Authors: Daiga Marnauza1, Marks Ronis1, Lana Mičko1, Linda Veidere1

Scientific research supervisor: Jānis Sokolovs M.D., otorhinolaryngologist 1,2

1 Rīga Stradiņš University, Latvia2 Children’s Clinical University Hospital, Latvia

A Retrospective Analysis Of Nasal BoneFractures in Adults in Pauls Stradins

Clinical University HospitalINTRODUCTIONNasal trauma plays an important role in the �eld of craniofacial injury. Nasal bone fractures account for greater than 50% of all facial fractures in adults [1]. As the bones and cartilage of the nose provide aesthetic and structural support for the midface and airway, it is necessary to emphasize the role of di�erent factors and causes leading to trauma to possibly decrease the frequency of nasal bone fractures and its rate of complications such as nasal airway compromise and nasal deformity.

AIM OF THE WORKTo obtain descriptive statistics regarding the adult population with the diagnosis “Fracture of Nasal Bones”, to determine the most common traumatic causes, as well as to establish a typical patient pro�le and nasal trauma risk groups to prevent further injuries and optimize patient care.

MATERIALS AND METHODSRetrospectively collect and analyze medical records of patients admitted to the ENT department and Emergency Care center of Pauls Stradiņš Clinical University Hospital with the diagnosis “Fracture of Nasal Bones” S02.2 (ICD-10) in the time period 01.01.12 - 31.12.14. Statistical analysis of data performed using IBM SPSS software (descriptive statistics, crosstabs with χ2 test). p<0,05 was considered statistically signi�cant.

RESULTSA total of 297 patients in the age group of 15 to 91 years old were selected for this study. The overall ratio of males to females was 3.6 : 1. Young adults belonging to age group of 21-27 were signi�cantly more likely to sustain nose fractures – 84% of all cases (Figure 1). The most common cause of injury was violence (n=171, 57.6%), followed by falls (n=63, 21.2%), sports trauma (n=32, 10.8%) and other – road tra�c accidents, occupational trauma, epilepsy (n=20, 6.6%). Nasal bone fractures related to criminal violence most commonly tend to occur in summer – 65.9%, most frequently in July and August (Figure 2). 133 (48.2%) of all patients sough for medical help during weekends (Figure 3). The most frequent emergency care visiting day was Saturday – 70 (23.6%) between 0 AM and 4 AM – 81 (27%) patients; 52 (40.3%) of them had alcohol intoxication (Figure 5). Moreover, among those patients who were involved in violence – 98 (78.4%) were under the in�uence of alcohol when receiving emergency care (Figure 7). There is no evidence that dislocation to the left side in criminal trauma is more frequent than dislocation to the right (Figure 6). No correlation between the etiology of trauma and full moon phase period was found (p>0.05) (Figure 4).

020406080

100Fig.1 Age Distribution

0%

50%

100%

CriminalTrauma

RoutineTrauma

SportsTrauma

Other

Fig.2 Trauma Frequency by Season

Winter Spring Summer Autumn

32 2837

20

47

70 63

01020304050607080

Fig.3 Fracture Frequency by Days of Week

Monday

Tuesday

Wednesday

Thursday

Friday

Saturd

ay

Sunday18%

21%

82%

79%

FULL MOON

OTHER MOON PHASES

Fig.4 Impact of Moon Phases on Frequency of Criminal Trauma

Days With Trauma Days Without Trauma

10

15

20

25

30

35

8-12 12-16 16-20 20-24 0-4 4-8

Fig.5 Alcohol Presence at Time of Trauma

No Presence of Alcohol Alcohol Intoxication

14%

44%42%

Fig.6 Side of Nasal Bone Dislocation in Criminal Trauma

No Dislocation Dislocation to Right Dislocation to Left

32%

66%

97%

68%

68%

34%

3%

32%

0%

20%

40%

60%

80%

100%

Criminal Trauma Routine Trauma Sports Trauma Other

Fig.7 Alcohol Presence in Types of Trauma

No Presence of Alcohol Alcohol Intoxication

REFERENCES1. Renner G J. Management of nasal fractures. Otolaryngol Clin

North Am //1991;24:195–213. [PubMed]2. d Injuries in Alexandria During the Egyptian Revolution 2011,

Neurosurgery Quarterly // February 2015 Vol. 25 - Issue 1: p 1–53. Murray J A, Maran A G. The treatment of nasal injuries by

manipulation. J Laryngol Otol. // 1980;94:1405–1410. [PubMed]

CONCLUSIONSThis study provides an overview of nasal bone fractures in adult population, illustrates trends and characteristics of this type of trauma. It is useful to predict the most frequent time of the day, day of the week and month of the year when patients visit otorhinolaryngologist due to nasal bone fractures. The study has shown a typical pro�le of the patient with a nasal trauma presenting to ENT specialist – a 24 years old man after alcohol intake with tendency of aggressive behaviour.

DISCUSSIONManagement of maxillofacial trauma is often challenging in emergency room. Alcohol intoxicated patients are usually di�cult to examine [2], they lack compliance, very often refuse admission to hospital and further investigations. Young adults in the age group of 21 – 27 were signi�cantly more likely to sustain nasal bone fractures, the explanation – the third decade of life represents the main period of activeness for individuals that are more involved in outdoor activities responsible for maxillofacial trauma [3]. Seasonal incidence of nasal bone fractures was slightly higher in the autumn. This �nding may be explained with the increase of student migration to the capital city at the beginning of the study semester, commonly associated with an increase in social activities often involving alcohol consumption.