鼻骨骨折の急性期手術　新しい整復用かん子とキルシュナー鋼線固定について

DOI 被引用文献1件 参考文献12件

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タイトル別名
  • Early repair of nasal bone fractures. New forceps and intranasal Kirschner wire suspension.
  • New Forceps and Intranasal Kirschner Wire Suspension
  • 新しい整復用鉗子とキルシュナー鋼線固定について

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Two different shapes (flat septum and dome-shaped dorsum) must be corrected in the treatment of nasal bone fractures. Several grasping instruments, such as Asch forceps and Walsham forceps, are available for closed reduction. However, these flat forceps are not suitable for reconstruction of a curved dorsum, and their thin blades may cause new mucosal lacerations during reduction. On the other hand, intranasal packing used for postoperative internal immobilization may become loose because of exudates, and is risky for patients who have respiratory difficulty. Instruments and methods: We divised two types of grasping forceps, one has a dull side to prevent mucosal laceration when elevating saddle nose deformity. The other has blades curved to conform to the shape of the nasal vault and is designed for nasal dorsum reduction. Instead of gauze packing, 1.2-mm-diameter Kirschner wire is used as an intranasal support by inserting it from outside of the skin down to the maxilla. Both forceps and wire have been clinically used for on closed reduction. Results: When the dull side was pressed against the ridge of the nasal bones, it was easy to re-shape the collapsed nose without mucosal laceration. The nasal vault was also reconstructed well using the curved forceps. Although the radius of the nose varies with the portion of the noses, age and the individual, the curvature of the forceps did not have to be changed. A single blade radius provided excellent control when the vault was lifted upward-and-outward. Fixation of the nose with Kirschner wire was more secure than with gauze packing. Even with a crushed maxilla, it was effective when the angle of insertion or the depth was adjusted. Moreover, nasal breathing was not disturbed after bleeding had stopped.

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