Manipulation under anaesthesia of fractured nasal bones - a 10-year retrospective study.

BACKGROUND: Nasal bone fractures are treated by manipulation under general or local anaesthesia procedures. Data on long-term benefits of manipulation under local anaesthesia are limited. This study aimed to quantify the proportion of patients requiring septoplasty or septorhinoplasty after manipulation under general and local anaesthesia procedures. METHODS: Anonymised data were collected from electronic records of all patients who underwent manipulation under anaesthesia at our centre over a 10-year period, including demographics, manipulation under anaesthesia timing and further surgery requirements. RESULTS: The study identified 625 manipulation under general anaesthesia and 52 manipulation under local anaesthesia procedures. Manipulation under local anaesthesia procedures were performed earlier (local anaesthesia = 9 days, general anaesthesia = 15 days; p < 0.05) and were more likely to achieve manipulation (local anaesthesia = 83 per cent, general anaesthesia = 76 per cent; p < 0.05). There was no difference between techniques in the percentage of patients requiring further surgery. CONCLUSION: This paper describes a large cohort of patients who underwent manipulation under anaesthesia over a 10-year period. Manipulation under local anaesthesia procedures have increased since the coronavirus disease 2019 pandemic, and the results are comparable to manipulation under general anaesthesia, with reduced delays between injury and manipulation.

How COVID-19 Changed Our Management of Nasal Bone Fractures and Its Impact on Patient Outcomes-A Retrospective Study.

OBJECTIVES: Nasal bone fractures are a common presentation to the Ear, Nose and Throat (ENT) surgeon. Simple, closed fractures are assessed and considered for closed manipulation under anesthesia (MUA #nasal bones). Most departments perform this under general anesthesia (GA). Our protocol changed in the face of COVID-19, where procedures were alternatively performed under local anesthesia (LA) in the clinic, to cope with lack of elective theater capacity during the pandemic, while still allowing a nasal fracture service to take place. We present postoperative patient outcomes on breathing and shape, comparing GA versus LA. METHODS: Patient records retrospectively analyzed (January 2020-August 2020), and patients undergoing MUA #nasal bones interviewed by telephone after one month. Exclusion criteria were open injuries or depressed nasal bones requiring elevation. Breathing and shape scores were evaluated subjectively using a Likert scale (1 = very unsatisfied, 5 = very satisfied). RESULTS: Two hundred five nasal injury referrals were made (21 MUA #nasal bones under GA and 27 under LA). Manipulation under anesthesia #nasal bones significantly improved both breathing satisfaction scores (GA; 2.88 ± 0.24 to 4.06 ± 0.23, P < 0.05; LA; 2.86 ± 0.22 to 3.77 ± 0.27, P < 0.05) and aesthetic scores (GA; 2.00 ± 0.21 to 3.94 ± 0.23, P < 0.05; LA; 1.64 ± 0.19 to 3.59 ± 0.28, P < 0.05) in both GA and LA groups. There was no statistically significant difference between LA and GA in postoperative outcomes. There was a trend toward greater satisfaction for GA, though this was not statistically significant and may be impacted by the rate of cartilaginous deformity in the LA group. Both techniques were well tolerated and most patients would repeat the procedure in hindsight. CONCLUSIONS: Local anesthesia could provide a safer, cheaper, and satisfactory alternative for performing MUA #nasal bones in the clinic for selected patients, particularly with reduction of elective theater capacity in the event of further COVID-19 surges. We recommend training junior ENT surgeons to perform this procedure under supervision with adequate protective measures.

Nasal fractures: a dedicated clinic providing reduction under local anaesthesia improves time to manipulation.

