Open vs closed approach to the nasal pyramid for fracture reduction.

OBJECTIVE To compare an open vs a closed approach to the nasal pyramid for the initial repair of nasal fractures. METHODS Retrospective medical record review of 49 patients with acute nasal fractures treated by a single surgeon during a 5-year period. Patients underwent a closed approach to the nasal pyramid (Boise elevator only) or an open approach using rhinoplasty techniques, including rasping, osteotomies, and cartilaginous resection or augmentation. Patients were further categorized based on whether septoplasty was performed. The primary outcome measure was the revision rate (RR). RESULTS All 49 patients with acquired nasal deformities underwent repair within 3 weeks of the date of injury. The cohort was filtered into the following 5 groups: group 1 (closed approach to the nasal pyramid; RR, 1/15 [6.7%]), group 2 (closed approach to the nasal pyramid with septoplasty; RR, 3/4 [75.0%]), group 3 (open approach to the nasal pyramid; RR, 0/10 [0.0%]), group 4 (open approach to the nasal pyramid with septoplasty; RR, 1/15 [6.7%]), and group 5 (prior cosmetic septorhinoplasty; RR, 5/5 [100.0%]). CONCLUSION In patients with nasal fractures and associated septal deviation requiring septoplasty, RRs may be notably reduced by using an open approach to the nasal pyramid at the time of the initial repair.