Management of Acute Nasal Bone Fractures in adults: Systematic Review and Meta-Analysis

Background: The optimal timing, patient selection, and surgical technique for the management of nasal trauma are not yet clearly established. The choice of surgical technique also varies depending on the severity of the injury, the patient's individual anatomy, surgeon selection and expertise. Methods: A systematic review and meta-analysis was conducted in March 2022 for papers published between 2002 and 2022. To compare the outcomes of closed nasal bone reduction, septal reduction to other treatments as open reduction, limited septoplasty, septo-rhinoplasty, and delayed rhinoplasty for nasal bone fractures. Also, to assess how reduction type, type of anesthesia, presence of septal fractures and the time interval between injury and treatment could affect patient satisfaction post operatively, rate of complications, revisional surgeries and olfactory dysfunction. Results: A meta-analysis of 19 studies found that reduction type and timing interval between injury and treatment had a significant impact on patient satisfaction. Reduction type and the type anesthesia also had a significant impact on post-operative complication rates. Conclusion: Open nasal reduction (ONR) is associated with higher patient satisfaction, however, closed nasal reduction may be safer. Patients with septal fractures are less satisfied with their results. General anesthesia has higher satisfaction rates and lower complication rates than local anesthesia. Early surgical intervention within 2 weeks of trauma is recommended.