INTRODUCTION: Guidelines for nasal injury state that assessment should be at 7-10 days post-injury and manipulation within 14 days. We performed a plan, do, study, act improvement cycle to assess whether a dedicated nasal fracture service led to better outcomes. MATERIALS AND METHODS: A retrospective study was carried out of all patients undergoing manipulation under anaesthesia for nasal trauma between February 2013 and December 2016 in a district general hospital. A dedicated nasal fracture clinic providing manipulation under local anaesthesia was implemented followed by a prospective study of all patients presenting to the clinic between February and November 2017. Main outcome measures included time from injury to otolaryngology assessment, time from injury to manipulation and incidence of secondary septorhinoplasty. RESULTS: The retrospective series involved 525 patients including 381 males (72.6%) and 144 females (27.4%). Mean time from injury to assessment was 10 days. Mean time from injury to surgery was 14.5 days. Mean time from assessment to surgery was five days. The incidence of septorhinoplasty was 2.3%. The prospective series involved 119 patients including 78 males (65.5%) and 41 females (34.5%). Following implementation of a nasal fracture clinic, mean time from injury to assessment and manipulation was 6.1 days and 5.4% of patients underwent septorhinoplasty for secondary deformity. DISCUSSION: Implementation of a nasal fracture clinic providing reduction under local anaesthesia reduced the time to assessment and manipulation. The incidence of septorhinoplasty is low following reduction under general or local anaesthesia. Assessment earlier than seven days is feasible and advice for referral can be changed accordingly.

Music Therapy for Pain and Anxiety Management in Nasal Bone Fracture Reduction: Randomized Controlled Clinical Trial.

OBJECTIVE: To evaluate whether listening to music through binaural headphones contributes to the perception of pain and anxiety in patients undergoing closed nasal bone fracture reductions. STUDY DESIGN: Randomized controlled trial. SUBJECTS AND METHODS: We recruited patients from San Juan de Dios Hospital with displaced nasal fractures who required a reduction and assigned them to a control group or a music group. For both groups, a protocolized closed reduction of the nasal fracture with local anesthesia was performed. The music group heard music through headphones during the pre-, intra-, and postprocedural periods of the intervention. Physiological variables (blood pressure and heart rate) were measured. An anxiety survey (State-Trait Anxiety Inventory) and the visual analog scale for measuring pain were also applied. RESULTS: The music group exhibited significantly lower levels of systolic blood pressure (P = .0001), anxiety (P < .0001), and pain (P = .0004) than the control group. CONCLUSION: Listening to music through headphones-a safe and low-cost intervention-appears to aid in pain and anxiety management associated with procedures that are usually uncomfortable, such as the reduction of nasal bone fractures with local anesthesia. We believe that this effect is achieved by the modulation of pain and anxiety on an emotional-affective dimension at a central level. Given its safety, feasibility, and low cost, music therapy should be considered a complementary treatment for pain and anxiety management for nasal fracture reduction performed with local anesthesia, as well as for other medical procedures of similar pain levels conducted without general anesthesia.

Endonasal Infiltrative Anesthesia for Nasal Fracture Reduction.

This study investigated the use of endonasal infiltrative anesthesia for the management of pain associated with nasal bone fracture reduction. Fifty-two patients with nasal bone fractures were distributed in 2 groups. In the first group, topical endonasal anesthesia and external transcutaneous infiltrative anesthesia were employed. In the second group, endonasal infiltrative anesthesia was also added. Visual analog scale pain scores related to the different steps of the procedure were registered. The addition of endonasal infiltrative anesthesia was associated with a significant decrease (p < .05) in pain during reduction maneuvers (6.71 vs. 4.83) and nasal packing (5.18 vs. 3.46). Addition of endonasal infiltrative anesthesia is an effective method of pain reduction during nasal bone fracture treatment.

Comparison of Postoperative Outcomes Between Monitored Anesthesia Care and General Anesthesia in Closed Reduction of Nasal Fracture.

Fracture of nasal bone is among the most common facial bone fractures. Reduction of nasal bone fracture is able to be performed under local or general anesthesia. The aim of this study is to compare monitored anesthetic care (MAC) and general anesthesia (GA) based on intraoperative vital signs, and the adverse effects after closed reduction of nasal bone fractures.The authors performed a retrospective study of 45 patients who underwent a closed reduction of nasal bone fracture between January 1, 2016 and December 31, 2016. Patients are divided into an MAC group (n = 17) or GA group (n = 28). A sore throat, postoperative pain scores, nausea, vomiting, hospital stay, operation time, and the result of surgery are compared between the groups. All the patients have interviewed their satisfaction of aesthetic and functional outcome.The operation time and hospital stay were lower in the MAC group. There is no difference in a sore throat, postoperative pain score, and the result of surgery significantly. In the MAC and GA groups, there was no statistically significant difference in the postoperative cosmetic and functional satisfaction scores.Closed reduction of nasal bone fracture using MAC is as safe and efficient as GA. However, MAC anesthesia may not be feasible if airway discomfort due to bleeding is expected, or fracture is severe and multiple manipulations are required. Therefore, MAC is considered to be a good alternative when patients undergoing short-term or small operations do not prefer general anesthesia.

