showed many discrepancies between findings documented at the time of clinic compared to at the time of theatre, particularly in relation to the nasal septum. If closed reduction of fractured nasal bones is conducted without addressing a septal fracture, the septum will in time move the nasal bones back towards their deviated position1, 4, 5. Moreover, our results showed that approximately 25 percent of patients who had an unsatisfactory outcome reported previous nasal fractures.Fractured nasal bones are successfully treated by closed reduction in the vast majority of cases, however a rising number of patients are now undergoing open surgery. We believe the reason for this increasing trend is multifactorial. Our results suggest that there is an increasing number of SIMONs within our society who are frequently unsatisfied with the result of cosmetic surgery or surgery following assault or injury. Furthermore factors such as status of the nasal septum and previous nasal injuries have to be considered if initial treatment is to be successful. Finally it is the authors experience that increasing numbers of patients with nasal fractures are being booked for septorhinoplasty at the outset rather than nasal bone manipulation if this is felt acceptable at the time of consultation and we predict that this trend will continue." @default.
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• W155173611 date "2014-01-01" @default.
• W155173611 modified "2023-09-23" @default.
• W155173611 title "What becomes of the broken nose?" @default.
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