Rhinoplasty makes use of a combination of surgical techniques selected to address the specific requirements of each individual nose. Several different surgical techniques may be used for addressing each section of the nose, with possible different functional effects.
Objective:
The purpose of this investigation is to compare the functional effect of the different surgical techniques used for addressing each section of the nose.
Methods:
Prospective study of 57 consecutive rhinoplasty patients. Patients were evaluated with peak nasal inspiratory flow (PNIF), Nasal Obstruction Symptom Evaluation (NOSE), and Visual Analog Scale (VAS) for nasal obstruction before and 1 year after rhinoplasty. Additionally, esthetic evaluation of the nose was obtained with Rhinoplasty Outcomes Evaluation (ROE). According to the surgical technique used to address each portion of the nose, groups of patients were created and the functional improvement of these groups was compared.
Results:
Using the TukeyHSD multiple pairwise-comparison test, the estimated difference of the increase of PNIF between using spreader grafts and using spreader flaps was 94.9 (95% CI 24.3, 165.5, P = .004) between spreader grafts and neither grafts or flaps was 79.2 (95% CI 5.8, 152.6, P = .03), between spreader grafts and bilateral spreader flaps plus a unilateral spreader graft was 90.2 (95% CI 22.1, 158.2, P = .005). In all other portions of the nose, no significant difference was found in the functional improvement between different surgical techniques.
Conclusions:
Spreader grafts increase PNIF more significantly than other surgical techniques used for dorsal mid-vault reconstruction. Spreader grafts should be preferred over other techniques whenever an improvement of nasal airflow is required. No significant differences were found between the functional effect of alternative techniques used in other sections of the nose. Additional cohort studies will be necessary to further confirm data from this investigation.
StewartMGWitsellDLSmithTLWeaverEMYuehBHannleyMT.Development and validation of the nasal obstruction symptom evaluation (NOSE) scale. Otolaryngol Head Neck Surg. 2004;130:157-163.
2.
BezerraTFPaduaFGPilanRRStewartMGVoegelsRL.Cross-cultural adaptation and validation of a quality of life questionnaire: the nasal obstruction symptom evaluation questionnaire. Rhinology. 2011;49:227-231.
AlsarrafR.Outcomes research in facial plastic surgery: a review and new directions. Aesthetic Plast Surg. 2000;24:192-197.
5.
AlsarrafRLarrabeeWFJrAndersonSMurakamiCSJohnsonCMJr.Measuring cosmetic facial plastic surgery outcomes: a pilot study. Arch Facial Plast Surg. 2001;3:198-201.
6.
EstevesSSilvaAFerreiraM, et al. Validação do questionário rhinoplasty outcome evaluation (ROE) para português. Rev Port Otorrinol Cir Cer-Fac. 2015;53:81-85.
7.
BallinACKimHChanceEDavisRE.The articulated alar rim graft: reengineering the conventional alar rim graft for improved contour and support. Facial Plast Surg. 2016;32(4):384-397.
8.
R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2020. https://www.R-project.org/. Accessed 2022.
9.
IzuSCKosugiEMBrandãoKV, et al. Normal values for the rhinoplasty outcome evaluation (ROE) questionnaire. Braz J Otorhinolaryngol. 2012;78:76-79.
10.
WähmannMSBulutOCBranGMVeitJARiedelF.Systematic review of quality-of-life measurement after aesthetic rhinoplasty. Aesthetic Plast Surg. 2018;42:1635-1647.
11.
Haddady AbianehSMoradi BajestaniSRahmatiJShahrbafMAFatehi MeybodiA.Evaluation of aesthetic and functional outcomes after open rhinoplasty: a quasi-experimental study by the aid of ROE and RHINO Questionnaires. Aesthetic Plast Surg. 2021;45:663-669.
12.
BiggsTCFraserLRWardMJSunkaraneniVSHarriesPGSalibRJ.Patient reported outcome measures in septorhinoplasty surgery. Ann R Coll Surg Engl. 2015;97:63-65.
13.
NellisJCIshiiMBaterKL, et al. Association of rhinoplasty with perceived attractiveness, success, and overall health. JAMA Facial Plast Surg. 2018;20:97-102.
14.
BulutOCWallnerFOladokunD, et al. Long-term quality of life changes after primary septorhinoplasty. Qual Life Res. 2018;27:987-991.
