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Introduction
The nose is prone to injury due to its prominent position on the face. Nasal bone fractures are the commonest type of bony injury of the facial skeleton.1 Facial injuries in general constitute approximately 500 000 attendances to UK accident and emergency departments annually.2 Assault and alcohol consumption have been identified as the two major factors responsible for serious facial injuries in adults.3 The high prevalence of nasal trauma presents a clinical challenge to the surgeon, as these injuries often bear long-term consequences, with the potential need for later reconstructive surgery.
The impact of nasal trauma should not be underestimated. Although nasal fractures are often considered as minor injuries, the incidence of unsatisfactory nasal aesthetics, even after fracture manipulation, is not insignificant.4 Up to one-third of these patients have post-reduction deformities which require reconstruction by rhinoplasty or septorhinoplasty.5 In addition, the psychological impact of nasal trauma can persist long after the injury has occurred. The low self-esteem resulting from patients' perception of their deformity may limit their ability to achieve their full potential.6,7
The primary aim of nasal fracture manipulation is to reduce the cosmetic deformity resulting from nasal bone fracture. While post-traumatic nasal deformity clearly has an impact on facial aesthetics, there is at present no 'gold standard' for assessing nasal deformity, such assessment being largely a subjective exercise. The effect of trauma on the aesthetic dimensions of the nose is poorly described in literature. The aim of this study was to identify the effect of nasal trauma and fracture manipulation on the aesthetic proportions of the nose.
Method
Ethical approval was obtained from the Tayside medical research ethics committee to recruit patients attending the nasal fracture clinic at Ninewells Hospital and Medical School. Patients with any additional maxillo-facial injuries were excluded, as were those with a history of nasal or facial surgery. To reduce the potential for inter-racial variation, the study was restricted to subjects of Caucasian racial origin. Consecutive patients meeting the study criteria were recruited over a three-month period.
All patients underwent standard closed nasal manipulation under local anaesthetic, as described previously,8 7 to 10 days after the initial injury. This was performed as a day case in an operating...