Gauze Fixation Technique for Stabilization of Depressed Nasal Bone Fracture: A Novel Approach

Abstract

Background:

Reduction and stabilization of depressed nasal bone fractures often rely on nasal packing, which may become dislodged, resulting in recurrent displacement. Open reduction with internal fixation is effective but more invasive, costly, and associated with visible scars. This study introduced and evaluated a novel percutaneous gauze fixation technique for stabilizing nasal bone fractures.

Methods:

This retrospective study was conducted between 2023 and 2024 and included 10 patients with nasal bone fractures treated by a single plastic surgeon. All underwent closed reduction followed by stabilization using a 5 × 5 cm paraffin gauze anchored with external silk sutures passed transcutaneously from the nasal vestibule to the forehead. The gauze was removed on postoperative day 10. Patients were followed up for 3 months, and outcomes were assessed through clinical examination and computed tomography imaging.

Results:

Ten patients (mean age: 28 y; 8 men and 2 women) were included. Most injuries were simple and unilateral; 2 were comminuted, and 1 was open. Septal injuries were noted in 2 patients. All patients presented with visible nasal deviation or depression preoperatively. At 3 months, computed tomography scans confirmed successful reduction with less than 1 mm of residual displacement in all cases. No patients experienced nasal obstruction, residual deformity, or visible scarring. Minor discomfort and transient thread-site irritation occurred in some cases.

Conclusions:

The described percutaneous gauze fixation technique provides effective, low-cost stabilization for nasal bone fractures with minimal morbidity, avoiding drawbacks of internal fixation or traditional packing.

Takeaways

Question: Can a novel external gauze fixation technique provide effective stabilization for reduced nasal bone fractures?

Findings: The technique ensured that the gauze remained in place, preventing displacement into the nasopharynx or outside the nose. At 3 months postoperatively, all patients demonstrated satisfactory nasal bone reduction, confirmed by clinical evaluation and computed tomography imaging.

Meaning: This low-cost, simple technique provides effective stabilization of nasal fractures, avoiding the complications of standard packing or open reduction. It offers a reliable and practical alternative, ensuring proper healing with minimal added operative time and improved patient outcomes.

INTRODUCTION

The nasal bones are among the most frequently fractured facial bones due to the prominence of the nose, which often makes it the first point of impact during facial trauma. Treatment approaches vary among surgeons, with closed reduction being one of the most commonly used techniques. This procedure is typically performed in the acute phase (within 1–2 wk) to minimize the risk of long-term nasal deformities and the need for secondary surgical interventions.¹

Depressed nasal bone fractures are often unstable following closed reduction. To stabilize the reduced fragments and reduce the risk of synechiae, bleeding, and hematoma formation, nasal packing is commonly used.^2,3 However, there is no consensus on the optimal type or duration of packing, leading to wide variations in clinical practice. Paraffin gauze is frequently used, but it may become dislodged due to sneezing, coughing, or inadvertent removal by the patient or slippage into the nasopharynx.⁴ In this study, we present a novel technique for percutaneous gauze fixation designed to prevent accidental displacement and enhance postoperative nasal bone stability.

METHODS

This was a retrospective study conducted between January 2023 and December 2024, approved by the institutional review board of Hôtel-Dieu de France hospital. All patients signed informed consent before inclusion. Inclusion criteria were patients aged 18 years or older with isolated nasal bone fractures, presenting with bony displacement and instability after closed reduction. Exclusion criteria included pediatric patients (<18 y), those with prior nasal surgery, and those refusing follow-up computed tomography (CT).

The primary outcomes evaluated were clinical (nasal deviation, depression) and radiological (bony alignment and residual displacement on CT). All procedures were performed by a single plastic surgeon under general anesthesia to avoid distortion from local anesthetic infiltration and to allow accurate palpation of bony contours. Reduction of the nasal bones was performed using a Boies elevator. In cases with septal injuries, reduction was achieved using Asch septum straightening forceps.

If the nasal bone reduction was judged unstable, paraffin gauze packing was used for stabilization. The fixation technique involved a 5 × 5 cm paraffin gauze and two 2-0 silk threads mounted on straight surgical needles. The gauze was tied at its center with the threads, and under direct vision, the needles were passed through the nasal mucosa and fracture site, exiting through the glabellar skin cephalad to the fracture. (See figure, Supplemental Digital Content 1, which displays the intraoperative needle passage. The needle was passed through the nasal skin before placing the gauze inside the nose for stabilization, https://links.lww.com/PRSGO/E298.) In small nostrils, a nasal speculum and lighted retractor were used to improve visualization.

Once the gauze was pulled under the nasal bones, one of the needles took a 1-cm subcutaneous bite just above the hairline, and both threads were tied under tension over a second piece of paraffin gauze to protect the forehead skin. (See figure, Supplemental Digital Content 2, which displays the intraoperative view showing the paraffin gauze stabilized beneath the nasal bones after needle passage through the nasal mucosa and glabellar skin, with the suture already exited just above the hairline for external fixation, https://links.lww.com/PRSGO/E299.) (See figure, Supplemental Digital Content 3, which displays the immediate postoperative view with gauze fixation. Postoperative image of the patient at the end of the surgery, demonstrating the completed stabilization technique with the gauze secured in place, https://links.lww.com/PRSGO/E300.) The packing was left in place for 10 days, during which oral antibiotic prophylaxis was administered.

