Sequential Assessment of External Nasal Deviation Angle Changes in Patients With a Deviated Nose Who Underwent Bilateral Osteotomy.

OBJECTIVE: A deviated nose is traditionally classified as bony, cartilaginous, or combined deviation. Osteotomy is commonly used to correct bony deviation, and accurate surgical techniques and postoperative patient management are important for favorable outcomes. The authors investigated the change in the external nasal deviation angle over time using sequential clinical photographs to identify the optimal postoperative follow-up duration. METHODS: Medical records and sequential standardized clinical photographs of 22 patients who underwent bilateral medial and lateral osteotomies without dorsal augmentation from January 1, 2014 to May 31, 2021, were retrospectively reviewed. Clinical photographs were classified into 4 periods: "a" preoperative, "b" postoperative day (POD) ≤3 weeks, "c" POD ≤9 weeks, and "d" POD >9 weeks. The angle of deviation (AoD) was measured in both frontal and chin-on-chest views for each period. Differences in AoD between temporally adjacent periods were analyzed. RESULTS: Nineteen men and 3 women (mean age: 28.8 y) were included. Thirteen patients showed rightward deviation, whereas 9 showed leftward deviation. Eleven patients underwent surgery through an endonasal approach, whereas the other 11 underwent surgery through an external approach. In the frontal view, AoD differences (mean ± SD) between periods "a" and "b," "b" and "c," and "c" and "d" were 5.79 ± 3.36 degrees (P < 0.001), 1.44 ± 1.14 degrees (P < 0.001), and 1.07 ± 1.24 degrees (P < 0.05), respectively. In the chin-on-chest view, the values were 5.17 ± 2.69 degrees (P < 0.001), 2.06 ± 2.63 degrees (P < 0.001), and 1.46 ± 1.31 degrees (P < 0.001), respectively. No statistically significant difference in AoD differences was observed between the two approaches. CONCLUSIONS: Angle of deviation can change even 9 weeks after bilateral osteotomy. Thus, long-term follow-up using sequential clinical photographs is mandatory. If needed, close follow-up with early postoperative interventions may be required. The chin-on-chest view showed better sensitivity for assessing AoD than the frontal view.

Correcting Different Degrees of Droopy Nose, an Overview of Techniques and Strategies at Tertiary Facial Plastic Center. A Retrospective Analysis.

BACKGROUND: The variety of noses in the mixed Saudi population keeps rhinoplasty surgeons on their toes. The main treatment goal for drooping nose tips is the first rotation of the nasal tip superiorly. Although droopy nose is a common disease in Saudi Arabia, none of the previous studies recognized the general features of droopy nose. METHODS: A retrospective analysis of 352 patients with nasal drooping nose from 2016 to 2022. The main outcome measurements were general characteristics of nasal tip ptosis, and the most common surgical techniques used to treat nasal tip ptosis in a tertiary hospital. RESULTS: Analysis of 352 patients with droopy nose showed that 29.0% were between 25 and 29 years old, and 56.3% were female patients. The most common characteristic seen with droopy nasal tip was a significant dorsal hump in 64.8% of patients, followed by amorphous, boxy, and bulbous nasal tip in 33.5%. Significant dorsal hump and bifid tip were more common between 18 and 24. Meanwhile, amorphous, boxy, and bulbous nasal tip were more common in female individuals. The surgical techniques mostly addressed the underlying cause, which was tip grafting (83.0%), lateral osteotomy (77.3%), hump removal (66.5%), lateral crura method (61.9%), and septal extension graft (40.9%). CONCLUSIONS: The research concluded that the surgeon should be familiar with the patient's underlying cause of nasal tip ptosis and use surgical techniques accordingly. To get a pleased long-term outcome, it is often essential to repair the inferiorly rotated tip using more than one surgical approach.

A New Classification of Pollybeak Deformity and Its Treatment in Asian Rhinoplasty.

