Advancing Precision Rhinoplasty: Preoperative Digital 3D Surgical Planning.

The aim of the study is to assess the efficacy and advantages of utilizing state-of-the-art three-dimensional (3D) reconstruction technology in preoperative planning for rhinoplasty surgery. It is a study of a single rhinoplasty case that was operated at a tertiary hospital. The patient was assessed through a detailed history, blood investigations, radiological investigations and preoperative 3D (three-dimensional) reconstruction of the face and nose. The study utilized high-resolution CT scans and 3D reconstruction software like 3D (three-dimensional) Slicer and Blender 3D (three-dimensional) to analyze nasal anatomy for preoperative planning in rhinoplasty. External and internal nasal measurements were taken, and axial cross-section analysis was conducted to assess nasal structure deviation. The benefits of 3D (three-dimensional) visualization in surgical planning were evaluated, and surgical management was based on preoperative reconstructions. Comprehensive preoperative evaluations were performed, adhering to ethical guidelines. Preoperative 3D (three-dimensional) reconstruction planning methods facilitated precise surgical planning and execution in rhinoplasty with satisfactory outcomes for both the patient and the surgeon. Incorporating 3D (three-dimensional) reconstruction technology in rhinoplasty preoperative planning enhances surgical precision and patient satisfaction, ensuring optimized surgical outcomes while adhering to ethical standards.

Types of nasal deformities in individuals seeking rhinoplasty at governmental hospital in Saudi Arabia.

Introduction: This study explores the profound impact of nasal structure on individuals' self-image and emotional well-being, emphasizing the increasing popularity of rhinoplasty in Saudi Arabia, influenced by societal beauty standards portrayed on social media. The investigation aims to unravel the complex interplay between demographic factors, such as gender and age distribution, and prevalent nasal deformities in a cohort of 293 participants. Material and methods: This retrospective study at the University of Hail and King Khalid Hospital, Saudi Arabia, investigated nasal deformities in 293 participants aged 15-54. Ethical approval was obtained, and data, including bio-demographics and nasal deformities, were retrospectively reviewed. Statistical analyses, utilizing chi-square and Fisher exact tests, assessed associations, enhancing internal validity. The study targeted a diverse population, emphasizing ethical guidelines and systematic sampling. Results: Our study of 293 participants revealed a prevalence of common nasal deformities. Dorsal hump deformity (59.0%) was the most prevalent, followed by external nasal deviation (54.6%). Significant gender differences were observed, with males more prone to external nasal deviation (65.6%), while decreased nasal tip rotation was more common in females (40.6%). Variations in nasal tip shape were statistically significant, with broad nasal tip shape more prevalent in females (35.2%). Conclusion: In conclusion, our study highlights the prevalence of common nasal deformities, emphasizing significant gender variations. These findings contribute to a deeper understanding of nasal anatomy, essential for informed decision-making in rhinoplasty.

Self-image, self-esteem, anxiety, and functional capacity in patients undergoing open-structure rhinoplasty.

BACKGROUND: Rhinoplasty may improve negative psychological aspects, such as mild to moderate body dysmorphic disorder; however, the repercussions on the self-image and quality of life of patients after the procedure are unknown. OBJECTIVE: To evaluate self-image, self-esteem, anxiety, and functional capacity of patients undergoing open-structure rhinoplasty. METHODS: A primary, analytical, clinical, longitudinal, and prospective study was conducted, which included 30 female patients, aged between 18 and 50 years with elongated nose and nasal hump, who underwent open and structured rhinoplasty. All procedures were performed by a team from the Rhinology DCP/Unifesp. The Rosenberg Self-Esteem Scale - EPM, BDSS, BDD-YBOCS, SF-36, SRQ-20, and STAI (T/E) questionnaires were administered before the surgery and at 6, 12, and 18 months after surgery. RESULTS: The results showed statistically significant differences in the Rosenberg scale - EPM (p = 0.017), BDSS (p < 0.001), BDD (p = 0.006), SF-36 (p = 0.041), SRQ-20 (p = 0.012), and STAI-T (p = 0.001) scores in general analyses. Additionally, the statistically significant changes persisted in various stratified postoperative periods. In the qualitative analysis, there was only statistical significance for the classification of the BDSS score, where the "Absent" (absence of body dysmorphism) index increased from 70.0% in the preoperative state to 96.7% in 18 months postoperatively. The "Present" (presence of body dysmorphism) index fell from 30.0% to 3.3% in the same period (p = 0.001). CONCLUSION: Open-structure rhinoplasty improved the patients' self-image, self-esteem, anxiety, and mental health.