Reducción de fracturas nasales con anestesia local. Nuestra experiencia / Reduction of nasal fracture with local anesthesia. Our experience / Redução de fratura nasal com anestesia local. A nossa experiência

Introducción: las fracturas nasales son la consecuencia más frecuente de los traumatismos craneofaciales. Su tratamiento puede involucrar una reducción cerrada de huesos propios nasales que puede realizarse con anestesia local. El objetivo del presente trabajo es evaluar los resultados funcionales, estéticos y el dolor en la reducción cerrada de fracturas nasales. Material y método: Estudio prospectivo, randomizado, y descriptivo que evaluó la funcionalidad nasal antes y después de la reducción, en dolor del procedimiento, y sus resultados estéticos. Resultados: Se realizaron un total de 21 reducciones cerradas. El signo más habitual fue la crepitación en 14 pacientes, laterorrinia en 13, y 4 epistaxis. En cuanto a ventilación nasal previo a la reducción, el máximo puntaje en la escala Nasal Obstruction Symptoms Scale fue de 13 puntos, con un promedio de 4,8 puntos; y luego de realizar la reducción nasal el puntaje más alto fue de 7, con un promedio de 1,09 puntos. Estéticamente, luego de realizar la reducción nasal 8 pacientes notaron que su nariz estaba "mucho mejor", 9 pacientes notaron que su nariz estaba "mejor", y 4 pacientes indicaron que estaba igual. En cuanto a eficacia anestésica el menor puntaje fue de 0 referido por tres pacientes, el más alto fue de 10 en 2 pacientes; y el puntaje promedio referido fue de 3,5. Conclusiones: La reducción cerrada de fractura nasal es una técnica que es posible de realizar bajo anestesia local, obteniendo óptimos resultados estéticos y funcionales, y siendo bien tolerada por el paciente si la técnica se hace adecuadamente. Es necesario contar con la experiencia y los medios necesarios para realizarla.

Introduction: nasal fractures are the most frequent consequence of craniofacial trauma. Its treatment may involve a closed reduction of nasal bones that can be performed under local anesthesia. The objective of the present study is to evaluate the functional, aesthetic and pain outcomes in the closed reduction of nasal fractures. Material and method: Prospective, randomized, and descriptive study, evaluating nasal function before and after reduction, the pain of the procedure, and its aesthetic results. Results: A total of 21 nasal fracture reduction were made closed. The most common sign was crepitus in 14 patients, laterorrinia in 13, and 4 epistaxis. As for nasal ventilation prior to reduction, the maximum score in the Nasal Obstruction Symptoms Scale was 13 points, with an average of 4.8 points; and after performing the nasal reduction the highest score was 7, with an average of 1.09 points. Aesthetically, after making the nasal reduction 8 patients noticed that his nose was "much better", 9 patients noticed that his nose was "better", and 4 patients indicated that was “same as before”. As for anesthetic efficacy was the lowest score of 0 was reported by three patients, the highest was 10 in 2 patients; and referred the average score was 3.5. Conclusions: Closed reduction of nasal fracture is a technique that can perform under local anesthesia, obtaining optimal aesthetic and functional results, and being well tolerated by the patient if the technique is done properly. You must have the experience and resources needed to perform it.

Introdução: as fraturas nasais são a consequência mais frequente dos traumas craniofaciais. Seu tratamento pode envolver uma redução fechada de ossos próprios nasais, a qual pode ser realizada com anestesia local. O objectivo deste estudo foi avaliar o resultado funcional, estética e a dor na redução de fracturas fechadas nasais. Material e método: Estudo prospectivo, randomizado e descritivo que avaliou a funcionalidade nasal antes e depois da redução, a dor do procedimento e seus resultados estéticos. Resultados: Foram realizadas 21 reduções fechadas. O sinal mais comum foi a crepitação em 14 pacientes, laterorrinia em 13 e epistaxe em 4. No tocante à ventilação nasal antes da redução, o valor máximo na escala Nasal Obstruction Symptoms Scale foi 13 pontos, com uma média de 4,8 pontos; e, após a redução nasal, o valor mais alto foi 7, com uma média de 1,09 pontos. Esteticamente, após a redução nasal, 8 pacientes notaram que seu nariz estava "muito melhor"; 9 pacientes notaram que seu nariz estava "melhor" y 4 pacientes disseram que estava igual. A respeito da eficácia anestésica, o menor valor foi 0 segundo três pacientes, e o maior foi 10 em 2 pacientes. O valor médio comentado foi 3,5. Conclusões: A redução fechada de fratura nasal é uma técnica que pode ser realizada sob anestesia local, com ótimos resultados estéticos e funcionais. É bem tolerada pelo paciente se a técnica é realizada adequadamente. É preciso contar com a experiência e os meios necessários para realizá-la.