BACKGROUND: Supratip deformity, also known as pollybeak deformity, is a common complication of primary and secondary rhinoplasty, characterized by fullness in the supratip region. The correction of pollybeak deformity is a challenging procedure, and its management requires a thorough understanding of the pathogenic mechanism of pollybeak deformity. OBJECTIVES: This study aimed to evaluate the effectiveness of surgical methods for correcting pollybeak deformity in Asian rhinoplasty. METHODS: A retrospective chart review was conducted for 53 patients who underwent pollybeak correction between 2021 and 2022. A modified classification system for pollybeak deformity, the Supratip Fullness Rating Scale (SFRS), was developed to evaluate supratip fullness. The aesthetic outcomes of the patients were assessed by surgeons using the visual analog scale (VAS), and patient was self-assessed using the Rhinoplasty Outcome Evaluation (ROE) scale. RESULTS: The study demonstrated that our surgical method resulted in satisfactory outcomes, with a mean SFRS score change from 2.34[0.65] to 0.23[0.42], a decrease in VAS score from 7.47[1.73] to 1.79[1.67] and a high satisfaction rate of 77.36%, calculated by ROE score. No complications were reported. CONCLUSION: Our surgical method for correcting pollybeak deformity in Asian rhinoplasty can result in satisfactory outcomes, particularly in terms of aesthetic appearance, without any side effects. The use of the modified classification system (SFRS) can provide an objective evaluation of supratip fullness, thereby aiding in the management of this challenging complication. 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 .

Simplified Septal Stabilization in Closed-Approach Low-Septal-Resection Dorsal Preservation Rhinoplasty.

BACKGROUND: Septal fixation is a basic step in low-septal-resection dorsal preservation rhinoplasty. Inadequate septal stabilization can lead to supratip depression or more severe saddle nose deformity. This paper presents a simple surgical maneuver to stabilize quadrangular septal cartilage instead of suture fixation to the anterior nasal spine. METHODS: Thirty patients who underwent closed-approach low-septal-resection dorsal preservation rhinoplasty between July and December 2021 were included in this retrospective study. Depending on the surgical maneuver performed to stabilize quadrangular septal cartilage, the patients were divided into 2 groups as follows: (1) a group in which the septum was stabilized with transfixion sutures (the transfixion suture group) and (2) a group in which the septum was fixed to the anterior nasal spine with suture (the anterior nasal spine suture fixation group). Standardized postoperative 12-month lateral-view photographs were scanned for the presence of supratip depression or saddle nose deformity that may indicate insufficient septum stabilization. RESULTS: Supratip depression was observed in 1 patient in the transfixion suture group (n = 16) and in 1 patient in the anterior nasal spine suture fixation group (n = 14; P > 0.05). No saddle nose deformity was observed in either group. CONCLUSIONS: Transfixion sutures seem effective in providing septal stabilization to prevent supratip depression or saddle nose deformity in closed-approach low-septal-resection dorsal preservation rhinoplasty. Transfixion sutures can be used for septal stabilization in closed-approach rhinoplasty, allowing the surgeon to take advantage of the ease of placement.

Traumatic injuries to the cartilage of the nose.

Injuries to the cartilaginous structures of the nose can arise after minor trauma and without a concomitant nasal fracture. They are diagnosed with a thorough clinical examination and can, if not diagnosed and treated in the acute phase, result in nasal/septal deformation, saddle nose or abscess formation with subsequent intracranial spreading of the infection. Even with proper treatment in the acute phase, the cartilage often heals with deviation. This can result in functional and cosmetic problems which may require later reconstructive surgery, as argued in this review.

Pollybeak deformity: how to avoid, how to cure.

