Aesthetic Outcomes of Rhinoplasty Performed in the Early Posttrauma Period after Nasal Bone Fracture

Overview

When to operate after a nasal bone fracture is contested, since early surgery works on swollen unhealed tissue while late surgery works on bone that has set. The authors examined whether timing affects the aesthetic result in 41 adults operated between 2006 and 2021, comparing before and after photographs on a visual analog scale.

Sections of note

• Design: retrospective comparison of two timing groups, 41 patients. Level of evidence 4. Early group: 28 patients operated within 14 days of trauma. Late group: 13 operated after 14 days.
• Spreader and shield grafts were used more often in the late group, p equal to 0.043 and 0.018.
• Patients with type IV or V fractures scored higher on the visual analog scale than those with types I to III, p equal to 0.003, as did those with a preoperative saddle nose, p equal to 0.020.
• No significant difference in overall aesthetic outcome was found between the early and late groups, and both achieved significantly better radix height, dorsal height and tip projection.

What it means for a patient

• Operating within two weeks of a broken nose gave results comparable to waiting, so early surgery is presented as a reasonable option.
• Patients who started worse, with more severe fractures or a collapsed bridge, showed the largest rated improvement, which is expected when there is more to correct.
• The later group needed more support grafts, consistent with bone having already healed in the wrong position.
• Limits: 41 patients split unevenly, retrospective, one centre, and outcome judged by an assessor rating photographs rather than by the patients.

Why this paper matters

Broken noses are usually treated by simple realignment within days, with definitive rhinoplasty deferred for months. Evidence that a full rhinoplasty done early performs as well would spare patients a second procedure. A larger prospective comparison would be needed to act on that.

Terms

• Nasal bone fracture: a break in the bones forming the upper third of the nose.
• Saddle nose: a collapsed bridge that dips in the middle.
• Spreader graft: a cartilage strip placed alongside the septum to hold the breathing valve open.
• Shield graft: a cartilage piece placed over the tip to shape and project it.
• Radix: the root of the nose, the area between the eyes.