Analysis of Patient-Perceived Nasal Appearance Evaluations Following Functional Septorhinoplasty With Spreader Graft Placement

Functional evaluation of Septal L-strut extension graft in East Asians

BACKGROUND

The septal L-strut extension graft (SLEG) consists of anterior extended spreader graft and caudal septal extension graft. SLEG is used to increase the anterocaudal projection from a low-profile nose by creating the de-novo septum. This retrospective study verified the effectiveness of SLEG in improving the nasal function in East Asians.

MATERIALS

Medical records of patients who underwent septorhinoplasty with SLEG were retrospectively reviewed. The clinical features showed under-projected lower two-thirds of the nose with septal deviation, saddle nose, and short nose. We analyzed the post-operative changes in the NOSE score and variables of nasal geometry measured using acoustic rhinometry through long-term follow-up.

RESULTS

Patients were divided into two groups, those who underwent SLEG with turbinoplasty (Group A) and SLEG alone (group B). The NOSE scores decreased significantly in groups A and B, and the improvement was statistically more significant in Group A (p < 0.05). Acoustic rhinometry showed an increase in nasal cavity volume (VOL1) on the deviated side in Group A, and an increase in minimal cross-sectional area 1 (MCA1) on the deviated side in Group B (p < 0.05). The non-deviated side did not show significant reduction in MCA1 and VOL1 after SLEG with or without turbinoplasty. Thus, SLEG, by itself, improved airway function in East Asians.

CONCLUSIONS

SLEG has proven to be valuable in improving nasal function.

Does being a healthcare professional affect satisfaction after septorhinoplasty?

This study aims to determine the differences in satisfaction levels after septorhinoplasty between patients who are healthcare workers and those who are not. The study includes patients who underwent primary septorhinoplasty surgery, divided into two groups: healthcare workers and non-healthcare workers. The Rhinoplasty Outcome Evaluation (ROE) questionnaire was administered to the patients at the 6th postoperative month. Among the 37 patients, 18 were healthcare workers, and 19 were non-healthcare workers. The mean Rhinoplasty Outcome Evaluation score for healthcare workers at the 6th postoperative month was 75.69 ± 16.06, while in the non-healthcare worker group, the ROE scores were 60.31 ± 27.69. The findings from our study indicated that individuals in the healthcare profession exhibited significantly greater satisfaction rates following septorhinoplasty in comparison to those in the non-healthcare worker group, with a statistically significant difference noted (p: 0.046). Having more knowledge about septorhinoplasty surgery and its complications among healthcare workers may allow for more realistic expectations regarding the surgical intervention. Simultaneously, it may facilitate better communication with the surgeon and the expression of expectations. Clinicians should pay attention not only to the patient's intellectual level but also to their health literacy in communication with the patient.

Rhinoplasty Health Inventory and Nasal Outcomes (RHINO) Scale: Translation, Cross-Cultural Adaptation and Validation for Hebrew-Speaking Patients

Patient-reported outcomes questionnaires are accepted measurement tools to evaluate procedures results. The Rhinoplasty Health Inventory and Nasal Outcomes (RHINO) scale is an English-language validated and reliable quality-of-life instrument that evaluates both functional and aesthetic outcomes after rhinoplasty, and is not available in Hebrew. We followed the forward-and-back-translation method, defined by the European Organization for Research and Treatment of Cancer. Translation of the RHINO scale and merging it into one version were performed, following back-translation and validation on native Hebrew-speaking patients who underwent rhinoplasty and control healthy group. Lastly, we review and analyzed the results. The translated questionnaire had high reliability measures, demonstrating homogeneity (α value 0.800 in the rhinoplasty group and 0.896 in the control group), test-retest reproducibility with no significant difference (p = 0.5), and high agreement scores represented by the Bland-Altman plot (95% limits of agreement ranged from 8.78 to 9.80). Validity demonstrated by significant differences between the two study groups' mean questionnaire scores (p < 0.001 for rhinoplasty vs. controls, p < 0.001 for preoperative vs. postoperative, and p = 0.002 for postoperative vs. control group) and also between the aesthetic scores and functional scores of the rhinoplasty group before and after the surgery (p < 0.001). There were no reported understanding problems. The Hebrew version of the RHINO scale is a reliable and valid tool for pre- and post-rhinoplasty surgery outcomes measuring among Hebrew-speaking patients, and can improve coordination of expectations, follow-up, and quantify subjective evaluation of the surgery. Level of evidence: IV.