We reviewed the Pollybeak deformity from prevention to treatment in all aspects. Research methods included searching online databases such as Google, Google Scholar, PubMed, and Proquest Central at King Saud University. We used terms like "Pollybeak deformity", "rhinoplasty", "etiology", and "treatment" to find related articles. Pollybeak deformity, an undesirable side effect of rhinoplasty, manifests as a dorsal nasal convexity resembling a parrot's beak. A dorsal hump that develops in the supratip region of the nose "pushes" the tip down, leading to under-rotation. Several factors may be at play here. When a surgeon fails to recognize the aberrant tip-supratip relationship that distinguishes this abnormality during the intraoperative evaluation of the nose, the result is a pollybeak. There is also the risk of pollybeak deformity, which the surgeon might be unable to predict. Supratip scar tissue is more common in people with thick skin and soft tissue envelopes. Medical intervention is only effective for soft-tissue pollybeaks when caught early. Injecting corticosteroids into the supratip dead space can alleviate edema and slow scar tissue formation. Surgical excision of scar tissue from the dorsum of the nose can repair the pollybeak deformity. Surgical correction of a supratip fullness that causes a disparity between the tip and supratip is known as a "pollybeak deformity". The appearance of the nose in some individuals with pollybeak deformity can resemble that of a bird, which can cause them to feel self-conscious and embarrassed. Therefore, treatment with medicine or surgery is required for these ailments.

The Morphological and Functional Effects of the Endoscope-Assisted One-Stage Approach for Crooked Nose.

BACKGROUND: A crooked nose is an external nose deformity predominantly caused by congenital aplasia or acquired secondary to trauma or surgery, often accompanied by a deviated nasal septum. Patients with crooked nose have dual needs to improve both esthetic and functional problems. METHODS: The clinical and photographic information of 48 patients diagnosed with a crooked nose and nasal septum deviation treated from January 2018 to January 2022 was acquired. The morphology and functional effects were investigated by evaluating the general condition of the operation, measuring the esthetic indexes of the nose, and subjectively scoring. RESULTS: For both morphology and function, endoscopy-assisted one-stage correction showed positive results in this study. The external nose deviation distance postoperatively measured 1.28 (0.85, 1.97) mm, which significantly decreased from the preoperative value of 3.96 (3.31, 5.29) mm. The scores of doctors and irrelevant medical students on nose morphology increased significantly from 4.75±1.88 and 3.84±0.76 to 6.48±1.21 and 7.21±0.67, respectively. The rhinoplasty outcome evaluation score and the "nasal obstruction symptom evaluation "score of patients were both significantly improved ( t = -7.508 and t =6.310, respectively, P < 0.001). CONCLUSION: Endoscope-assisted one-stage correction of the crooked nose can restore nasal morphology, improve the symptoms of nasal obstruction, and achieve patient satisfaction. It is a minimally invasive, safe, effective, and fast recovery approach for patients who need to solve both esthetic and functional problems.

Rhinoplasty for Sinonasal Deformities in Granulomatosis with Polyangiitis: A Systematic Review and Meta-Analysis.

BACKGROUND: Granulomatosis with polyangiitis (GPA) is a vasculitis that affects respiratory and kidney vessels. It primarily involves the nose and sinuses but can progress systemically. Granulomatosis with polyangiitis causes severe nasal deformities, impacting aesthetics and breathing. Literature focuses on rhinoplasty for saddle nose deformities in non-GPA patients, but its suitability for GPA patients remains uncertain. AIM: Our study aims to assess the effectiveness and safety of rhinoplasty in GPA patients by analyzing the existing literature. METHODS: Four databases were searched; 2 reviewers independently screened the retrieved references, then relevant data for our study were extracted. Categorical outcomes were analyzed using pooled proportions and 95% CI. Statistical heterogeneity was assessed using the I2 statistics χ 2 test with a P -value lower than 0.1 indicating heterogeneity. RESULTS: In our systematic review and meta-analysis, we incorporated 16 studies encompassing 136 patients who underwent nasal reconstruction as part of their treatment for GPA. The collective findings indicate a favorable success rate for rhinoplasty, with a pooled ratio of 89% (95% CI: 84%, 95%). The rate of revision surgeries was relatively low, with a pooled rate of 19% (95% CI: 12%, 26%). Furthermore, rhinoplasty demonstrated comparatively lower rates of recurrence (pooled rate: 22%, 95% CI: 3%, 42%) and complications (pooled rate: 12%, 95% CI: 7%, 18%). CONCLUSION: Rhinoplasty benefits GPA patients with saddle nose deformity and septal perforation with high success rates and low recurrence, revision, and complication outcomes. However, more research is needed for validation and refinement.

