CUHK
News Centre

Our nose is the centre piece of our face. It is a complex framework of bone and cartilage, enveloped by thin muscles and skin and is an important organ for functional breathing as much as defining facial beauty. Unfortunately as the nose is our most prominent feature of the face, it is also very vulnerable to trauma. Studies report up to 39% of facial traumas involved the nose.

Injuries to the nose can cause functional obstruction to breathing as well as cosmetic deformities. Usually these nasal fractures are treated by very simple closed reduction surgery within two weeks of the injury. However this routine treatment may fail to completely address the complex 3-dimensional bony-cartilaginous deformities caused by the trauma and there is increasing evidence to show that patients have persistent cosmetic concerns and nasal blockage after closed reductions. One European study reported that 41% of patients still had nasal deformities despite remedial closed reduction surgery. More so functionally, the persistent blocked nose can aggravate mouth-breathing; the drier mouth and throat may in time lead to recurrent throat inflammation, bad breath, dental caries and snoring can be precipitated. Overall there is a poorer sense of well-being. So how happy exactly are patients with the results of simple closed reduction surgery for their nasal injuries?

Doctors of the Division of Otorhinolaryngology, Department of Surgery at the Prince of Wales Hospital, the teaching hospital of The Chinese University of Hong Kong, conducted a patient-based interview to study satisfaction rates after closed reduction surgery of patients who injured their noses between July 2002 and June 2005. Sixty-two patients with a mean age of 27.7 years (range, 12-67 years) were interviewed. Fifty patients were male (81%) and 12 (19%) were female. A fifth (21%) of these patients continued to report that their noses were still blocked. Interestingly the doctors found that eighteen patients (29%) remained unhappy with the appearance of their nose. When the possibility of revision surgery was offered, a third (29%) of those studied welcomed further surgery to improve their nasal breathing and / or appearance.

Professor Terry Hung, Assistant Professor of the Division of Otorhinolaryngology who directed the study said, “Closed reduction for nasal fractures would satisfy a large number of patients who are unfortunate to have injury to their noses. However it remains clear from the study that a significant proportion of our patients remain dissatisfied with the appearance of their noses, their breathing or both. We should be alert to this fact and advise them on the appropriate course of treatment”.

Professor Michael Tong, Chief of Division of Otorhinolaryngology at The Chinese University of Hong Kong further added, “The nose can be commonly injured during traffic accidents, assaults and sporting activities. Patients are assessed and closed reduction surgery should be offered if necessary. However there are obvious situations when a more formal septorhinoplasty procedure should be offered, sometimes even at the outset, especially for injuries involving both the bony and cartilaginous framework of the nose.”

Septorhinoplasty is a more major alternative surgical procedure that fully reconstructs the complex bony-cartilaginous nose as one single integrated unit. It will improve not only the appearance of the nose but more importantly simultaneously corrects the nasal function. Both appearance and functional restoration of the Nose can increase an individual’s psychological well-being, their social interactions and ultimately self-confidence.