Adding Injury to Insult: A National Analysis of Combat Sport-Related Facial Injury.

OBJECTIVES/HYPOTHESIS: To estimate the incidence of patients presenting to emergency departments (EDs) for facial trauma sustained from participation in combat sports and evaluate injury patterns and patient demographics. METHODS: The National Electronic Injury Surveillance System (NEISS) was evaluated for facial injuries from wrestling, boxing, and martial arts leading to ED visits from 2008 to 2013. Relevant entries were examined for injury mechanism, location, type, as well as other patient characteristics. RESULTS: There were 1143 entries extrapolating to an estimated 42 395 ED visits from 2008 to 2013. Injury rates for boxing, marital arts, and wrestling were, respectively, 44, 56, and 120 injuries per 100 000 participants. Males comprised the majority (93.7%). A plurality of injuries involved lacerations (46.0%), followed by fractures (26.2%) and contusions/abrasions (19.3%). The proportion of fractures was highest among boxers (36.9%). Overall, the most common mechanisms of injury were punching, kicking, and head butting. CONCLUSIONS: The significant number of ED visits resulted from combat sports facial trauma, reinforcing the importance of familiarity with injury patterns among practitioners managing facial trauma. As most injuries involve individuals younger than 19 despite guidelines suggesting children and adolescents avoid combat sports, these findings may be used for patient education and encouragement of the use of personal protective equipment. Furthermore, injury patterns reported in this analysis may serve as an adjunct for enhancing clinical history taking and physical examination.

Local versus general anesthesia for the management of nasal bone fractures: a systematic review and meta-analysis.

PURPOSE: The aim of this study was to answer the following question: in patients with nasal bone fractures (NBFs), does closed reduction under local anesthesia (LA) produce comparable outcomes as closed reduction under general anesthesia (GA)? MATERIALS AND METHODS: A systematic review with meta-analysis and a comprehensive electronic search without date and language restrictions was performed in August 2014. The inclusion criteria were studies in humans, including randomized or quasi-randomized controlled trials (RCTs), controlled clinical trials (CCTs), and retrospective studies whose aim was comparing clinical outcomes between LA and GA for closed reduction of NBFs. RESULTS: Eight publications were included: 3 RCTs, 2 CCTs, and 3 retrospective studies. Three studies showed a low risk of bias, and 5 studies showed a moderate risk of bias. There was no statistical difference between LA and GA for closed reduction of NBFs with regard to patient satisfaction with anesthesia, patient satisfaction with function of the nose, need for subsequent retreatment (septoplasty, septorhinoplasty, or rhinoplasty with refracture), and a patient's chosen treatment for a refracture of the nose. There was a statistical difference between LA and GA for closed reduction of NBFs with regard to patient satisfaction with the appearance of the nose. CONCLUSION: Regardless of the cost and risks associated with GA, the results of the meta-analysis showed that GA provides better patient satisfaction with anesthesia, appearance and function of the nose, and preference of treatment for a refracture of the nose. In addition, the meta-analysis showed that GA decreased the number of subsequent corrective surgeries (septoplasty, septorhinoplasty, and rhinoplasty) required.

Criteria for the request of preoperative tests among oral and maxillofacial surgeons.

OBJECTIVE: The aim of this study was to analyze the criteria employed for the requesting of preoperative tests among maxillofacial surgeons. MATERIALS AND METHODS: Thirty maxillofacial surgeons working in Aracaju (Brazil) received a questionnaire to fill out. The study inquired about the practice of requesting preoperative tests for healthy patients scheduled to undergo elective surgery. RESULTS: Most of the surgeons interviewed requested tests that are not recommended for the case in question. The highest frequency of requests was a complete blood count, coagulation test, blood glucose test and chest radiograph. CONCLUSION: The absence of strict rules for the requesting of preoperative tests causes uncertainty and a lack of criteria regarding pre-surgical conduct. It was not possible to clearly define the criteria used by surgeons for requesting such tests, as the clinical characteristics of the hypothetical case presented suggest a smaller number of tests.