15.
YamasakiALevesquePABleierBS, et al. Improvement in nasal obstruction and quality of life after septorhinoplasty and turbinate surgery. Laryngoscope. 2019;129:1554-1560.
16.
FullerJCLevesquePALindsayRW.Assessment of the euroqol 5-dimension questionnaire for detection of clinically significant global health-related quality-of-life improvement following functional septorhinoplasty. JAMA Facial Plast Surg. 2017;19:95-100.
17.
Lavinsky-WolffMCamargoHLJrBaroneCR, et al. Effect of turbinate surgery in rhinoseptoplasty on quality-of-life and acoustic rhinometry outcomes: a randomized clinical trial. Laryngoscope. 2013;123:82-89.
18.
de MouraBHMigliavaccaROLimaRK, et al. Partial inferior turbinectomy in rhinoseptoplasty has no effect in quality-of-life outcomes: a randomized clinical trial. Laryngoscope. 2018;128:57-63.
XavierRAzeredo-LopesSPapoilaA.Spreader grafts: functional or just aesthetical?Rhinology. 2015;53:332-339.
21.
LodderWLLeongSC.What are the clinically important outcome measures in the surgical management of nasal obstruction?Clin Otolaryngol. 2018;43:567-571.
22.
FullerJCGadkareeSKLevesquePALindsayRW.Peak nasal inspiratory flow is a useful measure of nasal airflow in functional septorhinoplasty. Laryngoscope. 2019;129:594-601.
23.
FullerJCBernsteinCHLevesquePALindsayRW.Peak nasal inspiratory flow as an objective measure of nasal obstruction and functional septorhinoplasty outcomes. JAMA Facial Plast Surg. 2018;20:175-176.
24.
AndrewsPJChoudhuryNTakharAPoirrierALJacquesTRandhawaPS.The need for an objective measure in septorhinoplasty surgery: are we any closer to finding an answer?Clin Otolaryngol. 2015;40:698-703.
25.
OttavianoGPendolinoALNardelloE, et al. Peak nasal inspiratory flow measurement and visual analogue scale in a large adult population. Clin Otolaryngol. 2019;44:541-548.
26.
HsuHCTanCDChangCW, et al. Evaluation of nasal patency by visual analogue scale/nasal obstruction symptom evaluation questionnaires and anterior active rhinomanometry after septoplasty: a retrospective one-year follow-up cohort study. Clin Otolaryngol. 2017;42:53-59.
27.
XavierRAzeredo-LopesSMengerDJde CarvalhoHCSpratleyJ.Objective measurement and patient-reported evaluation of the nasal airway: is correlation dependent on symptoms or on nasal airflow?Clin Otolaryngol. 2021;46(4):744-751.
28.
Yepes-NuñezJJBartraJMuñoz-CanoR, et al. Assessment of nasal obstruction: correlation between subjective and objective techniques. Allergol Immunopathol. 2013;41:397-401.
29.
AndréRFVuykHDAhmedAGraamansKNolst TrenitéGJ.Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence. Clin Otolaryngol. 2009;34:518-525.
30.
StandleeAGHohmanMH.Evaluating the effect of spreader grafting on nasal obstruction using the NOSE scale. Ann Otol Rhinol Laryngol. 2017;126(3):219-223.
31.
BilginEKaya CelikEBaklaciDSayMADalgicM.Evaluation of the use of different spreader techniques in primary open septorinoplasty in terms of nasal and olfactory functions. J Craniofac Surg. 2021;32(6):2016-2018.
32.
AlbergoLDesioERevelliVEAcostaMB.Spreader graft for severe deviation of nasal septum with obstruction of the internal nasal valve: clinical and functional results. Facial Plast Surg. 2020;36(5):635-642.
33.
BarrettDMCasanuevaFJCookTA.Management of the nasal valve. Facial Plast Surg Clin North Am. 2016;24(3):219-234.
34.
TeymoortashAFasunlaJASazgarAA.The value of spreader grafts in rhinoplasty: a critical review. Eur Arch Otorhinolaryngol. 2012;269(5):1411-1416.
35.
SpielmannPMWhitePSHussainSS.Surgical techniques for the treatment of nasal valve collapse: a systematic review. Laryngoscope. 2009;119(7):1281-1290.
36.