Dorsal roof flap rhinoplasty: Updated results and a new classification of nasal dorsal deformity.

BACKGROUND: The dorsal roof flap (DRF) technique was developed as a modification of the retractable roof method, which is a variant of dorsal preservation (DP). OBJECTIVE: The paper aims to present new results of the DRF technique and dorsal deformity analysis created for the technique. METHODS: A total of 57 primary rhinoplasty patients treated with DRF technique between 2022-2023 years were included in the study. A dorsal deformity classification based on the anticipated amount of dorsal reduction, nasal bone shape, and hump content was used. According to the classification, the noses were categorized into 3 types. All data were obtained from patient records, computed tomography views, and pre-and postoperative photographs. Aesthetic and functional results were assessed pre-and postoperatively using a visual analog scale (VAS) (0-10, 0 points means very poor). RESULTS: The mean follow-up period was 10.1 ± 3.9 months. 23 cases were type 1, 14 were type 2, and 20 were type 3. The anticipated amount of dorsal reduction in type 1 was 2-4 mm, 5-7 mm in type 2, and 8-10 mm in type 3 deformity. Of the total, 27 cases had a V-shaped nasal bone and 30 had an S-shaped. The hump composition was cartilaginous in 13 cases and bone and cartilage in 44 cases. Pre- and postoperative aesthetic and functional VAS scores were significantly different (p ≤ 0.001). No complications and therefore no revisions were observed during the follow-up period. CONCLUSION: It is a versatile method to reshape the nasal dorsum and minimize the revisions associated with dorsal preservation when used in appropriate cases.

L-Strut Cartilage Graft: A Versatile Graft in Functional Rhinoplasty.

Anterior and high septal deviation can severely affect the functional and cosmetic outcomes of a patient. Conventional septoplasty would not be sufficient in these conditions to restore the functionality and aesthetics of a nose, and the majority of the patients require L-shaped grafts for the reconstruction of the septum. In the present study, we shared our experience in using an L-strut cartilage graft in functional rhinoplasty. It is a retrospective study of 60 patients who underwent septorhinoplasty from March 2020 to January 2023 using an L-strut cartilage graft for functional and aesthetic abnormality. The functional and aesthetic outcomes have been evaluated and compared before and 12 months after the surgery. L-strut cartilage graft was used in 60 cases of functional rhinoplasty. There was a significant improvement in the functional and aesthetic outcomes in all the cases (p < 0.05). No significant intraoperative and postoperative complications were detected in any of the patients until 12 months of follow-up. L-strut cartilage graft could be a versatile graft that can be successfully utilized in patients with gross anterior/dorsal septal deviation. It provides a stable, straight midline fixation of the neoseptum, ensuring good functional and aesthetic results without major complications.

A comparative study of the local effect of tranexamic acid and phenylephrine on the amount of bleeding in rhinoplasty: A randomized clinical trial.