Considerations for Optimal Grafting in Rhinoplasty

A wide variety of grafting materials and techniques can be used to create functional and aesthetic changes in rhinoplasty. Choosing the optimal grafting approach is critical to achieving an optimal patient outcome. We present a review of autografts, allografts, and alloplasts used in primary and revision rhinoplasty and discuss factors that impact graft choice. Autologous grafts serve as the pillar for grafting material in rhinoplasty given their reliable long-term outcomes, low rates of infection, resorption, and extrusion, and ability to provide structural scaffolding as well as contour. Cadaveric allografts can be utilized as a source of grafting material in certain clinical scenarios including revision rhinoplasty and have been shown to be equally safe and effective as autologous grafts while avoiding donor-site morbidity. Alloplasts can prove useful in rhinoplasty in cases of iatrogenic nasal deformities or revision cases. Careful consideration of clinical scenario, patient factors, and outcome goals is necessary to choose the appropriate grafting approach to address functional and cosmetic outcomes.

Casual Observers' Perception on the Aesthetics of the Butterfly Graft

OBJECTIVE

The butterfly graft is an effective technique for improving the internal nasal valve, however, there is hesitancy among surgeons due to possible aesthetic changes. This study aims to determine if average observers rated the post-operative appearance of the butterfly graft negatively.

METHODS

An online survey was distributed by social media to non-medical observers in which they rated either the pre-operative or post-operative appearance of 22 patients' noses (11 butterfly graft, 11 spreader graft). A heat map was used to determine if the supratip region was rated as the least aesthetically appealing. Post-operative ratings and heat maps of the butterfly graft patients were compared to pre-operative ratings as well as ratings of the spreader graft group.

RESULTS

226 observers responded. There was no difference in the pre-operative and post-operative rating of the butterfly graft group (58.27 vs. 58.00, p = 0.88) or the number of supratip regions selected as least attractive (165 vs. 169, p = 0.60). Similarly, there was no difference in post-operative ratings between the butterfly graft group and spreader graft group (58.00 vs. 58.21, p = 0.63) or in selection of the supratip as the least attractive region (169 vs. 172, p = 0.74).

CONCLUSION

The butterfly graft did not negatively affect observers' opinion of patients' noses.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:2578-2583, 2023.

Patient-Reported Outcomes Measures in Rhinoplasty: Need for Use and Implementation

Patient-reported outcome metrics (PROMs) are increasingly utilized to capture data about patients' quality of life. PROMs play an important role in the value-based health care movement by providing a patient-centered metric of quality. There are many barriers to the implementation of PROMs, and widespread adoption requires buy-in from numerous stakeholders including patients, clinicians, institutions, and payers. Several validated PROMs have been utilized by facial plastic surgeons to measure both functional and aesthetic outcomes among rhinoplasty patients. These PROMs can help clinicians and rhinoplasty patients participate in shared decision making (SDM), a process via which clinicians and patients arrive at treatment decisions together through a patient-centered approach. However, widespread adoption of PROMs and SDM has not yet been achieved. Further work should focus on overcoming barriers to implementation and engaging key stakeholders to increase the utilization of PROMs in rhinoplasty.

Best Practices for FACE-Q Aesthetics Research: A Systematic Review of Study Methodology

BACKGROUND

The FACE-Q Aesthetics module is a validated patient-reported outcome measure (PROM) that evaluates perspectives on facial aesthetic treatments. Improper administration and poor study methodology can compromise the validity and interpretation of this PROM.

OBJECTIVES

This systematic review sought to evaluate the administration and scoring of the FACE-Q Aesthetics scales within the literature.

