Minimum follow-up for closed rhinoseptoplasties.

BACKGROUND: There is no established consensus on the postoperative follow-up from which the aesthetic and functional outcomes of rhinoseptoplasty are considered as stable. OBJECTIVES: To contribute to defining the postoperative follow-up from which rhinoseptoplasty outcomes cease to evolve. METHODS: Postoperative assessments of Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcome Evaluation (ROE) scores from 357 closed structural rhinoseptoplasty procedures were prospectively gathered from January 2019 to December 2023. These measurements encompassed the postoperative period from 1 to 12 months. All procedures were performed utilizing closed technique. RESULTS: No statistically significant difference was detected between the scores at 1, 2, and 6 months versus 12 months postoperatively (ROE: p = 0.388; 0.268; 0.162; NOSE: p = 0.265; 0.192; 0.975, Mann-Whitney test). Similarly, no follow-up impact was revealed between the scores at 1, 2, 6, and 12 months postoperatively (ROE: p = 0.548; NOSE: p = 0.280, Kruskal-Wallis test). No significant correlation was established between follow-up (in months) and ROE and NOSE scores (ROE: p = 0.397; NOSE: p = 0.632, Spearman). CONCLUSION: Follow-up duration does not influence NOSE and ROE scores over the 1- to 12-month timeframe. The 1-month postoperative outcome can be regarded as a reliable indicator of the 12-month outcome. These conclusions apply to NOSE and ROE scores of rhinoseptoplasty conducted using closed technique for the 1- to 12-month period. Further research is needed for open techniques, preservation rhinoplasty, other patient-reported outcomes measures (PROMs) as well as for the follow-up beyond 12 months postoperatively.

Polish Translation and Validation of the SCHNOS (Standardized Cosmesis and Health Nasal Outcomes Survey) Questionnaire.

<b>Introduction:</b> Rhinoseptoplasty procedures are focused not only on the aesthetic but also on the functional aspects. Surgical outcomes have to be evaluated in each patient. To date, the Polish literature has lacked a tool facilitating simultaneous assessment of rhinoseptoplasty's impact on both the external appearance and functionality of the nose.<b>Aim:</b> The aim of this study was to translate, adapt, and validate the Polish version of the original SCHNOS (Standardized Cosmesis and Health Nasal Outcomes Survey) questionnaire as used for the assessment of the functional and aesthetic outcomes in patients after rhinoplasty.<b>Materials and methods:</b> A total of 31 subjects (N = 24 [77.4%] women and N = 7 men [22.6%]) aged 19 through 55 years (M = 31.32; SD = 8.50) participated in the study. The SCHNOS questionnaire was translated in accordance with international guidelines. The psychometric accuracy of translation was tested in native speakers of Polish. The authors measured the internal consistency, correlatability, and repeatability of the instrument to determine its validity. The data were subjected to statistical analysis.<b>Results:</b> The confirmatory factor analysis confirmed the two-factor structure of the scale. The satisfactory reliability amounted to 0.888 [95% CI: 0.804-0.940] for the SCHNOS-O and 0.883 [95% CI 0.795-0.937] for the SCHNOS-C scale. Differential accuracy was confirmed by AVE values of > 0.5 as well as by correlation of the results with the Rhinoplasty Outcome Evaluation (ROE) questionnaire scores.<b>Conclusions:</b> The SCHNOS questionnaire has been translated, adapted, and validated for use in the Polish-speaking population. The tool was found to be relevant and reliable.

Optimizing Postoperative Care in Rhinoplasty and Septoplasty: A Review of the Role of Nasal Packing and Alternatives in Complication Management.

Rhinoplasty, a common surgical procedure for nose reshaping, demands meticulous preoperative evaluation and precise execution. When coupled with septoplasty to address medical issues stemming from a deviated nasal septum, these procedures can lead to noteworthy postoperative complications. These encompass early issues like epistaxis and hematoma, as well as long-term challenges such as scarring and aesthetic deformities. Strategies like steroids and tranexamic acid are employed to prevent and manage these complications. A contentious aspect in postoperative care is the use of nasal packing. While some argue it aids healing and hemostasis, others avoid it due to patient discomfort. This review assesses the pros and cons of postoperative nasal packing following rhinoplasty and septoplasty. A thorough literature review spanning 2000-2023 yielded 30 relevant articles from 62. Discussion reveals that nasal packing offers limited benefits in reducing bleeding, edema and ecchymosis. In conclusion, the decision to employ nasal packing in rhinoplasty and septoplasty should be made carefully, considering patient comfort and surgical context. Evidence suggests that nasal packing may not consistently provide significant advantages and could lead to adverse outcomes. Nasal splints offer similar advantages and may be considered viable alternatives. Surgeons should tailor their approach to individual patient needs, with further research needed to refine postoperative management for these procedures.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 .

Application of dual-frequency ultrasound for reduction of perilesional edema and ecchymosis after rhinoseptoplasty.

