Die Fraktur des Os nasale: Eine Analyse an 300 Patienten

Fractures of the nasal bone belong to the most frequent fractures of the human body due to its central position in the face. From ancient times, therapy of choice is the reposition of the fractured bone at an early stage after the traumatic event. A major and therefore undesired complication is septal hematoma with a subsequent abscess. The aim of the present thesis is a retrospective analysis of 300 patients which were treated in the Department of Otolaryngology, Head & Neck Surgery, University of Marburg, Germany between 1999 and 2004 for fractures of the nasal bone. Special focus was paid to the development of posttraumatic septal hematoma and the former treatment concept with regard to future improvement of the strategy. The results were discussed reflecting the relevant literature. The average age of the affected patients was 29,6 years. 77% of the patients were male. Falls (30%), physical violence (28%) and sports injuries (27%) account for the most nasal fractures. 15 patients developed a posttraumatic septal hematoma. The weekly distribution of nasal fractures shows an increased incidence of injuries at the week-end. Reasons for that might be the higher percentage of extracurricular and sports activities as well as visits of discotheques and bars with an high incidence of interpersonal conflicts. The diagnosis of a nasal fracture is mostly confirmed by nasal bone x-rays even though the reliability of the nasal bone radiograph has recently been questioned. However, radiologic diagnosis is required in the daily clinical routine not only for medico-legal reasons. The treatment of choice is depending on the surgeons preference, hospital protocols and practical reasons. Closed reduction has been the treatment paradigm for more than 5000 years, but despite of the frequency of this injury there does not exist a uniform protocol for the management of nasal fractures. The present investigation showed satisfying cosmetic and functional results utilizing closed reduction under general anesthesia in case of simple fractures. 10,8% of the patients had esthetic or obstructive complaints after closed reduction. The technique of closed reduction is an effective first-line treatment for simple nasal fractures with good esthetic and functional results.