Background: Bleeding during nose surgery is very important, because it can cause a problem in the surgeon's field of view and lead to an increase in the probability of surgical complications. The aim of this study was to compare the local effects of tranexamic acid and phenylephrine on bleeding in rhinoplasty. Methods: The present study is a double-blind clinical trial in which 98 patients who were candidates for rhinoplasty Shiraz were randomly divided into 49 groups of phenylephrine and tranexamic acid. In the first group, 1 cc of phenylephrine and in the second group, 1 cc of tranexamic acid was used locally and then the variables in the two groups were compared. The current study was approved by the Iranian Clinical Trial Registration Center with code IRCT20201205049602N1. Results: The average blood pressure and heart rate in the phenylephrine group first increased and then decreased, but in the tranexamic acid group decreased from the beginning to 30 minutes. Based on the results of the test, there was a difference between the two groups in terms of the amount of bleeding, and a statistically significant relationship was observed. The average bleeding volume was lower in the phenylephrine group (p<0.0001). Conclusion: Results of this study showed that the amount of bleeding in the phenylephrine group was lower than that of tranexamic acid. It is recommended to use phenylephrine in rhinoplasty surgery to reduce bleeding and improve the surgeon's vision.

Surgical approach to congenital nasal dermoid sinus cyst in adult with external rhinoplasty and endoscopic approach: a case report.

Introduction and importance: Nasal dermoid sinus cysts (NDSCs) are rare congenital nasal lesions which typically arise in early childhood. Complete surgical excision is the only therapy, and many approaches have been used according to the location and the extension of the mass. Several studies have advocated external rhinoplasty and endoscopy. Case presentation: A 21-year-old female presented with a mass on the root of the nose, which appeared since childhood, and enlarged after puberty. Investigations including imaging revealed a lobulated mass extending from the osteocartilaginous junction towards the nasion, affecting the left lateral nasal wall. And its upper pole was resting on the floor of the left frontal sinus. Complete resection was performed using external rhinoplasty and endoscopy approaches, which improved esthetic results. Lateral osteotomy was used to compensate for the lateral nasal bone loss by narrowing the width of the nose. After 10 weeks of follow-up, no complications occurred, and the patient was satisfied with the cosmetic results. Clinical discussion: Nasal dermoid sinus cysts are congenital midline nasal lesions that can present as an isolated mass, or associated with intracranial extension. External rhinoplasty and endoscopy approaches are recommended for complete excision of NDSCs extending to the anterior skull base, especially when there is no intracranial involvement or in case of small intracranial extension. These two methods allow for repairing bone defects of the anterior skull base and improve esthetic results. However, in cases of large intracranial extension, craniotomy is preferred. Conclusion: The surgical approach used in the treatment of nasal dermoid sinus cysts should be a minimally invasive technique that reduces bone morbidity and provides good cosmetic results.

Thin Skin in Rhinoplasty: Considerations for Camouflaging Dorsal Nasal Irregularities.

Thin skin presents a challenge for achieving optimal aesthetic outcomes and minimizing complications. The review analyzes various materials and techniques employed to achieve this goal. A comprehensive electronic search was conducted across various medical databases, retrieved 965 studies, from which 15 studies were eligible for inclusion in this review with a total number of 679 patients with thin nasal skin. Techniques that promote graft integration, minimize resorption, and provide a smooth dorsal contour are crucial for thin-skinned patients. Diced cartilage with PRP, fascia lata grafts, and laser-assisted rhinoplasty appear to be particularly effective based on the available evidence. Platelet-rich fibrin (PRF) appears to play a role in some techniques by enhancing healing and tissue regeneration. Natural materials, like fascia lata and ligamentous grafts, offer potential benefits but require further exploration. Fat grafting techniques show promise but necessitate more research. This review provides a comprehensive overview of various techniques for addressing dorsal irregularities in rhinoplasty for patients with thin skin. Surgeons can utilize this information to select the most appropriate approach for achieving optimal aesthetic outcomes while minimizing complications.

Long-Term Surgical Outcomes of Primary Rhinoplasty.

