What are the best techniques for nasal bone reduction?

Best Techniques for Nasal Bone Reduction

The most effective technique for nasal bone reduction is closed reduction using a C-arm for real-time imaging, which significantly reduces complication rates and need for reoperation compared to traditional closed reduction methods. 1

Anatomical Considerations for Nasal Bone Reduction

When approaching nasal bone reduction, understanding the anatomical components is crucial:

• Anterior septal deviation and anterior inferior turbinate hypertrophy are major structural components causing nasal obstruction 2
• Compensatory turbinate hypertrophy typically occurs on the opposite side of septal deviation 2
• The nasal bones should be conceptualized as two thin plates that can be independently mobilized to affect dorsal width and bony base 3

Optimal Reduction Techniques

Closed Reduction Techniques

• C-arm guided closed reduction:

  • Allows indirect visualization of the fractured bone during the procedure
  • Enables immediate assessment of reduction results in the operating room
  • Significantly lowers complication rates and reoperation frequency 1

• Standard closed reduction:

  • Effective for simple nasal fractures without concurrent fractures or severe septal involvement
  • Can be performed under local or general anesthesia
  • Shows significant improvement in both functional and aesthetic parameters 4

Osteotomy Techniques for Complex Cases

For cases requiring osteotomies, the American Academy of Otolaryngology recommends:

• Medial oblique osteotomy:

  • Most effective when placed at the lateral aspect of the apex of the open roof
  • Can reduce dorsal width without requiring lateral osteotomy 5
  • Angle of 15-30 degrees off midline is optimal 5

• Percutaneous lateral osteotomy:

  • Recommended for severe cases with functional issues
  • Particularly effective when combined with middle vault problems 6
  • Should be performed with small skin punctures to preserve periosteal attachments 6

• Piezoelectric device technique:

  • Use settings of 25-30 kHz frequency
  • Offers superior precision and safety compared to conventional techniques
  • Particularly valuable when working near important neurovascular structures 6

Protocol to Reduce Secondary Deformities

Following this protocol can reduce secondary deformity rates to as low as 15.6% and revision surgery rates to 5.5% 7:

1. Identify exact location of nasal deformity before reduction
2. Determine optimal reduction or osteotomy sites based on patient's nasal anatomy and skin thickness
3. Use the smallest possible osteotomies to achieve desired mobilization
4. Preserve periosteal and mucosal attachments when possible
5. Consider post-reduction external manipulation for minor secondary deformities
6. Perform careful post-operative assessment for upper lateral cartilage avulsion from nasal bone (occurs in ~4.4% of cases) 7

Avoiding Complications

• Avoid intermediate osteotomies halfway up the nasal bone as they risk visible irregularities or step-off deformities 6
• Exercise caution with short nasal bones as they present relative contraindication for osteotomies due to risk of bony communication 6
• Avoid morselization for weakening cartilage as it increases surface area with higher risk of absorption and complicates secondary revisions 6
• Change sequence of osteotomies to medialize nasal bones and osseous septum "like opening a book" in cases of severe osseous deviation 6

Post-Reduction Management

• Regular clinical and functional assessments
• Consider radiographic evaluation at 12 months post-surgery
• Earlier assessment if bone deformity worsens or clinical concerns arise 6
• For minor secondary deformities, external manipulation may avoid need for secondary operation 7

The overall success rate of closed nasal reduction with postoperative manipulation (when necessary) can reach 94.5% when following a structured protocol 7.