METHODS

A search of Ovid Medline, Embase, Cochrane, and Web of Science was performed on December 20, 2022, with the assistance of a health-research librarian (CRD42022383676). Studies that examined facial aesthetic interventions using the FACE-Q Aesthetics module as a primary or secondary outcome measure were included for analysis.

RESULTS

There were 114 studies included. The Face Overall (n = 52, 45.6%), Psychological (n = 45, 39.4%), and Social (n = 43, 37.7%) scales were most frequently reported. Errors in FACE-Q administration were identified in 30 (26.3%) studies. The most common error was the presentation of raw ordinal scores rather than the converted Q score (n = 23). Most studies reported a time horizon for their primary analysis (n = 76, 66.7%); however, only 4 studies provided a rationale for this selection. Sample size calculations for the primary outcome were rarely performed (n = 9, 7.9%).

CONCLUSIONS

There continues to be limitations in PROM administration and the quality of articles that report FACE-Q Aesthetic scale data. The authors suggest that future investigators using the FACE-Q refer to the User's Guide regarding administration and scoring of this scale, report a rationale for the study time horizon, and provide an a priori sample size calculation for the primary outcome of interest.

Is There a Risk of Saddle Nose Deformity after Spreader Grafts and Flaps?

Spreader grafts have been used successfully for years to augment the nasal valves among other indications. Spreader flaps have been described as an alternative. However, the literature discussing the complications of these procedures is scarce. This study aims to report and discuss the improvements and complications resulting from using spreader grafts or flaps in a cohort of patients operated upon by the author. Particular stress is given to a group of patients who developed saddle nose deformity after surgery. This cohort included 80 cases of rhinoplasty involving the use of spreader grafts or/and flaps. There was a highly significant improvement in nasal functions postoperatively. Postoperative saddle nose deformity was observed in five patients (6.25%). Spreader grafts/flaps are highly effective in improving nasal functions, but saddle nose deformity appears to be a possible risk. This complication has not been previously reported in the literature in relation to these procedures.

The Use of the FACE-Q Aesthetic: A Narrative Review

INTRODUCTION

In the past decade there has been an increasing interest in the field of patient-reported outcome measures (PROMs) which are now commonly used alongside traditional outcome measures, such as morbidity and mortality. Since the FACE-Q Aesthetic development in 2010, it has been widely used in clinical practice and research, measuring the quality of life and patient satisfaction. It quantifies the impact and change across different aspects of cosmetic facial surgery and minimally invasive treatments. We review how researchers have utilized the FACE-Q Aesthetic module to date, and aim to understand better whether and how it has enhanced our understanding and practice of aesthetic facial procedures.

METHODS

We performed a systematic search of the literature. Publications that used the FACE-Q Aesthetic module to evaluate patient outcomes were included. Publications about the development of PROMs or modifications of the FACE-Q Aesthetic, translation or validation studies of the FACE-Q Aesthetic scales, papers not published in English, reviews, comments/discussions, or letters to the editor were excluded.

RESULTS

Our search produced 1189 different articles; 70 remained after applying in- and exclusion criteria. Significant findings and associations were further explored. The need for evidence-based patient-reported outcome caused a growing uptake of the FACE-Q Aesthetic in cosmetic surgery and dermatology an increasing amount of evidence concerning facelift surgery, botulinum toxin, rhinoplasty, soft tissue fillers, scar treatments, and experimental areas.

DISCUSSION

The FACE-Q Aesthetic has been used to contribute substantial evidence about the outcome from the patient perspective in cosmetic facial surgery and minimally invasive treatments. The FACE-Q Aesthetic holds great potential to improve quality of care and may fundamentally change the way we measure success in plastic surgery and dermatology.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anxiety and depression mood disorder in patients with nasal septal deviation: A systematic review and meta-analysis

BACKGROUND

Nasal septal deviation (NSD) is one of the most prevalent upper airway diseases causing airway obstruction, and it can negatively impact patients' quality of life (QoL).

OBJECTIVE

The aim of this study was to determine the risk of anxiety and depression mood disorders in patients with NSD.

