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Research Original Investigation

Nasal Valve Obstruction After Rhinoplasty

Table 1. Summary of Baseline Clinical Characteristics and Nasal Valve Interventions

Patient Group a

All (N = 79)

Functional (n = 31)

Aesthetic-Functional (n = 48)

P Value b

Characteristic Demographic

Abbreviations: IQR, interquartile range; NOSE, Nasal Obstruction Symptom Evaluation. a Unless otherwise indicated, data are expressed as number (percentage) of patients. b Indicates difference between the functional and aesthetic-functional groups. Differences were compared using the paired t test, Wilcoxon rank sum test, and χ 2 test for continuous, ordinal, and dichotomous variables, respectively, and the Fisher exact test for variables with a low event count. c Scores range from 0 to 100, with higher scores indicating greater severity of obstruction. d Performed by stabilizing the lateral nasal wall with a fine instrument at the specific site of collapse or pinching. The surgeon grades the reported improvement in nasal breathing on a 4-point scale (minimal, mild, moderate, or substantial). e Indicates degree of hypertrophy of inferior turbinates and septal deviation contributing to nasal obstruction, evaluated on a 4-point scale by the surgeon (minimal, mild, moderate, or severe).

Age, mean (SD), y

36 (14) 41 (52)

39 (15)

34 (13) 34 (71)

.15

Female

7 (22)

.001

Nasal obstruction assessment Baseline NOSE scale score, mean (SD) c Modified Cottle maneuver improvement, median (IQR) d Contribution of turbinate hypertrophy, median (IQR) e Contribution of septal deviation, median (IQR) e Nasal valve interventions, No. (%) Spreader graft

67.1 (19.7)

69.0 (17.6)

65.9 (21.1)

.49

Moderate (moderate-substantial)

.21

Minimal (minimal-mild) Mild (mild-moderate)

.35

.78

61 (77)

19 (61) 17 (55)

42 (88) 31 (65) 11 (23) 35 (73) 11 (23)

.007

Regular length (15-30 mm) 48 (61) Extended length (>30 mm) 13 (16)

2 (6)

Alar-batten graft

60 (76) 21 (27)

25 (81) 10 (32)

.43

Placement cephalic to lower lateral cartilage

Placement at lower lateral cartilage

12 (15)

5 (16)

7 (15)

Placement caudal to lower lateral cartilage

27 (34)

10 (32)

17 (35)

Source of graft material Septal cartilage

51 (65) 22 (28) 14 (18)

21 (68) 11 (35)

30 (63) 11 (23) 13 (27)

.63 .22

Auricular cartilage

Rib cartilage

1 (3)

.007

Other concurrent interventions Septoplasty

71 (90) 42 (53)

27 (87) 20 (65)

44 (92) 22 (46)

.51 .10

Turbinoplasty

entailedaesthetic tip interventions in41 patients (85%) andaes- thetic vault interventions in 33 patients (69%). In the func- tional group, limited tip interventions were performed in 5 pa- tients and limited vault interventions in 8 patients, but these interventions were not performed for aesthetic goals. Specific aesthetic interventions performed to the nasal tip included in- terdome or intradome suture (34 [71%]); lateral crus cephalic trim(24 [50%]); underlayor overlay lateral crus strut (14 [29%]); and tip repositioning tochangeprojectionor rotation (26 [54%]). Interventions to the nasal vault included augmentation (16 [33%]), reduction (19 [40%]), and lateral and medial osteoto- mies (23 [48%]). The functional group had osteotomies per- formed in8patients to facilitate theplacement of spreader grafts or to correct deviation. We found a moderate correlation be- tweenhump reduction and theuse of the spreader graft (Spear- man rank correlation, ρ = 0.25; P = .03). Overall, the patients in this study had improvement post- operatively in nasal breathing ( Figure 2 ). The mean improve- ment in the NOSE scale score was 48.6 points (95% CI, 41.9- 55.2; P < .001) at the 3-month assessment compared with the preoperative baseline score. Sixpatients experienced improve- ment of no more than 10% from the baseline score (surgical failure), and of those, only 2 (3%) were unsatisfied with the postoperative results. Figure 3 compares the NOSE scale out- come in the functional and aesthetic-functional groups. The functional and aesthetic-functional groups had a similarmag-

Figure 2. Postoperative Change in Nasal Obstruction Symptom Evaluation (NOSE) Scale Score From Baseline

0 Postoperative Improvement in NOSE Scale Score

Postoperative Assessment, mo

Surgeons used the alar graft method similarly in the func- tional and aesthetic-functional groups (25 [81%] vs 35 [73%]; P = .43); the use of the spreader graft method was more fre- quent in the aesthetic-functional group (19 [61%] vs 42 [88%]; P = .007). By criteria definition, the aesthetic-functional group had aesthetic interventions as part of their surgery. These The NOSE scale score ranges from 0 to 100, with a higher score indicating greater severity of obstruction. The data include 79 patients undergoing functional and aesthetic-functional rhinoplasty, with a mean (SD) baseline NOSE scale score of 67.1 (19.7). Data are presented as mean (95% CI [error bars]) improvement. Overall change was consistent over time.

JAMA Facial Plastic Surgery Published online December 10, 2015 (Reprinted)

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