[Retrospective analysis of 2461 patients with maxillofacial fractures].

OBJECTIVE: To review the 2461 cases of maxillofacial fractures. METHODS: From 2003 to 2009, 2461 maxillofacial fracture cases were treated in Foshan Hospital of Traditional Chinese Medicine, Guangzhou University of Traditional Chinese Medicine. Data regarding sex, age, cause of injury, occupation, geographic distribution, blood type, fracture site, multiple associated injuries, injury severity, the patient's first admitted department, treatment results were reviewed. RESULTS: The male and female ratio was 4.28:1, 1424(57.86 %) patients were between 20 and 40 years of age. The most common cause of injury was road traffic accident (938 cases, 40.98%). People in tertiary industry (900 cases, 78.53%) were most vulnerable to injuries. The zygomatic complex (22.08%), nasal bone (20.67%) and mandible (16.35%) were the most frequent fracture sites, which were often associated with skull (21.74%), brain (38.36%) and soft tissue contusion injury (48.84%). 85.98% (2116/2461 cases), of patients' AIS score was less than 2. Orthopaedics (939/2461 cases, 38.16%) was the first admitted department. CONCLUSIONS: The traffic accidents are the main cause of the maxillofacial fractures. Most injuries are found in the young and middle-aged people.

Manipulation of nasal fractures with local anaesthetic: a 'how to do it' with online video tutorial.

Nasal fractures are the most common facial fractures and displaced fractures may cause considerable cosmetic concern. Traditionally, displaced nasal fractures have been manipulated under general anaesthesia (GA) performed within 2 weeks of the injury. Despite evidence for the benefit of local anaesthesia (LA), nasal fractures are still most commonly reduced under GA. We have presented a method of reduction of simple nasal fractures under LA in an outpatient setting. This has the advantage of being painless, simple to attempt and cost-effective. If reduction is inadequate then a general anaesthetic reduction is still possible. A recent comprehensive systematic review of all the available evidence did not show any significant difference (in terms of cosmesis, pain or nasal obstruction) between using LA and GA methods and highlighted the evidence base to support LA. We describe our method of assessment and treatment of displaced nasal fractures and provide an online tutorial (http://sciencestage.com/v/22194/local-anaesthetic-nasal-fracture-reduction.html). It is important to keep in mind that any concerns should be referred to an otolaryngology specialist for further management and that practitioners attempting this technique should first receive training from an otolaryngologist.

Manipulation of nasal fractures under local anaesthetic: a convenient method for the Emergency Department and ENT clinic.

BACKGROUND: Nasal fractures are the commonest facial fracture. They can cause morbidity in terms of nasal obstruction and cosmesis. They can be treated by simple external digital manipulation, provided they are seen and assessed in a timely fashion. This manipulation is commonly done under general anaesthetic (GA), which utilises precious resources and may cause delays in treatment. SUMMARY OF EVIDENCE FOR PROPOSED METHOD: A recent comprehensive systematic review has shown local anaesthetic (LA) to be comparable to GA in terms of cosmesis, airway patency and patient acceptability. The experience for the patient is akin to that of a dental filling, and can be made more painless with the use of topical anaesthesia. PROPOSED METHOD: In the current age of evidence-based medicine and drive for cost-effective management decisions, it is thought that LA manipulation may offer a superior option to GA. A simple method for manipulation under LA is presented that can be done in the Emergency Department.

Bleeding from posterior superior alveolar artery in Le Fort I fracture.

This article describes a patient in whom significant oronasal bleeding developed after an injury to posterior superior alveolar artery of the maxillary artery in Le Fort I fracture.A 34-year-old man had a facial injury after an explosion of a furnace. Computed tomography demonstrated Le Fort I fracture, right open zygomatic tripod fracture, and open nasal bone fracture. Blood pressure, hemoglobin, and hematocrit levels had fallen to 110/60 mm Hg, 5.7 mg/dL, and 16.1%, respectively, 10 hours after injury despite continuous blood transfusion. Selective digital angiography confirmed an injury to the posterior superior alveolar artery, with extravasated pooling of contrast material in the maxillary sinus. The distal internal maxillary artery was embolized with n-butyl cyanoacrylate and lipiodol. Postembolization angiogram showed resolution of the contrast leak, and the patient's oronasal bleeding resolved.We suggest that if the oronasal bleeding continues in Le Fort fracture, bleeding from the posterior superior alveolar artery should be suspected. In case the vital sign is not stable, selective angiography should be performed before surgery.

