What becomes of the broken nose?

Authors have no conflict of interest. JC, et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome: report of an international workshop. et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). 3. Deane KD, West SG. Antiphospholipid antibodies as a cause of pulmonary capillaritis and diffuse alveolar hemorrhage: a case series and literature review. Diffuse alveolar hemorrhage and Libman-Sacks endocarditis as a manifestation of possible primary antiphospholipid syndrome. ME, Ytterberg S, et al. Primary antiphospholipid syndrome-associated diffuse alveolar hemorrhage. WhAT becoMes of The broken nose? Editor, Nasal fractures are the most common facial injury, frequently associated with aesthetic, functional and psychological complications 1. Closed reduction of fractured nasal bones is first line treatment commonly employed by Otolaryngologists and Plastic Surgeons, however some patients require open septorhinoplasty 1. 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 surgery 2. 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 assault 3. 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 fractures 1,4,5. Septal involvement is frequently underestimated by physicians when assessing and managing nasal fractures 1,4,5. Our study showed many discrepancies between findings documented at the …