A Protocol for Reducing Secondary Deformity
Postoperative care is fundamental to achieving the desired final result and minimizing the incidence of secondary surgery for deformity. The nasal packings are removed by the patient after 72 hours. All patients treated with closed nasal reduction are seen 1 week postoperatively. Despite excellent reduction in the operating room, nasal bones tend to revert to their previous traumatized shape. One week after closed reduction, the nasal bones remain mobile. The Denver Splint is removed during this first clinic visit. Any deviation or collapse is managed with external manipulation of the nose with consistent, uniform pressure using the pad of the thumb until symmetry is reestablished. The patient is then instructed to look in the mirror several times per day and apply continuous and firm pressure to the deviated side of the nose (if present) to keep it aligned in the midline. This involves the patient in their own care, and may in fact improve final outcome, as the patient may be more vigilant in detecting deformities before they are too late to correct with manipulation. Manipulation in the mirror may continue for 2 weeks until there is no longer any tenderness, indicating a healed fracture. If Doyle splints are used, these are removed after 2 weeks.
Finally, the patient will be seen roughly 1 month later (6 weeks postoperatively) for final evaluation. Using these simple steps and postoperative care regimen, patients have been very satisfied with results from closed treatments of nasal fractures.