Outcome of Nasal Valve Obstruction After Functional and Aesthetic-Functional Rhinoplasty

Abstract

INTRODUCTION Nasal valve insufficiency is distinct from other anatomic causes of nasal obstruction. Functional rhinoplasty refers to the collective techniques used to reconstruct the lateral nasal wall, typically achieved with the use of spreader and alar grafts. Patients undergoing functional rhinoplasty can also have aesthetic desires and goals achievable with combined aesthetic-functional rhinoplasty. OBJECTIVE To evaluate the improvement in nasal obstruction symptoms after cartilage graft reconstruction in patients with nasal valve insufficiency and to compare the postoperative improvement between patients undergoing functional and aesthetic-functional rhinoplasty. DESIGN, SETTING, AND PARTICIPANTS In this prospective multicenter cohort study, 12 participating surgeons enrolled 79 consecutive patients diagnosed as having nasal valve insufficiency as the primary cause of nasal obstruction. Patients underwent functional or aesthetic-functional rhinoplasty. The study collected demographic, clinical, and surgical data from March 2006 to September 2008. Nasal symptoms were evaluated using a validated, disease-specific, quality-of-life instrument. The Nasal Obstruction Symptom Evaluation (NOSE) scale was administered to participants at baseline and 3, 6, and 12 months postoperatively. Follow-up was completed on September 2008, and data were analyzed in September 2009 and in September 2013. MAIN OUTCOMES AND MEASURES Changes in NOSE scale score (range, 0 to 100, with a higher score indicating greater severity of obstruction) at 3 months between the functional and aesthetic-functional groups. RESULTS Of the 79 patients, 31 underwent functional and 48 underwent aesthetic-functional rhinoplasty. Overall, an improvement was found in nasal breathing, with a mean decrease of 48.6 points (95% CI, 41.9-55.2; P < .001) at the 3-month assessment compared with the preoperative baseline NOSE scale score (mean [SD], 67.1 [19.7]). The improvement in nasal breathing was similar whether patients underwent functional or aesthetic-functional rhinoplasty (mean [95% CI] NOSE scale score change, 51.4 [42.1-60.7] and 46.6 [37.1-56.1], respectively; P = .49). CONCLUSIONS AND RELEVANCE Nasal valve reconstruction with spreader and alar grafts is effective in treating patients with nasal valve insufficiency. Combining aesthetic interventions with functional rhinoplasty did not seem to affect the magnitude of improvement in nasal breathing outcome. LEVEL OF EVIDENCE 2.

Nasal obstruction symptom evaluation (NOSE) score outcomes after septorhinoplasty

“…Compared to previously published studies that looked at NOSE score trends over time, our study data appear to be externally consistent. Like Yeung et al and Fuller et al, we found that NOSE scores improve at the earliest time point (1–3 months) and remain improved at the later follow‐up time point (≥10 months.) In our review comparing preoperative and postoperative NOSE scores at three postoperative time intervals (early, middle, and late) we found significant and durable improvement in nasal obstructive severity scores reported as early as the 1‐ to 3‐month time interval, on average.…”

“…However, the ideal follow‐up duration after functional septorhinoplasty has not yet been determined. Previous literature utilizing NOSE scores report variable follow‐up, ranging from 1 month to 4 years …”

Partial inferior turbinectomy in rhinoseptoplasty has no effect in quality‐of‐life outcomes: A randomized clinical trial

“…To address this issue, Stewart et al recently have developed and validated the Nasal Obstruction Symptom Evaluation (NOSE) scale, a disease‐specific QOL instrument designed to determine the presence of nasal obstruction . Since then, several studies have compared pre‐ vs. postoperative NOSE scores to assess QOL associated with nasal obstruction …”

Evolution of the butterfly graft technique: 15‐year review of 500 cases with expanding indications

“…Unfortunately, this approach has a reported surgical failure rate to relieve NAO symptoms as high as 25% to 53%, and multiple studies have demonstrated poor correlation between patient‐reported symptoms and objective findings . Failures following surgical correction of deformities involving the inferior nasal corridor oftentimes reveal a previously undiagnosed nasal valve compromise (NVC) that remains unresolved, or incompletely resolved, by otherwise successful correction of targeted anatomic NAO …”

“…[2][3][4][5][6][7] Failures following surgical correction of deformities involving the inferior nasal corridor oftentimes reveal a previously undiagnosed nasal valve compromise (NVC) that remains unresolved, or incompletely resolved, by otherwise successful correction of targeted anatomic NAO. [8][9][10] Numerous surgical procedures exist to address NVC beyond the inferior nasal corridor, including spreader grafts, spreader flaps, butterfly grafts, flaring and spanning sutures, batten grafts, and others. Spreader grafts popularized by Sheen 11 can be used unilaterally, bilaterally, asymmetrically, or in combination with flaring 12 and/or spanning sutures.…”