METHODS

A systematic review and meta-analysis was performed according to the PRISMA statement. An electronic search was performed on PubMed/MEDLINE, Scopus and Google Scholar. Raw affect size data were pooled comparing standardized between group mean differences.

RESULTS

A total of 625 patients (males: 53 %, n = 280/525) with a mean age of 32.4 years (n = 375, 95 % CI: 25.3-39.4) were included. The pooled standardized mean differences (SMD) for the prevalence of the anxiety disorder was 1.17 (n = 625, 95 % CI: 0.34-2.0). The pooled SMD for the prevalence of the depression disorder was 0.30 (n = 490, 95 % CI: 0.12-0.48).

CONCLUSION

Prevalence of anxiety and depression mood disorders is higher in patients with NSD compared to controls. These diseases should be investigated and considered during the diagnostic and therapeutic process to improve the QoL of patients with NSD.

Association Between Satisfaction with Nasal Appearance and Olfactory Function in Patients Undergoing Septorhinoplasty Surgery

BACKGROUND

Any surgery has some complications, and septorhinoplasty is not an exception. The aim of this study was to highlight the relationship between satisfaction with nasal appearance and olfactory function in patients undergoing septorhinoplasty.

METHODS

This is a cohort study. In this study, 384 patients aged 18 to 45 years who referred to the Ear, Nose and Throat department at Rasoul Akram hospital and private clinics in 2019 underwent septorhinoplasty. All patients were tested by the Persian Smell Identification Test (PSIT) or Rapid Smell Test (RST) before surgery. They were also reassessed one and three months after surgery. Those patients with dissatisfaction with olfactory function after surgery were also followed up for three months and assessed by PSIT or RST to determine their olfactory dysfunction.

RESULTS

One month after surgery, 73.5% of patients who were not satisfied with their nasal appearance also complained about the olfactory sense. In addition, 1.5% of patients who were satisfied with their nasal appearance also complained about the olfactory sense. There was a significant difference regarding complaints of the olfactory sense between patients satisfied with their nasal appearance and those not satisfied with their appearance (P<0.05). Three months after surgery, 78.9% patients who were not pleased with their nasal appearance also had an olfactory complaint. Besides, 0.9% of patients who were pleased with their nasal shape also had an olfactory complaint. There was a significant difference regarding olfactory complaints between patients who were pleased with their nasal shape and those who were not (P<0.05).

CONCLUSION

One and three months after septorhinoplasty, most patients who are satisfied with their nasal appearance have no complaints about their olfactory sense, and most patients who are not satisfied with their nasal appearance complain about the olfactory sense. An appropriate outcome of septorhinoplasty with regard to improving olfactory functional status is accompanied by patients' satisfaction level of achieving good nasal appearance.

Surgical treatment of dynamic nasal collapse

Nasal obstruction is a prevalent issue that significantly impacts patient quality of life and contributes to a large-scale financial burden. Internal or external nasal valve collapse may play a role in nasal obstruction, with varying etiologies. Surgical correction of nasal valve collapse is indicated when septal and/or turbinate surgery alone are not sufficient in correcting the nasal obstruction. The choice of how to address nasal valve repair depends on presenting findings, associated aesthetic concerns, particularly of the nasal tip, patient anatomy, and surgeon preference. This article provides a methodical approach to the diagnosis of nasal valve collapse, indications for repair, and provides detailed explanation of the operative techniques used to address nasal valve collapse, while also discussing the advantages and disadvantages of each approach.

The Impact of Component Dorsal Hump Reduction on Patient-Perceived Nasal Aesthetics and Obstruction in Rhinoplasty

OBJECTIVE

This study aimed to evaluate functional and aesthetic patient-reported outcomes using validated metrics after component dorsal hump reduction (DHR) with spreader graft placement, which have not been previously reported.

STUDY DESIGN

Prospective cohort study.

