Closed Reduction

Closed Reduction

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Closed Reduction for Fracture OS Nasal

Management options for Os fractures Nsal can be with closed reduction or open reduction considering the type and severity of the fracture. The best time for proper and most accurate management is done immediately after injury, before there is significant tissue edema. The goal of management is to restore appearance, restore airway patency, midline septum, maintain nasal valve integrity, prevent postoperative complications such as stenosis, septal perforation, columella retraction, and saddle deformity or persistent deformity.

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Deformity due to nasal bone fracture is often encountered and requires reduction. with fixation adequate to fix nasal position. Handling of simple nasal bone fractures can be done by repositioning the fracture under local anesthesia. If bleeding occurs Keep going ongoing, nose must closed with gauze tape Vaseline for 48 hours. If possible, the bone fragments should be repositioned within a few hours before swelling occurs which will cause deformity. External splints are used to maintain the position of the nasal bones. If splints are not used, deformity is likely to occur. ^13,26,29

Chart 2. Handling trauma nose ³

Splint fracture OS nasal simple describe splint nose perfect as a piece of soft metal plate (size 22) shaped like an hourglass. So the bottom in accordance with the shape of the nose and parts on from the plate is on the forehead. Splint nose This is splint normal Which can to form nose and evens out the pressure on all sides, then held in place by a T-shaped adhesive plaster. across forehead in part on And plaster in part lower withhold nose. Only moderate pressure can be used and the bandage cannot be removed for a long period of time. time minimum two days. Limit time the use of medication is until the nose is not inflamed and swollen. ²³

The closed reduction manipulation technique is a technique used to reduce a newly occurring nasal bone fracture. Approximately 2-3 weeks after the trauma, it will form network fibrotic on fragment bone in position Which No should And this is it Which cause reduction with technique This No Possible done. In

nasal bone reduction action, some tools that can be used such as blunt elevators ( Boies Nasal Fracture Elevator ), Asch forceps , Walsham forceps , short nasal speculum, Killian long speculum and bayonet tweezers. Nasal bone fractures can be reduced with forceps Walsham Which have distance between eye knife And cover section, Where part the allow closing network nose Which not destroyed. 10,21,26

Picture 11. Walsham forceps , Boies elevator , Ash forceps , nasal speculum, nasal suction , bayonet forceps. 

Eye knife Walsham forceps which wide rather grooved to achieve the outer wall of the nose and protects nasal skin. The inner blade is smaller and shaped to reach the inner nose. ^23,26

Doctor expert surgery must be careful in determine location from line fracture and it is very important not to use Walsham forceps in above the fracture line for move second process nasofrontalis. However forceps Walsham can be used For move second process nasal go out maxilla and use controlled force to avoid sudden jerking movements. To reposition the nasal bones, the septum is then grasped with Asch forceps. Which placed in behind back rice, manipulation septum nasal using Asch forceps to straighten the nasal septum. Forceps This was created on the same principle as forceps Walsham , but forceps Ash have eye knife Which can hold septum, Where part eye knife the separated from handle main part lower with size more big And curve Which useful For avoid the occurrence of severe or more extensive compression and damage to the columella. ^23,26

Picture 12. Reduction closed with use forceps Asch 

Reposition open under consideration For done when 1) has happen septal fracture open, 2) fracture dislocation wide bone nose And septum nasal, 3) the occurrence of caudal septal fracture dislocation, 4) pyramid deviation of more than half the width of the nasal bridge, 5) permanent changes in shape after closed repositioning, 6) Because reposition change form septum Which No adequate, 7) occurrence of hematoma septum, 8) combination of changes form septum and alar cartilage, as well as 9) the occurrence fracture displacement spine rice front And existence history intranasal surgery . ^2.27

Picture 13 . Technique incision with reduction open on fracture OS nasal.16^​

Reposition open done If must do reposition part nasal pyramid consequence fracture occurrence bone nasal And bone vulnerable septum nasal Which interrelated. The septum can be reached through a hemitransfixion incision on the dislocated side, then the nasal bone fracture line can be reached through bilateral intercartilage incisions. The dorsal skin raised in above the lateral cartilage top and periosteum nasal bone is removed. ²⁰ Another technique uses an intranasal approach through an incision. intercartilaginous For reduce depression broken bone nose. After surgery mucoperiosteal tunnel segment lower, wire placed in distal part below the root of the nose stable and lower distal lateral cartilage For guard fragment Which elevated. Wire cut And piece small left in cavity rice to enable retrieval after 10 to 14 days. The success rate of action with this method is reported to be 85%. ¹⁶

The presence of epistaxis can heal spontaneously, but if necessary, cauterization, anterior or posterior nasal tampons or ligation of blood vessels can be performed. Bleeding from the anterior side is usually due to laceration of the anterior ethmoid artery, a branch of the ophthalmic artery. Bleeding from the posterior side comes from the posterior ethmoid artery or the lateral nasal branch of the sphenopalatine artery, if necessary, ligation of the internal maxillary artery. ^28,30

Prophylactic antibiotics should be given to patients with chronic weakness and with septal or dorsal hematoma. If there is a cerebrospinal fluid leak due to a fracture of the cribriform plate or posterior wall of the frontal sinus, it will usually close spontaneously with 4-6 weeks of observation. ³⁰

2. Complications Slow ( late )

Airway obstruction, secondary deformities, adhesions, fibrosis (formation of network tie) or contracture (shortening) network muscle nasal), saddle nose, and septal perforation are late complications of nasal fractures. Complications This should can prevented more beginning, disproportion nasofacial can occurs with the formation of a long nose especially during puberty. In addition, it can occur obstruction duct nasolacrimalis which causes epiphora, thing This can be diagnosed radiologically by inserting contrast through the inferior punctum. The part of the duct above the blockage will appear widened. Once the location of the blockage is known, a new channel can be created connecting the lacrimal sac with the inferior meatus using polyethylene pipe, this action called dacryotic rhinotomy. ^3,28,30

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