OBJECTIVE: To examine the impact of primary rhinoplasty on subsequent rhinoplasties for patients with cleft lip nasal deformity. DESIGN: Retrospective cohort study. SETTING: Tertiary care pediatric hospital. PATIENTS/PARTICIPANTS: Individuals who underwent definitive cleft lip repair at our institution from 2000 to 2006 with a current age of 18 or older. MAIN OUTCOME MEASURES: Number and timing of subsequent rhinoplasties. RESULTS: Among 199 individuals, 94 (47.2%) underwent primary rhinoplasty. Follow-up was 15.0 ± 4.8 years in the PR cohort and 15.0 ± 5.1 years in the NPR cohort (p = 0.993). In bilateral cleft lip, interdomal suture predicted fewer subsequent rhinoplasties (ß=-0.310, p = 0.033), while history of primary rhinoplasty predicted greater age at subsequent rhinoplasty (ß=1.800, p = 0.040). Among individuals with follow-up beyond age 18, intranasal stenting predicted fewer subsequent rhinoplasties (ß=-0.609, p = 0.015). Most underwent subsequent nasal correction aside from 7 (19.4%) and 9 (20.9%) in the PR and NPR cohorts, respectively (p = 0.536). There was no difference in mean subsequent rhinoplasties between cohorts (1.1 ± 0.8 versus 1.3 ± 1.1, p = 0.284). Individuals with complete cleft lip underwent more lifetime rhinoplasties (1.9 ± 1.0 versus 1.2 ± 1.2, p = 0.007). CONCLUSIONS: Primary rhinoplasty with interdomal tip sutures in bilateral cleft lip was associated with fewer subsequent rhinoplasties. Primary rhinoplasty may delay subsequent nasal correction, though most who underwent primary rhinoplasty ultimately required nasal correction later in childhood. Postoperative nasal stenting may provide longer-term nasal benefits and should be considered at time of definitive cleft lip repair.

Trends in Rhinoplasty Research in Saudi Arabia: A 30-Year Bibliometric Analysis.

Rhinoplasty is one of the most commonly performed aesthetic surgeries. Saudi Arabia has a large number of rhinoplasty publications. Here, we aimed to assess the past, present, and future research output related to rhinoplasty in Saudi Arabia and compare it with global output. We performed a bibliometric analysis to evaluate rhinoplasty research productivity trends in Saudi Arabia from 1995 to 2021 in both cosmetic and reconstructive rhinoplasties. We considered all publications whose first authors were from Saudi Arabia or whose authors contributed significantly to a paper from Saudi Arabia, even though the first author was not from the Kingdom of Saudi Arabia. We evaluated the research quality of the articles using the impact factor of the journal in which the article was published. For each article, the number of authors, number of citations received, study design, region of the first author, and the level of evidence were collected. We gained several insights into the global trends of rhinoplasty in research and its position. We observed a significant increase in the number of publications on rhinoplasty in Saudi Arabia. Although there was no significant increase in the impact factor, most publications had a level of evidence of I or II.

Patient compliance with medications, nasal douching, smoking cessation and long-term outcomes of surgical septorhinoplasty - a prospective series of 56 cases.

INTRODUCTION: Septorhinoplasty addresses both functional and cosmetic concerns with the nose and has been shown to have consistent, long-term benefits for patients. Nasal irrigation and medication such as antimicrobials are prescribed postoperatively to improve outcomes. Patient compliance with these interventions and outcomes of surgery have not been described. We aim to describe what the effects of compliance with these interventions may be in long-term follow-up. METHODS: Patients undergoing septorhinoplasty were reviewed prospectively from 2015 to 2022. At time of operation, patients were prescribed medications, saline douching and given smoking cessation advice. Patients underwent rhinoplasty outcomes evaluation (ROE) preoperatively, at four weeks, and 3, 12, 24 and 36 months postoperatively. Compliance with postoperative interventions was measured at four weeks. Statistical tests were performed. RESULTS: A total of 56 patients underwent septorhinoplasty. Preoperative ROE scores were improved significantly at all stages of postprocedure follow-up (p<0.0001). Multiple linear regression found no significant differences in patients who were not compliant with medications (p>0.40), nasal douching (p>0.22), both medication and nasal douching (p>0.40), and a positive smoking status (p>0.11) at four weeks. At 3- and 24-months follow-up, there were no significant differences in ROE scores between compliant patients and those who were noncompliant with medications, nasal douching or both (p>0.13). CONCLUSIONS: Our data represent the only series of patient-reported outcomes from septorhinoplasty patients where compliance with nasal irrigation, smoking cessation and antimicrobials is considered. Compliance with nasal irrigation, topical antimicrobials or smoking cessation did not influence postoperative ROE scores.

