Comparative Functional Effect of Alternative Surgical Techniques Used in Rhinoplasty

Abstract

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.