METHODS

This prospective cohort study was conducted in a tertiary care medical center. Participants underwent septorhinoplasty (SRP) with spreader graft placement with cosmetic, component DHR (cosmetic DHR), or SRP with spreader graft placement without dorsal hump reduction (noncosmetic, non-DHR). The Nasal Obstruction Symptom Evaluation (NOSE) scale and the FACE-Q Satisfaction with Nose, Nostrils, and Social Functioning scales were administered to patients preoperatively and postoperatively (at 2, 4, 6, and/or 12 months). Pre- and postoperative NOSE and FACE-Q scores were compared.

RESULTS

A total of 226 patients underwent SRP with spreader graft placement; 113 (50.0%) with cosmetic DHR and 113 (50.0%) noncosmetic, non-DHR (control). Patients who completed the NOSE and FACE-Q surveys preoperatively and at least at one postoperative time point were included. Both cohorts had a statistically and clinically significant improvement in NOSE and FACE-Q scores. There were similar improvements in NOSE scores in both cohorts. Postoperative FACE-Q scores were higher in the cosmetic DHR cohort despite lower preoperative FACE-Q scores when compared to the control cohort.

CONCLUSIONS

Although there are multiple techniques for DHR, component DHR with spreader graft placement has long been considered the standard. Therefore, it is important to note the significant postoperative cosmetic and functional improvements reported by patients who have undergone this procedure to compare to newer techniques as they evolve.

LEVEL OF EVIDENCE

3 Laryngoscope, 2022.

Assessment of Different Middle Vault Reconstruction Techniques in Rhinoplasty from Multiple Patient-Reported Outcome Measures

It is important to assess the patient satisfaction with shape and function by patient-reported outcome measures (PROMs) following structural or dorsal preservation rhinoplasty (DPR) techniques on the middle nasal vault. To analyze the results of different middle vault rhinoplasty techniques with multiple PROMs and compare their differences according to the findings of PROMs. Four different techniques were performed for the middle vault: spreader graft, L-strut graft, DPR with high strip (DPRwHS), DPR with low strip. The outcomes were evaluated preoperatively, 2 and 12 months postoperatively with the following PROMs: Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcomes Evaluation, and Standardized Cosmesis and Health Nasal Outcomes Survey. This study included 129 patients. All techniques provided significant improvements in all PROMs (p < 0.001), except DPRwHS in NOSE. Between postoperative short- and longer-term, no significant differences were observed in DPR groups (p > 0.05), unlike structural techniques. In this comparative study of different middle nasal vault rhinoplasty techniques, we did not detect a difference in the improvement of the patient-reported outcomes of DPR techniques from as early as 2 months to 1 year postoperative.

The Safety and Efficacy of Spreader Grafts and Autospreaders in Rhinoplasty: A Systematic Review and Meta-analysis

BACKGROUND

The aim of this study was to systematically evaluate the evidence of surgical outcomes and complications of spreader grafts and autospreader flaps in the context of middle vault reconstruction after dorsal hump removal.

MATERIAL AND METHODS

A systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Inclusion and exclusion criteria were based on the population, intervention, comparison, and outcome (PICO) framework. Medline (via PubMed), EMBASE, Cinahl, Scopus, and Web of Science were searched for Clinical and observational studies published in peer-reviewed academic journals with abstracts available that reported rhinoplasty employing either spreader graft or autospreader flap techniques and were published prior to March, 2021.

RESULTS

Fifty-two of 1129 relevant studies were included in the qualitative analysis. Thirty-four studies (65.4%) were related to spreader graft (SG), 10 (21.1%) studies of autospreader flap (AF) alone and 8 (13.5%) studies involving both grafts. Meta-analysis was performed on 17 studies reporting change in NOSE scores, with pooled effect of - 23.9 (95% CI, - 26.7 to - 21.1) points. High heterogeneity with I² = 99%. Summary data showed no differences between groups, AF group versus no graft (p = 0.7578), AF versus SF group (p = 0.9948), and SG group versus no graft (p = 0.6608).