Patient-Reported Outcome Measures in Nasal Valve Repair and Nasal Obstruction.

Although no gold-standard test exists for measuring the success of surgery in functional rhinoplasty, the patient's own subjective experience of their nasal airway obstruction and its impact on quality of life is paramount in outcomes assessment. Patient-reported outcome measures (PROMs) are questionnaires designed to evaluate both disease-specific nasal functional and esthetic domains and global health-related quality of life domains. Ideal PROMs are derived from patient input, psychometrically validated, reliable, and responsive. Assessment at both preoperative and postoperative visits allows for quantitative analysis of surgical outcomes and helps promote communication between the patient and surgeon.

Advancement of Generative Pre-trained Transformer Chatbots in Answering Clinical Questions in the Practical Rhinoplasty Guideline.

BACKGROUND: The Generative Pre-trained Transformer (GPT) series, which includes ChatGPT, is an artificial large language model that provides human-like text dialogue. This study aimed to evaluate the performance of artificial intelligence chatbots in answering clinical questions based on practical rhinoplasty guidelines. METHODS: Clinical questions (CQs) developed from the guidelines were used as question sources. For each question, we asked GPT-4 and GPT-3.5 (ChatGPT), developed by OpenAI, to provide answers for the CQs, Policy Level, Aggregate Evidence Quality, Level of Confidence in Evidence, and References. We compared the performance of the two types of artificial intelligence (AI) chatbots. RESULTS: A total of 10 questions were included in the final analysis, and the AI chatbots correctly answered 90.0% of these. GPT-4 demonstrated a lower accuracy rate than GPT-3.5 in answering CQs, although without statistically significant difference (86.0% vs. 94.0%; p = 0.05), whereas GPT-4 showed significantly higher accuracy for the level of confidence in Evidence than GPT-3.5 (52.0% vs. 28.0%; p < 0.01). No statistical differences were observed in Policy Level, Aggregate Evidence Quality, and Reference Match. In addition, GPT-4 rated significantly higher in presenting existing references than GPT-3.5 (36.9% vs. 24.1%; p = 0.01). CONCLUSIONS: The overall performance of GPT-4 was similar to that of GPT-3.5. However, GPT-4 provided existing references at a higher rate than GPT-3.5. GPT-4 has the potential to provide a more accurate reference in professional fields, including rhinoplasty. LEVEL OF EVIDENCE V: 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 .

Free Crushed Cartilage Filler Graft to Optimize Tip Aesthetics in Asian Rhinoplasty.

BACKGROUND: The thick skin and weak cartilages make tip rhinoplasty very challenging in Asian patients. Most require an open approach for structural grafting in order to achieve the desired projection and rotation. This need for substantial tip grafting may result in subtle imperfections that are only noticed as the incisions are closed. OBJECTIVES: This study describes the senior author's technique of free crushed cartilage filler graft to optimize nasal tip aesthetics in Asian rhinoplasty. The goal is to introduce this easy-to-use and effective technique to refine the final nasal tip aesthetic with immediate visual and tactile feedback. METHODS: This is a retrospective review of all patients with free crushed cartilage filler graft with at least 12 months of follow-up. Medical records were reviewed for patient demographics, intra-operative manoeuvres, and complications. Photographs were analysed to evaluate changes in nasal length, tip height, and nasolabial and columellar-labial angles as well as aesthetic complications. RESULTS: Sixty-six patients were included in this study, with an average follow-up of 16.3 months. Nasal length was 8.3% greater than pre-op (P < 0.01), and nasal tip height was 12.7% greater than pre-op (P < 0.01). Aesthetic analysis demonstrated that 6.1% of patients had an amorphous tip, 3.0% had an irregular or asymmetric tip, and 4.5% had visible tip grafts. 12.1% of patients expressed aesthetic dissatisfaction, but none was recommended for or pursued revision surgery. CONCLUSIONS: When used correctly, free crushed cartilage filler graft can improve the final tip aesthetic and help camouflage underlying prominences to give the patient a natural result. 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 .