Septal Reconstruction: Simple to Complex.

Nasal septal deviation is a frequent problem treated by otolaryngologists and facial plastic surgeons. Complete correction of the septal deformity is often essential both for straightening a crooked nose and for restoration of the nasal airway. While standard septoplasty techniques provide excellent outcomes in most patients, severe septal deformities may require treatment with more advanced maneuvers including adjacent grafting, caudal septal replacement, and even extracorporeal septoplasty. This article reviews a range of septoplasty techniques, with an emphasis on complex septal reconstruction and approaches that can be utilized to maintain keystone stability and establish a robust midline L-strut even in cases with challenging anatomy.

New classification system of contracted nose and its treatment algorithm.

BACKGROUND: The nasal contracture after rhinoplasty is one of the most severe complications in East Asian patients. The classification and treatment algorithm of nasal contracture have not yet been established. This study aimed to develop a new classification system and treatment algorithm of contracted noses in East Asian patients to improve treatment outcomes. METHODS: A retrospective study was conducted with 62 patients with nasal contracture who underwent a revision rhinoplasty between March 2017 and March 2021. The authors classified the 62 patients into 3 groups based on the classification system. All patients underwent rhinoplasty designed according to the corresponding classification. The patients were followed up after surgery, and the rhinoplasty outcomes evaluation (ROE) was used to evaluate their satisfaction rate. RESULTS: A total of 59 female patients and 3 male patients (mean age, 29.45 ± 7.73 years) were included in this study. Forty-five cases presented mild nasal contracture (72.58%), 11 presented moderate nasal contracture (17.74%), and 6 presented severe nasal contracture (9.68%). There were statistically significant differences in the number of prior rhinoplasty procedures, infection history, and preoperative ROE scores among the three groups, with no differences in sex ratio, age, kinds of initial implant materials, and postoperative ROE scores. Almost all patients achieved satisfactory outcomes after the revision surgery designed by different classifications. CONCLUSION: The authors have established a new classification system and treatment algorithm for contracted noses based on the change in pathological anatomy of nose, which is effective for guiding the treatment of contracted noses with good results.

The Management of Posttraumatic Nasal Deformities.

Nasal bone fractures are the most common fractures of the facial skeleton and are often accompanied by bony, cartilaginous, and soft tissue injuries. These injuries are often complex, and when untreated or inadequately treated, can lead to posttraumatic nasal deformity. The most common deformities are the crooked nose and the saddle nose. Both deformities may result in significant cosmetic and functional concerns. The treatment of these deformities can be complex, requiring careful evaluation of the nose and thoughtful planning to correct the cosmetic deformity and restore functional integrity. The rhinoplasty surgeon will benefit from having a large repertoire of techniques to achieve these repairs. In this article, we discuss the options and concepts for the management of nasal bone fractures as well as complicated posttraumatic nasal deformity. Level of evidence is not available.

Management of the Middle Vault.

Early reductive rhinoplasty techniques focused on hump reduction and tip plasty with minimal focus on treating or preserving the integrity and width of the middle vault. With time, rhinoplasty surgeons noted the aesthetic and functional complications of the deformities that may occur in the middle vault with reduction techniques and developed methods to treat and also avoid these complications. Thus, the importance of protecting the integrity of the middle third of the nose has been increasingly emphasized over the years. Primary deformities of the middle vault that result in nasal obstruction require attention of the rhinoplasty surgeon, as well as preservation of support structures of the middle vault and internal nasal valve to minimize secondary deformities and functional compromise after rhinoplasty surgery.

Septoplasty and/or inferior turbinoplasty produce significant improvements of the sense of smell.