CONCLUSION

Based on available data, change in NOSE scores after rhinoplasty was similar in procedures that used spreader graft only or autospreader flap only.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Addressing the Nasal Valves: The Endonasal Approach

The external and internal nasal valves are directly implicated in nasal valve collapse. A variety of endonasal techniques have been developed to address nasal dysfunction while maintaining or improving aesthetic appearance. This review discusses the biomechanics, surgical approach, indications, and evidence of functional and aesthetic results for each maneuver. While the endonasal approach is safe and effective, a thorough understanding of the advantages and limitations is fundamental to selecting the most appropriate surgery for the individual patient.

The Impact of Upper Lateral Cartilage Release on Patient-Perceived Nasal Appearance and Obstruction

OBJECTIVES/HYPOTHESIS

Although upper lateral cartilages are commonly released from the dorsum of the septum during spreader graft placement in septorhinoplasty (SRP), there has been a focus on maintaining integrity of connections in the middle vault. Avoiding release of upper lateral cartilages in certain patient groups may represent an early step in this paradigm shift. We aim to assess satisfaction with nasal appearance and correction of nasal obstruction in patients who underwent SRP with spreader graft placement without upper lateral cartilage release and compared it to the traditional upper lateral cartilage release cohort.

STUDY DESIGN

Prospective cohort study.

METHODS

A total of 559 patients who underwent SRP with spreader graft placement with upper lateral cartilage release and 30 patients who underwent SRP with spreader graft placement without release between 2012 and 2020 were administered the Nasal Obstruction Symptom Evaluation (NOSE), FACE-Q Satisfaction with Nose, and FACE-Q Social Functioning scales pre- and postoperatively. Pre- and postoperative NOSE FACE-Q, and negative inspiratory force (NIF) scores and changes were compared between groups.

RESULTS

Results demonstrated clinically and statistically significant improvement at follow-up for both groups. There was no significant difference between groups in mean improvement of NOSE, FACE-Q, and NIF scores at time of last follow-up.

CONCLUSION

SRP with spreader graft placement with and without upper lateral cartilage release provide clinically and statistically significant improvement, and no significant difference in functional outcome. This suggests that upper lateral cartilages do not need to be released to achieve functional improvement and that surgeons should consider whether release is necessary to achieve goals of surgery.

LEVEL OF EVIDENCE

3 Laryngoscope, 2021.

Comparative Effectiveness of Cartilage Grafts in Functional Rhinoplasty for Nasal Sidewall Collapse

Objective: To compare the patient-reported outcomes among patients with nasal obstruction undergoing two rhinoplasty techniques to a control group. Methods: Prospective longitudinal study in a university-based tertiary care medical center. All patients undergoing functional septorhinoplasty for correction of lateral wall insufficiency between October 2015 and March 2019 were included; n = 704, mean age (standard deviation) 39.0 (15.4) years, 52.7% females. Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) and FACE-Q subscales pre- and postoperatively. Patients were divided into three cohorts: spreader and lateral crural strut (LCS) grafts (n = 141), spreader and alar rim (AR) grafts (n = 104), and the control spreader grafts alone (n = 218). Results: The median NOSE scores at last postoperative visit were improved from baseline (p < 0.001) for all cohorts. The FACE-Q nasal satisfaction median scores also improved postoperatively in all cohorts, AR, LCS, and spreader, respectively (p = 0.001, p < 0.001, and p < 0.0001). Conclusions: There was no detectable difference in the improved subjective nasal function, nor adverse aesthetic outcomes in the patients with lateral wall insufficiency treated with functional rhinoplasty techniques in this study.

Spreader Graft Placement: An Effective Procedure for Alleviation of Internal Nasal Valve Collapse

PURPOSE

The internal nasal valve (INV) is one of the most commonly involved areas in patients with nasal obstruction, and surgeries such as turbinate reduction and septal recontouring affect the physiology of the nasal valve area. With this concept, a cohort study was conducted to evaluate spreader graft's effectiveness in recontouring INV and relieving nasal obstruction.