Premaxillary Graft with Costal Cartilage in Rhinoplasty: A Technique to Support the Nasal Tip.

BACKGROUND: Rhinoplasty is an ever-evolving field, with innovative techniques continually being developed to enhance both aesthetic and functional outcomes for patients. Increasingly, research has focused on the integral role of the facial skeleton in providing nasal support and projection. Central to the structural integrity of the nose is the maxillary bone, which occupies a pivotal position in the midface. METHODS: The objective of this study is to assess the outcomes of patients who underwent rhinoplasty involving the placement of a premaxillary graft fashioned from costal cartilage. The study aims to evaluate the graft's tolerance, stability, and potential complications. The patient cohort comprised individuals who underwent open approach rhinoplasty with premaxillary insufficiency, necessitating the placement of a costal cartilage graft anterior to the nasal spine, performed by the same surgeon between 2021 and 2022. A total of 38 patients, consisting of 5 men and 33 women aged between 18 and 58 years, were operated on during this period. RESULTS: Consistent maintenance of tip support was observed across all cases. Among the 33 patients, 20 were randomly chosen for a comparative assessment of the nasolabial angle in preoperative and postoperative profile photographs, demonstrating a statistically significant improvement. No complications such as graft displacement, scarring, extrusion, or infections were reported. CONCLUSION: The use of a premaxillary graft with costal cartilage appears to be a viable, well-tolerated option with favorable long-term outcomes. LEVEL OF EVIDENCE IV: 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 .

Granulosis rubra nasi from plastic surgery perspective.

Affecting the eccrine glands, granulosis rubra nasi (GRN) is an inherited disorder that manifests itself as redness, sweating, and papules distributed mainly in the center of the face. It is diagnosed clinically and the cornerstone of management is reassurance and education about the benign nature of the condition. A wide array of treatment modalities has been proposed, such as Botox and corticosteroids injections; however curative measures are yet to be discovered. In this paper, we present a case of a 26-year-old man complaining of chronic nose sweating. The case was successfully managed with Botox injections, though we suggested our theory of undercutting the glands through aggressive defatting as part of open rhinoplasty to the patient; he declined our suggested modality. It remains an untested option and caution should be exercised in high-risk patients to avoid compromising blood supply to the skin and risking skin necrosis.

Autospreader Flaps in Closed Rhinoplasty: Our Technique and Long-Term Results.

INTRODUCTION:  Rhinoplasty is a common and complex surgical procedure. Respiratory and aesthetic dissatisfaction are major causes of revision surgeries. Multiple techniques were described to reconstruct the middle nasal vault and improve functional outcomes. One of these techniques is the use of autospreader flaps. These flaps were constantly modified by different surgeons. In our practice, we use a modified technique of autospreader flaps in closed rhinoplasty. Neither upper lateral cartilage scoring nor suture fixation to the septum was done. METHODS:  We conducted a retrospective study on 183 patients, analyzing revision rates and long-term functional results using the NOSE scale. Data analysis was done using IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. RESULTS:  Long-term results showed satisfactory aesthetic outcomes with low revision rates (13.6%). Concerning the NOSE score, it was completed by 87 of the 183 patients, yielding a response rate of 47.5%. A mean NOSE score of 18.1 +/- 21.1 at 4.4 years of follow-up was obtained. CONCLUSION:  Autospreader flaps offer simplicity, reproducibility, and effectiveness in closed rhinoplasty. It represents a valuable option for selected patients, especially in populations with high dorsal reduction surgery demand.