Local anaesthesia for manipulation of nasal fractures: systematic review.

OBJECTIVE: To determine the most effective local anaesthetic method for manipulation of nasal fractures, and to compare the efficacy of local anaesthesia with that of general anaesthesia. METHOD: Systematic review and meta-analysis. DATABASES: Medline, Embase, Cochrane Library, National Research Register and metaRegister of Controlled Trials. INCLUDED STUDIES: We included randomised, controlled trials comparing general anaesthesia with local anaesthesia or comparing different local anaesthetic techniques. Non-randomised studies were also systematically reviewed and appraised. No language restrictions were applied. RESULTS: Five randomised, controlled trials were included, three comparing general anaesthesia versus local anaesthesia and two comparing different local anaesthetic methods. No significant differences were found between local anaesthesia and general anaesthesia as regards pain, cosmesis or nasal patency. The least painful local anaesthetic method was topical tetracaine gel applied to the nasal dorsum together with topical intranasal cocaine solution. Minimal adverse events were reported with local anaesthesia. CONCLUSIONS: Local anaesthesia appears to be a safe and effective alternative to general anaesthesia for pain relief during nasal fracture manipulation, with no evidence of inferior outcomes. The least uncomfortable local anaesthetic method included topical tetracaine gel.

Outcome analysis of sports-related multiple facial fractures.

In this paper, we report a retrospective study of 236 patients with facial bone fractures from various sports who were treated at the Department of Plastic and Reconstructive Surgery, Inha University Hospital, Incheon, South Korea, between February 1996 and April 2007. The medical records of these patients were reviewed and analyzed to determine the clinical characteristics and treatment of the sports-related facial bone fractures. The highest frequency of sports-related facial bone fractures was in the age group 11 to 20 years (40.3%); there was a significant male predominance in all age groups (13.75:1). The most common causes of the injury were soccer (38.1%), baseball (16.1%), basketball (12.7%), martial arts (6.4%), and skiing or snowboarding (11%). Fractures of the nasal bone were the most common in all sports; mandible fractures were common in soccer and martial arts, orbital bone fractures were common in baseball, basketball, and ice sports, and fractures of the zygoma were frequently seen in soccer and martial arts. The main causes of the sports injuries were direct body contact (50.8%), and the most commonly associated soft tissue injuries were found in the head and neck regions (92.3%). Nasal bone fractures were the most common (54.2%), and tripod fractures were the most common type of complex injuries (4.2%). The complication rate was 3.0%. Long-term epidemiological data regarding the natural history of sports-related facial bone fractures are important for the evaluation of existing preventative measures and for the development of new methods of injury prevention and treatment.

Reduction of nasal bone fractures: a comparative study of general, local, and topical anesthesia techniques.

UNLABELLED: The aim of the current study of nasal bone fracture reduction carried out under topical, local, and general anesthesia was to suggest a proper treatment of patients with nose fractures. METHOD: The patient candidates for close nasal bone reduction (CNR) were divided into 3 groups: topical anesthesia (TA), local anesthesia (LA), and general anesthesia (GA), and CNR was performed. After reduction, pain scores and satisfaction and failure rates after 2 and 30 days were noted. All the patients were followed up for at least 1 month. RESULTS: The mean pain scores (TA = 2.35, LA = 2.47, and GA = 1.9) showed no significant difference among these 3 groups (P > 0.05). The percentages of the patients' satisfaction in the groups were as follows: TA = 84.6%, LA = 83.8%, and GA = 91.7%. These values had no statistical difference (P > 0.05). There was no significant difference among the failure rates on the second day and after 1 month of follow-up (after 2 d, TA = 10%, LA = 18%, and GA = 14%, and after 1 month, TA = 2%, LA = 7%, and GA = 5%). CONCLUSIONS: If the selection of patients is done properly, CNR under TA/LA will have considerable success in comparison with GA. Topical anesthesia is suggested in simple nasal fracture with unilateral depression or minimal displacement.