A Study on 3D Deep Learning-Based Automatic Diagnosis of Nasal Fractures

This paper reported a study on the 3-dimensional deep-learning-based automatic diagnosis of nasal fractures. (1) Background: The nasal bone is the most protuberant feature of the face; therefore, it is highly vulnerable to facial trauma and its fractures are known as the most common facial fractures worldwide. In addition, its adhesion causes rapid deformation, so a clear diagnosis is needed early after fracture onset. (2) Methods: The collected computed tomography images were reconstructed to isotropic voxel data including the whole region of the nasal bone, which are represented in a fixed cubic volume. The configured 3-dimensional input data were then automatically classified by the deep learning of residual neural networks (3D-ResNet34 and ResNet50) with the spatial context information using a single network, whose performance was evaluated by 5-fold cross-validation. (3) Results: The classification of nasal fractures with simple 3D-ResNet34 and ResNet50 networks achieved areas under the receiver operating characteristic curve of 94.5% and 93.4% for binary classification, respectively, both indicating unprecedented high performance in the task. (4) Conclusions: In this paper, it is presented the possibility of automatic nasal bone fracture diagnosis using a 3-dimensional Resnet-based single classification network and it will improve the diagnostic environment with future research.

Pearls of plastics in ENT practice that Conceals & Camouflages the Camber, Contour & Cosmesis in Facial Trauma

Facial trauma can involve soft tissue injuries such as burns, lacerations, bruises and even fractures of the facial bones such as nasal fractures and fractures of the jaw as well as injury to the eye. Symptoms are specific to the type of injury that can be either signs of inflammation or changes in facial definition. Facial injuries have the potential to cause temporary deviations in facial delineation to permanent disfigurement of facial structures.

Effects of the COVID-19 Pandemic on Pediatric Nasal Fractures

Objectives Nasal bone fracture is a frequent entity consulted to the otolaryngologists, approximately accounting for 39% of all facial bone fractures. The most frequent mechanisms of injury consist of assault, sport-related injuries, falls, and motor vehicle accidents. In this study, we examined the effects of the COVID-19 pandemic on pediatric nasal fractures. Methods Children with nasal fracture who applied to Malatya Training and Research Hospital during the year before the first case and the following year were included in this study. Data of 172 patients for the pre-pandemic period and 79 patients for pandemic were available and included in the study. Demographic information, clinical features, nasal fracture etiology, nasal fracture type, type and time of intervention, and other accompanying pathologies were recorded. Results While falls was the leading cause of fracture etiology before the pandemic (64 patients [37.21%]), assault seems to be the leading cause during the pandemic period (27 children [34.18%]). In the pre-pandemic period, the intervention for patients with nasal fractures was performed on an average of 5 days, while this period was calculated as an average of 6 days during the pandemic period. When the 2 groups are compared in terms of nasal fracture intervention time, it was seen that the intervention time was statistically significantly later in the pandemic period ( P < .001). According to the results of the analysis, the most cases in the pandemic period were seen in the fourth month, which indicated a-month period between 11 June and 11 July. Conclusions In conclusion, our number of nasal fracture cases was decreased during the pandemic period compared to the 1-year period before the pandemic. We observed the most common type IIA nasal fracture. We gave outpatient treatment to most of the patients. Our most common cause of fracture was assault. We intervened in our cases in an average of 6 days and preferred closed reduction most frequently. We could not find any study on the same subject in the literature, and we aimed to contribute to the literature with this study.

Nasal and Naso-orbito-ethmoid Fractures

Craniofacial fractures are common among trauma patients. Nasal fractures are the most common craniofacial fracture. Understanding how to evaluate and manage craniofacial fractures is important for the craniofacial trauma consultant. This manuscript describes the appropriate workup and management of nasal and naso-orbito-ethmoid fractures.

