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Clinical Note |

A Complication From Neurocranial Restructuring:  Nasal Septum Fracture

Greg E. Davis, MD; Michael P. Murphy, MD, MPH; Bevan Yueh, MD, MPH; Ernest A. Weymuller Jr, MD
Arch Otolaryngol Head Neck Surg. 2003;129(4):472-474. doi:10.1001/archotol.129.4.472.
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We report a case of nasal septum fracture after a complementary and alternative medicine procedure called neurocranial restructuring (NCR) that was used to treat a patient with chronic sinusitis. We initially evaluated this patient, obtained a computed tomographic scan, and recommended frontal sinus obliteration. The patient opted to see an alternative medicine practitioner, who performed NCR. This treatment involves the expansion of endonasal balloons in the nasopharynx that are used to "alter the skeletal structure." During the NCR procedure, the patient experienced severe midface pain and a crunching sound. Because of persisting pain, she presented to the emergency department, at which time another computed tomographic scan showed new septal fractures. The patient ultimately received a frontal sinus obliteration, bilateral revision antrostomies, and repositioning of her nasal septum. To our knowledge, this is the first published case report of a complication from NCR.

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Figure 1.

Coronal maxillofacial computed tomographic scans before (A) and after (B) neurocranial restructuring. Note the new anterior nasal septum fracture in the "after" image (arrow). Also seen is evidence of prior sinus surgery including bilateral ethmoidectomies and antrostomies.

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Figure 2.

Coronal maxillofacial computed tomographic scans before (A) and after (B) neurocranial restructuring. There is a new posterior nasal septum fracture in the "after" image (arrow). Also seen is evidence of prior sinus surgery including bilateral ethmoidectomies and antrostomies.

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