MATERIALS AND METHODS

A prospective cohort study was performed, including patients with nasal obstruction with INV involvement. To quantify and compare the amount of nasal obstruction, Gertner Metal Plate (GMP) was used, and to assess the relief in associated symptoms, the Sino-Nasal Outcome Test (SNOT-22) was taken into consideration. GMP and SNOT 22 were performed preoperatively and postoperatively at the 1^st, 3^rd, and 6^th months, and the data obtained were analyzed by SPSS 22 software using paired t-tests. The postoperative broadening of the nasal dorsum and patient satisfaction with the surgical outcome were also assessed using the visual analog scale .

RESULTS

A total of 38 patients were included, with 28 males and 10 females. The data obtained were analyzed by using paired t-tests. Improvement in GMP assessment showed that t = 10.392305, 13.391485, and 15.985243 at the 1^st, 3^rd, and 6^th months, respectively, with an overall P ≤ .00001 and relief in associated symptoms assessed by SNOT 22 computed t = 12.24228, 15.824486, and 18.046395 at the 1^st, 3^rd, and 6^th month, respectively, with an overall P ≤ .00001. A total of 81.57% of patients did not perceive significant nasal dorsum broadening, and 86.84% of patients were highly satisfied by the surgical outcome based on the visual analog scale.

CONCLUSION

We conclude that in patients with nasal obstruction associated with INV involvement, spreader grafting provides rapid relief of nasal obstruction and associated symptoms, does not cause any appreciable broadening, and provides a high degree of patient satisfaction. Hence, it should be preferred over septal recontouring and turbinate reduction.

Modified Skoog Method for Hump Reduction

Dorsal hump reduction is a key component of rhinoplasty. Spreader grafts are the most frequently used technique; however, dorsal irregularities may result. The modified Skoog method involves removal of the osseocartilaginous dorsal hump, its modification, further reduction of the nasal dorsum, replacement of the modified dorsal segment, and suspension of the upper lateral cartilages. The dorsal segment acts as an onlay spreader graft, preserves the middle vault, closes the open roof deformity, and creates a smooth dorsal contour from radix to anterior septal angle. The modified Skoog method produces optimal functional and aesthetic outcomes in appropriately selected patients.

Patient Satisfaction following Structural versus Preservation Rhinoplasty: A Systematic Review

Recently, dorsal preservation rhinoplasty has been gained acceptance among facial plastic surgeons. Despite this, there is limited literature on patient satisfaction following preservation rhinoplasty. This systematic review aims to evaluate all studies quantifying patient satisfaction and to compare results between structural and dorsal preservation rhinoplasty. OVID Medline, EMBASE, and PubMed databases were searched. All studies from the years 2010 to 2020 evaluating satisfaction in patients receiving either structural or dorsal preservation rhinoplasty were included. Data regarding study demographics as well as patient satisfaction results were extracted from included studies. Descriptive results and analysis were calculated. A total of 2,172 articles were initially identified, of which 29 articles were included in the final analysis. Of the 29 articles, 25 were focused on structural rhinoplasty and 4 were focused on preservation rhinoplasty. Of the 25 structural rhinoplasty articles, 17 used the Rhinoplasty Outcome Evaluation (ROE) questionnaire to evaluate patient satisfaction and 5 used the FACE-Q scale. Among the 25 structural rhinoplasty studies, 14 (56%) reported statistically significant improvements in patient satisfaction evaluation scores after rhinoplasty. Among the four preservation rhinoplasty studies, one (25%) study reported significant improvements in satisfaction scores after rhinoplasty. Despite this, most studies included a statement that satisfaction improved in patients following rhinoplasty. Literature in this review supports both structural and preservation rhinoplasty, resulting in high satisfactory results for patients following surgery. More research must be conducted to further quantify satisfaction following preservation rhinoplasty and prospectively compare satisfaction between the two rhinoplasty techniques.

Patient-Perceived Nasal Appearance After Septorhinoplasty With Spreader Versus Extended Spreader Graft

OBJECTIVES/HYPOTHESIS

Standard spreader grafts (SSGs) are commonly used in septorhinoplasty to treat internal nasal valve narrowing and have been shown to improve nasal airway obstruction. Extended spreader grafts (ESGs) have also been proven effective for correcting nasal deviation. To date, the effectiveness of ESGs using patient-reported outcome measures has not been demonstrated, and results of ESGs have not been compared to SSGs. This study aims to assess satisfaction and nasal appearance in patients who have undergone septorhinoplasty with SSG versus ESG.