BACKGROUND: Patients with septal deviation and/or turbinal hypertrophy may experience olfactory disfunction (OD). The aim of this study was to analyse the effect of septoplasty and/or turbinoplasty on both lateralized and bilateral olfactory function. METHODOLOGY: Prospective study of 47 patients with nasal obstruction secondary to septal deviation and/or turbinal hypertrophy and 20 healthy controls. The Barcelona Olfactory test (BOT-8), a new supraliminal orthonasal subjective olfactometry, was applied 3 times in a row (in each nostril separately and in both simultaneously). The 8 items were applied randomly to minimize the possible risk of learning. The test has not established the minimal clinically important difference (MCID). Anterior rhinomanometry and acoustic rhinometry were performed. All participants self-assessed smell loss and nasal obstruction using a visual analogue scale (VAS) and completed questionnaires for nasal obstruction (Nasal Obstruction Symptom Evaluation, NOSE) and for quality of life (QoL), using disease-specific (SinoNasal Outcome Test-22, SNOT-22) and generic (Short Form-12 Health Survey, SF-12) questionnaires. Nasal measurements and questionnaires were performed preoperatively and 12 months after surgery. RESULTS: Before surgery, patients reported worse VAS on smell loss and on nasal obstruction compared to controls. Patients scored lower BOT-8 than controls. Lateralized preoperative olfactory function showed that all BOT-8 characteristics were lower at the narrow side than the wider one. Smell function and QoL improved significantly one year after surgery. CONCLUSIONS: Nasal septal deviation and turbinal hypertrophy lead to an olfactory impairment on the obstructed nostril. Nasal surgery provides a positive outcome on olfactory function, as well as on subjective and objective outcomes.

Evaluation of the Patient with Nasal Obstruction.

Patients often present with a complaint of nasal blockage, either primarily, or in conjunction with aesthetic concerns. The evaluation of the patient with nasal obstruction involves a comprehensive history and a detailed physical examination. The nose is an organ in which form and function are inseparable, and as such, examination of the patient with nasal obstruction must focus not only the internal structures that may cause obstruction of the nasal airway, but also the external structure of the nose as it impacts nasal breathing. Detailed facial analysis and a systematic nasal examination will reveal details regarding nasal obstruction due to internal sources such as septal deviation, turbinate hypertrophy, or nasal lining abnormalities, and structural abnormalities such as nasal valve collapse or external nasal deformity. This approach, in categorizing each component of the nasal exam and its findings, allows the surgeon to formulate an appropriate treatment plan that emerges from the details of the examination.

Efficacy of Nostril Supportive Splint Treatment for Nasal Septum Deformities after Le Fort I Osteotomy.

This retrospective study aimed to evaluate the efficacy of support splint treatment for deformities and deviations of the nasal septum after Le Fort I osteotomy (LFI). Patients were divided into two groups: the retainer group wore a nasal support splint immediately after LFI for 7 days, and the no retainer group did not wear a nasal support splint. Evaluation was performed by measuring the ratio of the difference between the left and right sides of the nasal cavity area (ratio of nasal cavity) and the angle of the nasal septum using three computed tomography frontal images (anterior, middle, and posterior) before and one year postoperatively. Sixty patients were included and divided into two groups, the retainer and no retainer group (n=30 each). Regarding the ratio of nasal cavity on middle images at one year postoperatively, the retainer and no retainer groups differed significantly (0.79±0.13 and 0.67±0.24, respectively; P =0.012). The angle of the nasal septum on anterior images at one year postoperatively was 164.8±11.7° in the retainer group and 156.9±13.5° in the no retainer group, showing a significant difference ( P =0.019). This study suggests that support splint treatment after LFI is effective in preventing post-LFI nasal septal deformation or deviation.

[Functional disorders of the nose - definition, diagnostics and treatment options]. / Funktionelle Formstörungen der Nase ­ Definition, Diagnostik und Therapieoptionen.

The surgical spectrum of functional rhinosurgery includes nasal septum surgery, septorhinoplasty and nasal concha surgery. Based on the German guideline "Disorders of the inner and/or external nose (with functional and/or aesthetic impairment)" published in April 2022, which was prepared on behalf of the German Society of Otorhinolaryngology, Head and Neck Surgery, we discuss the indications, diagnostic approaches, the planning of the surgery and postoperative care. The most common findings of the external nose with a functional impairment include crooked nose, saddle nose, and tension nose. Combined pathologies occur. Well-documented in-depth consultation is essential for rhinosurgical procedures. In the case of revision surgery, the possible necessity of autologous ear or rib cartilage should be considered. Despite correct surgical performance, no "guarantee" can be given for the surgical (long-term) result in rhinosurgery.

