The Impact of Age on Late Complications after Nasal Bone Fractures from Blunt Trauma: A 10-Year Retrospective Review

Background: Nasal bone fractures are the most frequent fractures in facial trauma due to its central location and protruding framework. The impact of age on development of late complications after nasal bone fractures has not been well-studied. A greater understanding of the impact of age-related differences on outcomes after nasal bone fractures is essential in order to improve clinical assessment and management.

Methods: A 10-year retrospective chart review of adults with nasal bone fractures presenting to a Level 2 trauma center was performed to evaluate the late complications related to nasal bone fractures. This study variables considered include age, gender, mechanisms of injuries, nasal deformities, sinusitis, olfactory disturbances, airway obstruction, septal perforation, synechiae, types of fractures, and any post-injury operative interventions. Our data was organized into 2 cohorts: adult (aged 18-64 years) and elderly (>64 years). The impact of age on late complications was statistically assessed with statistical significance of p-value less than or equal to 0.05.

Results: There were 833 adult patients who sustained nasal fractures from 2007 to 2017. There was 123 patients in the elderly cohort and 710 adult patients aged 18-64 years. The most common mechanism of injury resulting in nasal bone fractures in the elderly was mechanical falls (52%), and the most common mechanism in the adult cohort was motor vehicle accidents (33.8%). There was no statistically significant difference in nasal bone fracture patterns between both groups (p>0.05). Adult patients were more likely to undergo a post-injury operative intervention (p<0.05).  There was a higher percentage of elderly patients who had late complications compared to the adult cohort. The most common late complication was olfactory disturbances in both groups. Nasal deformities and airway obstruction, however, were more often reported in the adult cohort, and sinusitis as well as olfactory disturbances are more frequently reported in the elderly (p<0.05).

Conclusion: Mechanical falls accounted for the majority of nasal bone fractures in the elderly, whereas a motor vehicle accident was the common mechanism of injury in the adult cohort. There was no difference in nasal bone fracture patterns between the elderly and the adult cohorts. Age, however, did affect the decision to undergo operative interventions, especially in the adult cohort. Elderly patients experienced more complications than their adult counterpart. Posttraumatic olfactory disturbance was the most frequent complication reported in both groups, secondary to distortion of the sinus tract. Sinusitis and olfactory disturbances are more likely to be experienced in the elderly.