GoudakosJKFishmanJMPatelK.A systematic review of the surgical techniques for the treatment of internal nasal valve collapse: where do we stand?Clin Otolaryngol. 2017;42(1):60-70.
37.
SahinMSOzmenOA.Early results and description of a new modification of spreader graft to enlarge nasal valve area: modified triangular spreader graft. J Craniofac Surg. 2016;27(4):839-842.
38.
TastanEDemirciMAydinE, et al. A novel method for internal nasal valve reconstruction: H-graft technique. Laryngoscope. 2011;121(3):480-486.
39.
ParkSS.The flaring suture to augment the repair of the dysfunctional nasal valve. Plast Reconstr Surg. 1998;101(4):1120-1122.
ZeidNGMohamedASElSayed ElFoulyMAzoozKOAleryanMMAbd Elmottaleb SabaaM.Objective comparison between spreader grafts and flaps for mid-nasal vault reconstruction: a randomized controlled trial. Plast Surg. 2020;28(3):137-141.
42.
SowderJCThomasAJGonzalezCDLimayeNSWardPD.Use of spreader flaps without dorsal hump reduction and the effect on nasal function. JAMA Facial Plast Surg. 2017;19(4):287-292.
43.
SaediBAmalyAGharavisVYektaBGMostSP.Spreader flaps do not change early functional outcomes in reduction rhinoplasty: a randomized control trial. Am J Rhinol Allergy. 2014;28(1):70-74.
44.
XavierRAzeredo-LopesSMengerDJCyrne de CarvalhoHSpratleyJ.Which nasal airway dimensions correlate with nasal airflow and with nasal breathing sensation?Facial Plast Surg Aesthet Med. Published online September 6, 2021. doi:10.1089/fpsam.2021.0148
45.
ErolOBuyukluFKoycuABasCErbekSS.Evaluation of nasal tip support in septorhinoplasty. Aesthetic Plast Surg. 2019;43(4):1021-1027.
46.
Sawh-MartinezRPerkinsKMadariSSteinbacherDM.Control of nasal tip position: quantitative assessment of columellar strut versus caudal septal extension graft. Plast Reconstr Surg. 2019;144(5):772e-780e.
47.
PatelPNAbdelwahabMShuklaND, et al. Functional outcomes of septal extension grafting in aesthetic rhinoplasty: a cohort analysis. Facial Plast Surg Aesthet Med. 2021;23(3):172-179.
48.
VachhaniKLapainePSamiezadehSWhyneCMFialkovJA.The impact of surgical manipulation on lower lateral cartilage stiffness. J Plast Reconstr Aesthet Surg. 2018;71(12):1804-1809.
49.
TelliogluATCimenK.Turn-in folding of the cephalic portion of the lateral crus to support the alar rim in rhinoplasty. Aesthetic Plast Surg. 2007;31(3):306-310.
50.
ReckerCHamiltonGS3rd. Evaluation of the patient with nasal obstruction. Facial Plast Surg. 2016;32(1):3-8.
51.
InsalacoLRashesERRubinSJSpiegelJH.Association of lateral crural overlay technique with strength of the lower lateral cartilages. JAMA Facial Plast Surg. 2017;19(6):510-515.
52.
AbdelwahabMPatelPKandathilCKWadhwaHMostSP.Effect of lateral crural procedures on nasal wall stability and tip aesthetics in rhinoplasty. Laryngoscope. 2021;131(6):E1830-E1837.
53.
XavierRAzeredo-LopesSMengerDJde CarvalhoHCSpratleyJ.Cephalic malposition of the lateral crura and parenthesis deformity: a cadaver study in caucasians. Aesthetic Plast Surg. 2020;44(6):2244-2252.
54.
SilvaEN.The relation between the lower lateral cartilages and the function of the external nasal valve. Aesthetic Plast Surg. 2019;43(1):175-183.
55.
IlhanAESaribasBCaypinarB.Aesthetic and functional results of lateral crural repositioning. JAMA Facial Plast Surg. 2015;17(4):286-292.
56.
HamiltonGS3rd. Form and function of the nasal tip: reorienting and reshaping the lateral crus. Facial Plast Surg. 2016;32(1):49-58.
57.
YehCCWilliamsEF3rd. Cosmetic and functional effects of cephalic malposition of the lower lateral cartilages: a facial plastic surgical case study. Otolaryngol Clin North Am. 2009;42(3):539-546.
