A study of the Division of Otorhinolaryngology, Department of Surgery, Faculty of Medicine, The Chinese University shows that simple closed reduction surgery used to treat nasal fractures may fail to completely address the complex 3-dimensional bony-cartilaginous deformities caused by traumas. Therefore, septorhinoplasty, a more major alternative surgical procedure, is recommended for the full reconstruction of the complex bony-cartilaginous nose as one single integrated unit. This surgical procedure will not only correct the nasal function but also improve the appearance of the nose.
Injuries to the nose can cause functional obstruction to breathing as well as cosmetic deformities. Usually these nasal fractures are treated by very simple closed reduction surgery within two weeks of the injury. However this routine treatment may fail to completely address the complex 3-dimensional bony-cartilaginous deformities caused by the trauma and there is increasing evidence showing that patients have persistent cosmetic concerns and nasal blockage after closed reductions. One European study reported that 41% of patients still had nasal deformities despite remedial closed reduction surgery. What is more, the persistent blocked nose can aggravate mouth-breathing. And the drier mouth and throat may in time lead to recurrent throat inflammation, bad breath, dental caries and snoring. Overall there is a poorer sense of well-being.
Doctors of the Division of Otorhinolaryngology, Department of Surgery, conducted a patient-based interview at the Prince of Wales Hospital between July 2002 and June 2005 to study the satisfaction rates of the patients who received closed reduction surgery after having nose injuries. Of the 62 interviewed patients, 50 (81%) were male and 12 (19%) were female. A fifth (21%) of them continued to report that their noses were still blocked and 18 patients (29%) remained unhappy with the appearance of their nose. When the possibility of revision surgery was offered, a third (29%) of the interviewees welcomed further surgery to improve their nasal breathing and / or appearance.
Prof. Terry Hung, Assistant Professor of the Division of Otorhinolaryngology who directed the study, said, 'Closed reduction for nasal fractures would satisfy a large number of patients who are unfortunate to have injury to their noses. However, it is clear from the study that a significant proportion of our patients remain dissatisfied with the appearance of their noses, their breathing or both. We should be alert to this fact and advise them on the appropriate course of treatment'.
Prof. Michael Tong, Chief of Division of Otorhinolaryngology, added, 'The nose can be commonly injured during traffic accidents, assaults and sporting activities. Patients are assessed and closed reduction surgery should be offered if necessary. However there are obvious situations when a more formal septorhinoplasty procedure should be offered, sometimes even at the outset, especially for injuries involving both the bony and cartilaginous framework of the nose.'
Septorhinoplasty is a more major alternative surgical procedure that fully reconstructs the complex bony-cartilaginous nose as one single integrated unit. It will improve not only the appearance of the nose but more importantly simultaneously corrects the nasal function. Both appearance and functional restoration of the Nose can increase an individual's psychological well-being, their social interactions and ultimately self-confidence.