Page 1 of 2: ent

deepti · Credits: 3263 My Scrapbook

a patient with traumatic nasal deformity seen one month after the injury shud have -
1 closed reduction
2 rhinoplasty in 6mnths
3 rhinoplasty as soon as possible
4 no trt if nasal airway is adequate

BRAVO · Credits: 45704 My Scrapbook

age group of the pt. is not given

am · Credits: 326 My Scrapbook

if the pt. comes after 2 wks of nasal trauma .. reduction is difficult .. hence d is the option

BRAVO · Credits: 45704 My Scrapbook

i agree with am.

bhavu · Credits: 9481 My Scrapbook

me too.ek bar agar koi nak kata hi leta hai to fir woh jodne se koi fayda nahi.

anjali_a · Credits: 4125 My Scrapbook

BHAVU DEAR I MUST SAY U HAVE A GREAT SENSE OF HUMOR.I ENJOY READING UR REPLIES

entconsultant · Credits: 2074 My Scrapbook

sorry to disagree guys
there is NASAL DEFORMITY which require correction
ofcource if the patient wants it.
again age of the patient is not given
assuming it is adult the closed reduction is not possible as one month is too late.
then rhinoplasty is the option usually done after around 6 months to one year

shraddha · Credits: 19590 My Scrapbook

i have a doubt
since airway is adequate
there is no need for sx as a compulsion
rhinoplasty is needed only if pt. wishes for

so the answer should be D

sajjanshenoy · Credits: 4274 My Scrapbook

Yeah, I feel entconsultant is right on that one. When they ask you what is the treatment, they mean that the patient has come to you with the problem and what will you do to solve the patient's problem. Now, nasal deformity is not something like conjunctival hemorrhage which is going to resolve on itself even if you don't do any active management. So, this condition demands that you do something for the patient. So, option D is definitely wrong.

Answer 1 is wrong because closed reduction is very difficult in a nasal fracture after 2 weeks of injury because it heals by that time. (Ref : Dhingra Page 223)

Now, we are left with options C and D.
Dhingra Page 224 gives that "Healed nasal deformities resulting from nasal trauma can be corrected by rhinoplasty or septorhinoplasty". He does not mention when it should be done.

As for entconsultant's answer that it should be done after 6 months, I request entconsultant to please give the reference and reason as to why the operation should be done after 6 months and not immediately?

entconsultant · Credits: 2074 My Scrapbook

Cummings otorhinolaryngology and head and neck surgery 3 edition page 880 says
( i don,t have scott-brown with me at present)

“ Patients who desire a reduction rhinoplasty when a post traumatic deformity is being corrected will require a controlled septorhinoplasty. The ideal period for such corrective surgery is usually 3-6 months after injury. Once all swelling has disappeared and the bones have become completely stable.
In children, the timing of revision surgery is somewhat controversial. When the deformity is minimal, the surgery can be delayed until child is 15 or 16 years of age, when facial growth is nearly complete. This is conservative approach with little chance of additional damages to growth centers. However if significant deformity or dysfunction exists, early precise intervention is indicated.”

Stable nasal bone is required for making precise osteotomies to correct the deformity.
In this question answer given is rhinoplasty in 6 months. And I will go for it.

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