Using the sino-nasal outcome test (SNOT-22) to study outcome of treatment of nasal obstruction.

OBJECTIVE: To validate the sino-nasal outcome test (SNOT-22) as an outcome measure for nasal obstruction, and to determine if it correlates with the nasal obstruction and septoplasty effectiveness (NOSE) scale. STUDY DESIGN: Prospective cohort study. METHODS: All patients presenting to our otolaryngology clinic for nasal obstruction secondary to nasal septal deviation and/or inferior turbinate hypertrophy between August 2020 and June 2022 were asked to fill both the SNOT-22 and the NOSE questionnaires. Demographics and comorbidities were reviewed. Patients with chronic rhinosinusitis (CRS) were excluded. SNOT-22 total and subdomain scores were then compared to NOSE scores. RESULTS: 126 patients completed both surveys. Average age was 42.6 years (range 13.8-78.3 years), and 40.5 % were female. 35 patients had septoplasty and inferior turbinoplasty (IT), 34 had functional septorhinoplasty and IT, 6 patients had IT, 7 had nasal septal perforation repair and 44 patients had medical treatment. Overall, SNOT-22 and NOSE scores correlated well preoperatively and postoperatively (r = 0.54, p < 0.0001; r = 0.68, p < 0.0001 respectively). The rhinologic and sleep SNOT-22 subdomains scores had the strongest correlation to NOSE score (r = 0.56, p < 0.0001; r = 0.64, p < 0.0001 respectively). Both NOSE and SNOT-22 scores showed improvement postoperatively [NOSE: 67.4 vs 25.1 (p < 0.0001) at 3 months, 69.5 vs 34 (p < 0.0001) at 6 months; SNOT-22: 37.1 vs 25.2 (p = 0.002) at 3 months, 38.1 vs 22.6 (p = 0.002) at 6 months]. No significant improvement in NOSE or SNOT scores was seen in the medical treatment group. CONCLUSION: SNOT-22 instrument can be used to study the outcome of treatment for nasal obstruction secondary to nasal septal deviation and/or inferior turbinate hypertrophy.

High and Low Septal Strip Excision on Dorsal Preservation Rhinoplasty to Fix Septal Deviation.

ABSTRACT: Rhinoplasty is one of the leading procedures among aesthetic and plastic surgery interventions. Dorsal hump and nasal deviation deformities are prevalent among the general population. Patients who have both dorsal hump and nasal deviation deformities can be considered challenging for rhinosurgeons. Dorsal preservation techniques are of great interest for obtaining better and more satisfactory aesthetic and functional results. Dorsal strip excision plays a considerable part in dorsal preservation techniques. In this study, the author defines a new method that includes excisions of low and high septal strips in the subdorsal area to straighten deviation in the lower part of the distal septum and fix it on the middle line. The present study was designed as retrospective. Sixty-nine patients met the inclusion and exclusion criteria, and their records were assessed (49 females and 20 males). The patients who were included in the study have undergone surgery with high and low septal strip excision through either push-down or let-down techniques. Patients were evaluated using the "Rhinoplasty Outcome Evaluation" (ROE) questionnaire before and 12 months after surgery. The follow-up period ranged between 12 and 20 months (median, 16.3 months). All procedures were performed by the same surgeon between October 1, 2018, and April 1, 2020. The ROE scores ranged between 82 and 100 points after 1 year. The initial median ROE score was 56.5, and it increased to 93.00 points 12 months after surgery (P < 0.001). Patient satisfaction was excellent in 88.76% of the included patients. The combination of let- and push-down methods with low to high septal strip excision resulted in favorable outcomes in patients who had concomitant hump and septal deviation deformities. This new approach presents a suitable and easy method to the surgeons who are interested in dorsal preservation rhinoplasty.