Since nasal bone fractures are the most common among facial bone fractures, they are frequently encountered in clinics. Also, since the operation is comparatively simple, it could be misunderstood to be an easy operation and there is a tendency to overlook the accompanying nasal septal fracture [5
]. Kim et al. [5
] reported that 46.9% of nasal bone fractures are accompanied by septal fractures. Rhee et al. [6
] classified nasal septal fractures into four categories according to the degree of damage to the nasal septum seen on CT, and he laid down the principle of performing a septoplasty in cases in which the perpendicular plate of the ethmoid bone and the quadrangular cartilage were dislocated by more than 50% from the center. However, recently, a septoplasty performed even in cases with a slight dislocation is known to have positive results, and hence the trend is to perform active surgical treatment. Kim et al. [5
] achieved a positive result by performing a primary septoplasty in patients with nasal bone fracture accompanied by a small nasal septal fracture.
There is a report that the incidence of nasal deformation ranges from 14% to 50% after closed reduction of nasal bone fractures during rhinoplasty or septoplasty [6
]. Consequently, the nasal septal damage that may accompany the nasal bone fracture can be the main cause of nasal deformation and nasal obstruction after reduction [2
]. Similarly, in cases with a nasal bone fracture accompanied by a traumatic injury to the nasal septal cartilage, there is a more severe secondary nasal deformation than in cases with a nasal bone fracture but without an accompanying nasal septal injury. Hence, the application of an external splint for two weeks after closed reduction is not adequate to prevent secondary deformation of the nasal septal cartilage. Also, the results of septoplasty, which is generally performed with preservation of the nasal septal cartilage, cannot be predicted if there is no adequate clinical experience. Hence, we tried to prevent secondary deformation of the nasal septal cartilage by approaching the nasal septal fracture with open reduction, preserving the nasal septal cartilage, and fixing the bioabsorbable mesh into the perichondrium as an internal splint. This is considered to be a technique that properly complements closed reduction and open reduction performed for nasal septal fractures.
Bioabsorbable mesh is used in craniofacial plastic surgery as well as in facial bone fractures as a treatment option since it causes a negligible foreign body reaction and it does not need to be removed. It can also be used in the patients who are growing because it does not influence growth [4
]. We have been using bioabsorbable mesh for years in facial bone fractures and based on this experience, bioabsorbable mesh was easily applied in septoplasty. The bioabsorbable mesh used in this study has a simple design such that it can be easily inserted, does not cause any specific complications, and does not affect the union although it is placed between the septal cartilage and the perichondrium; in addition, the soft tissue can communicate through the various holes located on the mesh [7
]. However, since mesh exposure is likely to occur, extra care needs to be taken while elevating and dissecting the perichondrium off the convex side of the septal cartilage, especially the thin flap of perichondrium. The bioabsorbable mesh degrades after two to three years depending on the patient's metabolism. The important point is that the internal splint is absorbed before the bioabsorbable mesh is degraded, and this provides a sufficient time period for the bioabsorbable mesh to function as a buttress after the reduction.
In patients with a nasal bone fracture accompanied by a nasal septal fracture, we reduced the fractured nasal septum while not removing the damaged cartilage during septoplasty. We straightened the bent cartilage by making a cross-hatching incision on the nasal septal cartilage and fixed a piece of bioabsorbable mesh as an internal splint between the perichondrium and the cartilage.
Obtaining a satisfactory result in this patient using this technique indicates that open reduction can be easily performed in cases with a nasal septal fracture. However, it is thought that the author's technique requires a longer follow-up, and since the investigation has been performed in only a few patients, this research should be conducted in many cases according to the classification based on the type of nasal septal fractures. There is no data on the interaction between the cartilage and the bioabsorbable mesh, so additional research is needed.