RESULTS

A total of 10 patients (mean age: 28 y; 8 men and 2 women) with nasal bone fractures underwent closed reduction followed by stabilization using paraffin gauze and external silk suture fixation. The study was conducted retrospectively between 2023 and 2024. The mean interval between injury and surgery was 7 days. Nine injuries were closed, and 1 was open. Fracture patterns included 8 unilateral simple fractures and 2 comminuted fractures. Septal injuries were identified in 2 patients and were reduced simultaneously during the same procedure. The most common mechanism of injury was sports-related trauma (6 patients), followed by falls (3 patients) and interpersonal violence (1 patient). Clinically evident nasal depression or deviation was observed preoperatively in all patients. (See figure, Supplemental Digital Content 4, which displays the patient demographics, fracture characteristics, and clinical outcomes, https://links.lww.com/PRSGO/E301.)

The average operative time was 20 minutes. At the 3-month follow-up, CT scans demonstrated less than 1 mm of residual displacement in all cases, indicating radiographic anatomic reduction.⁵ No patient reported nasal obstruction, and no residual deviation or depression was observed at the last follow-up. Mild discomfort from the gauze was reported in 4 patients, and 3 developed transient skin irritation at the thread exit site, which resolved spontaneously. No visible or hypertrophic scarring was observed at the forehead entry point.

Figures 1 and 2 illustrate a patient’s frontal appearance preoperatively and 3 months postoperatively. Figures 3 and 4 demonstrate the preoperative and postoperative axial CT scans, confirming bony stabilization.

Fig. 1.

Preoperative frontal view of the patient showing left nasal bone inward displacement.

Fig. 2.

Three-month postoperative frontal view of the patient showing satisfactory nasal bone alignment after reduction and stabilization.

Fig. 3.

Preoperative CT scan (axial view) demonstrating a displaced left nasal bone fragment.

Fig. 4.

Three-month postoperative CT scan (axial view) showing well-aligned nasal bone fragments with maintained stability.

DISCUSSION

Depressed nasal bone fragment reduction, if unstable, is typically stabilized using nasal packing. However, conventional packing may become accidentally dislodged into the nasal fossa, potentially leading to premature loss of stabilization and recurrence of bone displacement. An alternative approach is open reduction with internal fixation, which provides rigid stabilization but is more complex and costly, may leave visible scars, and sometimes necessitates a second surgery for implant removal.

Various methods have been reported to support reduced nasal bones. Although some surgeons use standard packing materials, including absorbable⁶ and nonabsorbable options,⁷ others have adopted more intricate techniques. For instance, Kim et al⁴ describe a method combining Vaseline gauze with an airway silicone splint.

Standard nasal packing techniques have been criticized for causing discomfort, nasal obstruction, headaches, toxic shock syndrome, and displacement. Our gauze fixation technique addresses these concerns by securing the gauze externally, preventing displacement either outside the nose or into the nasopharynx. In our protocol, the gauze is maintained for 10 days to ensure adequate stabilization. The gauze is positioned high, directly under the nasal bones, leaving the airway unobstructed. Other advantages include reduced cost and a minimal increase in operative time—estimated at just 5 minutes. Potential drawbacks include the usual discomfort associated with nasal packing, skin irritation from the fixation threads, and aesthetic concerns due to the visible forehead positioning of the suture.

Compared with other closed and open techniques, our method offers a reliable, cost-effective, and minimally invasive alternative for stabilizing nasal bone fractures. Standard closed techniques—such as polyvinyl alcohol sponges or gauze—have demonstrated a higher incidence of packing dropout, which can compromise long-term bone stabilization.⁸ Open reduction with internal fixation, although effective, introduces trade-offs such as scarring and increased operative complexity. However, in selected cases—particularly in patients with an existing dorsal laceration and significantly depressed isolated nasal fractures—open reduction may be especially advantageous. It allows direct access for precise manipulation and fixation, potentially eliminating the need for future nasal revisions.⁵

This study has several limitations. It is a retrospective analysis with a small sample size, which may limit the generalizability of the findings. The scar at the glabellar site, resulting from percutaneous suture passage, was not evaluated using a validated scar scale, potentially affecting the objectivity of cosmetic outcomes. Additionally, the follow-up period was short (3 mo), which limits the assessment of long-term results. We also did not evaluate whether any patients required secondary rhinoplasty for cosmetic or functional reasons. Future prospective studies with larger cohorts, longer follow-up periods, and objective outcome measures—including scar assessment and need for secondary procedures—are warranted.

CONCLUSIONS

The described technique ensures the secure stabilization of the gauze, effectively aiding in the stabilization of the reduced bone fragments following depressed nasal bone fracture reduction. Its low cost, simplicity, and minimal additional operative time make it a practical, efficient, and well-tolerated alternative to more invasive procedures, offering a reliable solution for managing nasal fractures.

DISCLOSURE

The authors have no financial interest to declare in relation to the content of this article.

PATIENT CONSENT

The patient provided written consent for the use of his image.