STUDY DESIGN

Prospective cohort study.

METHODS

Five hundred sixty-eight patients who underwent septorhinoplasty with SSGs and 126 patients who underwent septorhinoplasty with ESGs between 2012 and 2018 were administered the Nasal Obstruction Symptom Evaluation (NOSE) scale and FACE-Q Satisfaction With Nose, FACE-Q Satisfaction With Nostrils, and FACE-Q Social Functioning scales pre- and postoperatively. Pre- and postoperative NOSE and FACE-Q scores, negative inspiratory force (NIF), and changes in these values were compared between groups.

RESULTS

Results demonstrated clinically and statistically significant improvement at follow-up for both groups. There was no significant difference between the SSG and ESG groups in mean improvement of NOSE scores, FACE-Q scores, and NIF at follow-up of 6 months and at 12 months.

CONCLUSIONS

This study demonstrates that SSGs and ESGs both provide clinically and statistically significant improvement, and no significant difference in functional outcome. Both techniques can be effective. The etiology of the nasal obstruction and/or deformity should be considered when deciding which type of spreader graft to use.

LEVEL OF EVIDENCE

3 Laryngoscope, 131:765-772, 2021.

Revision Septorhinoplasty: An Illustrative Case Report

BACKGROUND

Rhinoplasty is one of the most popular procedures in facial plastic surgery. It is a technically demanding surgery with a long learning curve. The outcome may be very beneficial to the function of the nasal breathing as well as the patient's social life but harbors many pitfalls and sequelae from minor to devastating. This grants a high demand on the knowledge of the nose's anatomy and the implication of each conducted maneuver or grafting during the surgery both short and long term.

METHODS AND RESULTS

In the presented case report, we demonstrate the sequelae of a secondary rhinoplasty case, analyze the outcomes, present the revision surgery in detail, and show the follow-ups. Most negative outcomes of primary rhinoplasty may be led back to the particular techniques applied. Leading causes of revision surgery include loss of tip projection, inverted-V-deformity, axis deviation, dorsal irregularities, internal and external nasal valve collapse, damage to the soft tissue envelope, and many more.

CONCLUSIONS

We believe that through such an illustrative case discussion, we may enhance the skills and critical appraisal of young surgeons in decision-making.

Prospective Qualitative Multidimensional Assessment of the Postoperative Rhinoplasty Experience

Background: Understanding the multidimensional postoperative patient experience after rhinoplasty is critical for preoperative counseling and postoperative management. Methods: A prospective clinical study was conducted from June to December 2019 for 60 patients undergoing cosmetic and/or functional rhinoplasty by two facial plastic surgeons. All patients were administered the brief pain inventory, a clinically validated pain instrument, including multiple quality of life (QOL) domains, survey at postoperative days (PODs) 1, 2, 3, and 8. Nasal Obstruction Symptom Evaluation (NOSE) scores were used to predict patients having greatest QOL disturbance. Primary outcomes were postoperative QOL domains, pain scores, and oxycodone usage. Statistical analysis was performed using STATA 14.0 (STATA Corp., College Station, TX). Preoperative NOSE and postoperative Euro Quality of Life 5-Dimension scores were also recorded. Results: Patients showed greatest disruption to QOL in the first 3 PODs and essentially returned to normal levels by POD8, which mirrored trends in pain and opioid usage. All tested QOL domains (general activity, sleep, work, mood, enjoyment, and relationships) were strongly correlated with overall pain. NOSE scores were not significantly associated with pain or QOL impairment. Conclusions: This is the first study to prospectively evaluate the rhinoplasty patient's postoperative experience using a pain instrument, including multiple QOL domains. Utilizing a validated clinical instrument allows for standardized comparison of postrhinoplasty pain and QOL disruption with other surgical procedures and disease processes. These data may help guide preoperative counseling and set accurate patient expectations for the postoperative period.