Open treatment of nasal fracture; complicated, with internal and/or external skeletal fixation
CPT4 code
Name of the Procedure:
Open Treatment of Nasal Fracture; Complicated, with Internal and/or External Skeletal Fixation
Summary
This procedure involves surgically repairing a complex nasal fracture that may require the use of internal or external skeletal fixation devices to ensure proper healing and alignment of the nasal bones and cartilage.
Purpose
This surgery aims to correct nasal fractures that are complex and involve multiple bone fragments or significant displacement. The goal is to restore the normal structure and function of the nose, improve breathing, and enhance cosmetic appearance.
Indications
- Severe nasal fractures with multiple bone fragments
- Significant displacement of nasal bones
- Associated injuries to facial structures
- Persistent nasal obstruction after trauma
- Cosmetic deformities resulting from the fracture
Preparation
- Patients may need to fast for several hours before the procedure.
- Medication adjustments may be necessary, especially blood thinners.
- Pre-operative assessments such as X-rays or CT scans to evaluate the extent of the fracture.
- Discussion of anesthesia options and obtaining informed consent.
Procedure Description
- Anesthesia: Administered general anesthesia to ensure the patient is fully asleep and pain-free.
- Incision: A surgical incision is made to access the nasal bones and cartilage.
- Realignment: The surgeon carefully repositions the fractured nasal bones into their proper place.
- Fixation: Depending on the complexity, internal fixation (e.g., plates and screws) or external fixation (e.g., splints) devices are used to stabilize the bones.
- Closure: The incision is closed with sutures, and nasal packing or splints may be applied to support the structure during healing.
Duration
The procedure typically takes between 1 to 2 hours, depending on the complexity of the fracture.
Setting
This surgery is generally performed in a hospital operating room or an outpatient surgical center.
Personnel
- Surgeons specializing in otolaryngology or plastic surgery
- Anesthesiologists to manage anesthesia
- Surgical nurses to assist with the procedure
- Technicians for operating and monitoring equipment
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Poor wound healing or scarring
- Nasal obstruction due to improper healing
- Anesthesia-related complications
- Need for additional surgery if bone alignment shifts during healing
Benefits
- Improved nasal structure and function
- Enhanced cosmetic appearance of the nose
- Relief from nasal obstruction and improved breathing
- Reduced risk of long-term complications from a poorly healed fracture
Recovery
- Patients may need to stay overnight if significant post-operative monitoring is required.
- Pain management with prescribed medications.
- Avoiding heavy lifting, strenuous activities, and nasal trauma for several weeks.
- Follow-up appointments to monitor healing and potentially remove fixation devices.
- Full recovery may take several weeks to months.
Alternatives
- Closed reduction (manipulating bones without incision) for less complex fractures
- Non-surgical management with nasal splints for minor fractures
- Pros: Less invasive, quicker recovery for some alternatives
- Cons: May not be sufficient for complex fractures, higher risk of poor alignment
Patient Experience
- Patients will be under anesthesia during the procedure and will not feel pain.
- Post-operatively, there may be some discomfort, swelling, and bruising around the nose and eyes.
- Pain can be managed with medications.
- Instructions on keeping the nasal area clean and avoiding certain activities will be provided to ensure optimal healing.