The Impact of Scroll Ligament Preservation on Nasal Airway Patency in Rhinoplasty: An Objective Study with Rhinomanometry and Acoustic Rhinometry.

BACKGROUND: Rhinoplasty is a critical surgical intervention aimed at enhancing nasal form and function. However, traditional approaches often compromise the integrity of nasal scroll ligaments, vital for the functionality of the internal nasal valve, leading to potential postoperative nasal dysfunction. Despite the importance of scroll ligaments in maintaining nasal structure and function, the literature lacks objective, quantifiable evidence of their role. This study sought to objectively compare nasal functionality and anatomy between patients undergoing rhinoplasty with bilateral preservation of scroll ligaments and those with bilateral sacrifice of these ligaments, employing computerized rhinomanometric and acoustic rhinometric measurements as evaluative tools. METHODS: This retrospective, double-blind study was conducted at Tekirdag Namik Kemal University's Plastic Reconstructive and Aesthetic Surgery and Ear, Nose, and Throat Clinics. The study population comprised patients who underwent rhinoplasty between May 1, 2018, and October 1, 2019. Patients were rigorously selected based on their medical history, including previous nasal surgeries, aesthetic dissatisfaction, and minimal nasal septum deviation. They were then categorized into two distinct groups: one undergoing rhinoplasty with an emphasis on preserving the scroll ligaments (n = 31) and the other where these ligaments were intentionally sacrificed (n = 30). A comprehensive analysis involving preoperative and six-month postoperative computerized rhinomanometry and acoustic rhinometry measurements was conducted to assess the surgical impact on nasal functionality and structure. The statistical comparison focused on evaluating the changes in air pressure and airflow rates, aiming to delineate the functional outcomes attributable to the differing surgical techniques. RESULTS: Our findings reveal a stark contrast in postoperative nasal functionality between the two groups. In the group with preserved scroll ligaments, there was a significant improvement in postoperative computerized rhinomanometric measurements, indicating enhanced nasal airflow and reduced airway resistance. Conversely, the group with sacrificed scroll ligaments exhibited deteriorated postoperative outcomes, with increased nasal airway resistance and decreased airflow. These differences underscore the pivotal role of scroll ligaments in maintaining nasal airway patency and functionality. CONCLUSION: The study unequivocally demonstrates that the preservation of scroll ligaments during rhinoplasty significantly benefits nasal airway function, as evidenced by improved postoperative rhinomanometry and acoustic rhinometry measurements. This objective data provide a compelling argument for the functional importance of scroll ligaments, advocating for surgical techniques that prioritize their preservation. By highlighting the positive correlation between ligament preservation and enhanced nasal functionality, this research contributes valuable insights into rhinoplasty practices, suggesting a paradigm shift towards approaches that safeguard nasal structural integrity for optimal functional outcomes. LEVEL OF EVIDENCE IV: 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 .

Evaluation and Management of Lateral Wall Insufficiency.

Successful treatment of nasal airway obstruction depends on accurate diagnosis of the underlying etiology. Lateral wall insufficiency (LWI) is a common cause of obstructed nasal breathing and should be recognized and treated accordingly by the rhinoplasty surgeon. LWI refers to dynamic collapse of the lateral nasal sidewalls at the internal (zone 1) and external (zone 2) nasal valves. This article serves as an overview of the important aspects in evaluation and management of LWI.

Rhinoplasty for Patients with Cleft Lip-Palate: Functional and Aesthetic Concerns.

Cleft lip and palate, the most common congenital orofacial anomalies, result in complex nasal deformities due to deficient bony maxilla, dentoalveolar arch, teeth, and soft tissues. This article explores nasal deformities in patients with cleft lip and palate, surgical techniques and considerations in cleft rhinoplasty, particularly focusing on nasal valves in both unilateral and bilateral cases. Unilateral cleft lip deformities include asymmetry of the nasal tip, flattened nostril, and displaced caudal septum, while bilateral cleft lip deformities present a wider and flatter nose with complex nasal features.