A Single Center Review of Pediatric Nasal Bone Fractures

An Analysis of Concomitant Injuries, Management, and Outcomes

Meher Pandher, BS; Thayer J. Mukherjee, BA; Jordan N. Halsey, MD; Margaret M. Luthringer, MD; Roman Povolotskiy, BA; Ian C. Hoppe, MD; Mark S. Granick, MD

Disclosures

ePlasty. 2021;21(e7) 

In This Article

Abstract and Introduction

Abstract

Background: Pediatric nasal bone fractures presenting as isolated fractures or with concomitant facial injuries are rare and not well documented. Analysis of treatment at an urban, level-one trauma center provides insight into their management.

Methods: Data were collected for pediatric nasal bone fractures diagnosed between January 2000 and December 2014. Patients were divided into groups based on presence or absence of isolated nasal bone fractures. Groups were compared using Chi-squared analysis, and a Bonferroni correction was used for a more conservative alpha (a = .004).

Results: Assault was the most common etiology presenting in 46 of 122 pediatric nasal bone fractures. There was no significant difference in surgical versus non-surgical management of isolated and non-isolated nasal bone fractures (P = 0.98). Treatment for both was predominantly watchful waiting in 91% to 95% of the cases followed by closed reduction in 3.2% to 3.3%. In the patients with isolated fractures, 11.5% sustained intracranial hemorrhage, compared to 35.6% of multifracture cases (P = .002); 15.0% of isolated fractures sustained a traumatic brain injury, compared to 55.9% of multifracture cases (P = .000003). No significant difference in fatality existed between groups (P = 0.53).

Conclusions: Multi-facial fracture cases were more likely to present with traumatic brain injuries and be admitted to the intensive care unit than isolated nasal bone fractures. Rates of surgical and non-surgical management were not significantly different between the 2 groups. Watchful waiting of pediatric nasal bone fractures was the management approach selected 92% to 95% of the time regardless of the presence or absence of concomitant facial fractures.

Introduction

Pediatric facial fractures are rare, accounting for only 15% of all facial fractures due to pediatric facial bone elasticity, full facial fat pads, small face to head volume ratio, incomplete pneumatization of sinuses, and maxillary stabilization by unerupted dentition.[1] The thin, prominent nature of nasal bones, however, still leaves them vulnerable for injury, and pediatric nasal bone fractures often prove challenging for both the patient and the physician.[1] The most common causes of nasal bone fractures in the pediatric population are assault and motor vehicle collisions, often related to airbag deployment or lack of seat belt restraints leading to facial injury.[2–4] Typical management strategies of isolated nasal bone fractures in children consist of watchful waiting versus closed reduction.[5–7] For pediatric nasal bone injuries, literature is limited on suggested management protocols to limit long-term sequelae of functional and aesthetic deformity of unrepaired fractures. Analysis of trends and management patterns at an urban, level-one trauma center provides insight into more severe clinical presentations. A single institution, 14-year retrospective review was conducted comparing all pediatric patients who sustained isolated nasal bone fractures to those with nasal bone fractures and concomitant facial fractures, as well as the morbidity and mortality between groups and the reconstructive options utilized.

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