From the Guidelines
For nasal bone reduction, infraorbital nerve blocks and external nasal nerve blocks are the most commonly used anesthetic blocks to provide effective pain control. These blocks are used to interrupt sensory nerve transmission from the nasal region, providing anesthesia to the nasal bones, cartilage, and overlying skin. The procedure involves injecting 1-2 mL of 1-2% lidocaine with epinephrine (1:100,000) at the infraorbital foramen for the infraorbital nerve block, and at the junction of the nasal bone and upper lateral cartilage bilaterally for the external nasal nerve block 1. Additionally, a dorsal nasal block can be performed by injecting 2-3 mL of anesthetic at the radix of the nose to block the dorsal branches of the anterior ethmoidal nerve. Local infiltration along the nasal dorsum and around the fracture site with 1% lidocaine with epinephrine can supplement these nerve blocks, allowing for comfortable manipulation and reduction of nasal fractures without the need for general anesthesia in appropriate cases. Some key considerations for nasal bone reduction include:
- The configuration of lateral osteotomies should be tailored to the patient's anatomy 1
- The osteotomy should be started on the piriform aperture, just above the attachment of the turbinate, aiming to preserve a spickle of bone that supports the suspensory ligaments of the lower lateral cartilages 1
- Sliding low over the nasal facial groove to prevent step off deformities, the osteotomy ends high on the nasal bone at the level of the medial canthus 1
- Camouflaging techniques, such as onlay grafts, may be used in addition to or as an alternative for osteotomies and nasal bone fracturing to achieve the desired outcome 2.
From the Research
Nasal Bone Reduction Blocks
There are no specific blocks mentioned in the provided studies for nasal bone reduction.
Alternative Methods
- The studies discuss various methods for treating nasal bone fractures, including closed reduction 3, 4, 5, 6 and open reduction with internal fixation 3.
- Ultrasonography-assisted closed reduction is also mentioned as a useful technique for confirming proper reduction under local anesthesia 4.
- Septal body volume reduction is discussed as a treatment for nasal obstruction caused by septal body hypertrophy 7.
Fracture Types and Treatment
- The studies classify nasal bone fractures into different types, including unilateral, bilateral, frontal, laterofrontal, and comminuted types 3, 5, 6.
- The treatment approach may vary depending on the fracture type, with closed reduction being suitable for certain types and open reduction with internal fixation being necessary for more complex cases 3, 6.