1402 Impact of COVID-19 on Nasal Fracture Presentation and Epidemiology: A Retrospective Comparative Case-series Study

Aim Nasal fractures (NF) are the most common ENT presentation and commonly managed in the clinic or A&E. With the recent COVID pandemic, this study aims to assess the difference in demographics, incidence and aetiology in NF since the start of the first lockdown (16/03/2020) as well as management of nasal fractures. Method Retrospectively, data collection on demographics, history and management over 5 years (2015-2020) for all patients presenting with symptoms of nasal fracture. Data was collected on password-protected Excel spreadsheet and subsequent statistical analysis performed using IBM SPSS Statistics. Results A total of 346 patients were identified of which 36 were diagnosed during the lockdown. Seventy-one percent were ≤40 years old and common aetiology recorded was assault (n = 85), sports (n = 85) and falls (n = 77). Mechanical fall was the common aetiology in older patients. Across gender, falls was the most common aetiology in females (37/94) and assault for males (72/246). Epistaxis (57%) and nasal congestion (31.8%) were most commonly reported symptoms. Before lockdown, Fifty-six percent of the cohort underwent manipulation of NF under local anaesthetic and no intervention needed in 39% while 58% underwent no intervention during the lockdown. No patients were readmitted in 30 days who were treated conservatively or with local anaesthetic during the lockdown. Conclusions This study showed that the most common cause of NF was sports and assault while during the lockdown, falls was the leading cause. More patients were managed conservatively during the lockdown with no 30-readmission showing that conservative management was as effective as management under local anaesthetic.

Sport and Recreational Causes of Nasal Bone Fractures

Objective: Nasal bone fractures are the most common facial bone fractures. However, there is limited literature on the etiology of these fractures, particularly distribution across sports and other recreational activities. Methods: The Nationwide Electronic Injury Surveillance System (NEISS) national injury database was queried for emergency department visits involving the diagnosis of nasal or nose fractures associated with sports and recreation activities over the most recent 10 year span available. Demographic, disposition, and weighted incidence were analyzed. Results: Total incidence of nasal fractures across 10 years was 158 979. The mean age of nasal bone fractures was 20.4 years old. Nasal fractures were more common in males (74.6%) and white patients (54.1%). National estimated incidence of nasal fractures decreased from 21 028 in 2009 to 11 108 in 2018, a reduction of 47.2%. The most common causes among all patients were basketball (23.2%), baseball (17.1%), softball (9.8%), soccer (7.4%), and football (7%). In pediatric patients, the most common cause was baseball (25.1%). The majority (98.1%) of patients were discharged from the emergency department, while 0.9% of patients were admitted. Conclusion: The most common recreational causes of nasal fractures are sports, with the most common being non-contact sports like basketball and baseball. However, the incidence of nasal bone fractures due to recreational causes nationwide has decreased significantly over the past 10 years. This may reflect improved safety protocols among athletes.

686 Evaluating and Modernising the Management of Nasal Trauma in Emergency ENT Clinic

Aim 1. Optimise and compare management of nasal fractures at a single UK based centre with nationally excepted standards from ENT UK and published literature. 2. To measure the non-attendance (DNA) rate in the emergency ENT clinic for patients with nasal trauma. 3. To assess the ratio of face to face (F2F) appointments to patients listed for a manipulation under anaesthesia MUA. 4. To provide additional insight into the aetiology of nasal trauma Method Retrospective analysis of clinical notes for all nasal traumas reviewed in the ENT emergency clinic at a single centre from 1st July 2019 – 1st March 2020. Parameters investigated included – demographics, days from injury, F2F:MUA, DNA rate and aetiology of injury. Implementation of a video-based clinic and local anaesthetic MUA clinic. Results At total of 255 patients and 311 appointments notes were reviewed in this period. DNA rate was found to be 28%. F2F:MUA was found to be 4:1. Patients were reviewed on average 9 days post-injury. Most common causes of trauma were assault (39%), fall (31%), sport (13%), accidental hit (10%). Conclusions The DNA rate was found to be 20% higher than the national average for outpatient clinics and a F2F:MUA of 4:1 displays a high burden of unnecessary F2F contact. A video-based and local anaesthetic nasal fractures clinic has been implemented to combat these issues which will be re-audited.