A Clinical Study of Nasal Synechiae Causing by Closed Reduction for Nasal Bone Fractures

 Hwan-Jun Choi, MD, Chang-Yong Choi, MD, and Hyung-Eun Yang, MD
INTRODUCTION: Several authors reported about the post-traumatic nasal aesthetic complications. However, the study for functional or intra-nasal complications has been reported not enough. The aim of this study is to observe the incidence of intranasal synechia.

 METHODS: We reviewed the data from 401 consecutive patients with nasal bone fracture from september 2006 to December 2007. We enforced evaluation with preoperative CT in all patients but postoperative CT within complicated patients. We classified the nasal bone fracture according to the anatomy and severity of fracture. Type I is nasal tip fracture(15%, n=59), Type II is simple lateral without septal injury(38%, n=152), Type III is simple lateral with septal injury(23%, n=92), Type IV is closed comminuted(20%, n=82), Type V is open comminuted or complicated(4%, n=16). We studied 98 patients with nasal bone fracture who had postoperative symptoms or undergone postoperative endoscopic evaluation. And then we evaluated the postoperative endoscopic finding and nasal synechal formation after operation.

 RESULTS: The incidence of intranasal synechiae was 15%(n=62). According to the endoscopic findings, the incidence of intranasal synechiae was 10%(n=6) in Type I, 8%(n=12) in Type II, 16%(n=15) in Type III, 24%(n=20) in Type IV, and 56%(n=9) in Type V. Additionally, the incidence of subjective nasal obstruction and olfactory dysfunction is 18%(n=72) and 13%(n=51). But the incidence of symptomatic synechiae of nasal obstruction and olfactory dysfunction is 92%(57/62) and 55%(34/62).

 CONCLUSION: We identified relatively high prevalence of nasal obstruction and olfactory dysfunction in nasal synechiae. Based on the results of this study, intranasal synechiae really caused airway obstruction(92%). Our data showed significant relationship between intranasal synechiae and severity of the fracture, because of increasing mucosal handling and destructive closed reductional procedures. First of all, education of delicate
procedure regarding this subject should be empathized accordingly.

Fig. 1. (Left) Preoperative axial CT finding. (Center) Intranasal endoscopic finding shows synechia formation
between superior concha and septum. (Right) Endoscopic finding shows synechia formation in middle meatus.
Fig. 2. (Left) Preoperative CT finding shows communited fracture. (Center) Intranasal endoscopic finding shows synechia formation in right middle meatus. (Right) Removal of synechia by scissors.

 REFERENCES
1. Chung SH, Park JI, Choe J, Baek SM: Clinical analysis of satisfaction of nasal bone reduction. J Korean Soc Plast Reconstr Surg 21: 984, 1994
2. Park WY, Kim YH: A clinical study of the nasal bone fracture according to Stranc classification. J Korean Soc Plast Reconstr Surg 35: 289, 2008
3. Kim SB, Han SK, Kim WK: Airway improvement after reduction of nasal bone fracture. J Korean Soc Plast Reconstr Surg 32: 49, 2005
4. Dogru H, Tuz M, Uygur K, Cetin M: A new turbinoplasty technique for the management of concha bullosa: Our short-term outcomes. Laryngoscope 111: 172, 2001