OBJECTIVES: Biological aspect and clinical research demonstrated that dual-frequency ultrasound (local dynamic micro-massage, LDM) waves of very high frequency can significantly modify cellular signaling providing anti-inflammatory and anti-fibrotic effects. During the recent past, these waves were successfully applied for the treatment of various inflammatory skin conditions, hypertrophic scars, and chronical wounds. Since the main complications after rhinoseptoplasty are caused by excessive inflammatory reactions and development of fibrosis along nasal implants which can lead to a revision rhinoseptoplasty, in this retrospective multicenter blinded study we have evaluated the efficacy of LDM ultrasound for the treatment of the postoperative perilesional ecchymosis and edema in patients after rhinoseptoplasty. METHODS: Twenty-four patients received daily LDM treatment (study group) for 5 days starting from the first day postoperative, whereas 24 patients (control group) were treated with conventional ice packs. Dynamic reduction of the postoperative perilesional ecchymosis and edema was followed up, and the total duration of these side effects was determined within specific paranasal anatomical areas. RESULTS: Post-rhinoseptoplasty ecchymosis and edema were observed in the areas of anterior cheek, lower eyelids, and upper eyelids. Duration of the postoperative perilesional edema was significantly reduced in the group treated with LDM (1.9 ± 0.9 days) compared with control group (4.5 ± 2.1 days). Duration of the ecchymosis was also significantly reduced in LDM group (2.8 ± 1.4 days) compared with controls (7.4 ± 2.8 days). Postoperative patient satisfaction in LDM-treated and control groups was 3.1 ± 1.3 and 1.5 ± 0.7, respectively, demonstrating significantly higher satisfaction in LDM-treated group. CONCLUSIONS: This study proved that the post-rhinoseptoplasty group treated with LDM ultrasound showed a significantly shorter duration of the postsurgical perilesional ecchymosis and edema, with no substantial adverse effects other than those observed in the control group. It can be suggested that ultrasound treatment can serve as an alternative option for the noninvasive management of postoperative perilesional ecchymosis and edema.

Proposal for Perioperative Pharmacological Protocol for the Reduction in Early Complications in Orthorhinoseptoplasty: Five Years of Experience.

Septorhinoplasty is a crucial intervention in functional and aesthetic facial surgery. Although rare and usually manageable, complications could lead to disfiguring consequences. There is no universal protocol for perioperative management in the literature. The aim of this article is to analyze the surgical complications in patients who underwent open rhinoseptoplasty and were treated in the perioperative period with the standardized protocol used in our department, in order to propose it as a standardized protocol for a more global application. METHODS: The patients included underwent rhinoplasty between 2017 and 2022 and were managed with the same treatment protocol. Perioperative and intraoperative data, as well as possible complications, were collected. RESULTS: A total of 129 patients were included, 73% of which reported either mild or no complications. Abnormal scar healing was the most frequent complaint (9%), followed by edema (6.2%), nasal dyspnea (3.9%), infection (2.3%), and bleeding (2.3%). No severe complications were reported. CONCLUSIONS: Our protocol appears to be effective in minimizing complications such as infection and bleeding, although it is very difficult to compare the results with the literature.

[The effect of increased secretory activity of the nasal mucosa on the duration of the recovery period after anterior tamponade with gauze tampons during surgery of the nasal septum]. / Vliyanie kombinirovannoi sekretoliticheskoi i protivovospalitel'noi terapii na techenie vosstanovitel'nogo perioda posle rinoseptoplastiki.

OBJECTIVE: To assess the effect on the duration and course of the nasal mucosa function recovery after anterior nasal packing during surgery involving the nasal septum and inferior nasal conchae combined with concomitant therapy with the herbal medicinal product Sinupret extract (Bionorica SE, Germany). MATERIAL AND METHODS: The study included 25 males aged 18-50 (the main group), permanent residents of the Novosibirsk region diagnosed with deviated nasal septum at least 2 years ago. All patients underwent rhinoseptoplasty with nasal packing with gauze tampons for 24 hours at the clinical base of the Otorhinolaryngology Department of the Novosibirsk State Medical University.Patients of the main group received Sinupret extract 1 tablet BID for 10 days before the planned rhinoseptoplasty and 7 days after the rhinoseptoplasty. Patients in control group 1 (n=16) received Sinupret 2 coated tablets TID for 10 days before the surgery and 7 days after the surgery. Patients in control group 2 (n=16) did not receive secretory therapy in the preoperative and postoperative periods of rhinoseptoplasty. RESULTS: The herbal medicinal product improved nasal breathing. All studied parameters demonstrated the benefit of the treatment including Sinupret extract (p<0.05). On day 5 in patients of the main study group, nasal breathing was normal, and nasal crusting was reduced due to activation of the mucous membrane secretory function. Nasal mucosa ciliary clearance was better in patients in the main group than in patients in the control groups at all stages of the study. Sinupret extract for 10 days before and 5 days after the surgery helps reduce nasal crusting and restore nasal breathing by day 2 and normalizes ciliary clearance by day 5 after nasal packing. CONCLUSION: Due to the wide use of nasal packing with gauze tampons, otorhinolaryngologists commonly administer herbal medicinal products as a means of drug protection of the nasal mucous membrane.

Nasal Packing in Septal Surgery: A Narrative Review.

Recently, alternatives to intranasal packing following septoplasty and rhinoseptoplasty have been widely used and promoted. Here, we aimed to systemically review and compare the different types of nasal packing used in these two surgeries. To assess patient comfort and surgical outcomes, we conducted a comprehensive search of multiple databases such as PubMed, MEDLINE, Web of Science, and Google Scholar to identify and evaluate relevant articles. A detailed and extensive search was performed with the help of the keywords "nasal packing," "septoplasty," "rhinoseptoplasty," "nasal splints," and "intranasal packing." Overall, our review findings indicate that alternative methods (e.g., trans-septal suturing and insertion of intranasal splints) are better options than intranasal packing.

Rinoplastia en nariz mestiza, un desafío quirúrgico / Rhinoplasty in mestizo nose, a surgical challenge

Las características anatómicas de pacientes con nariz mestiza, generalmente, incluyen una nariz aparentemente grande, un dorso convexo con radix bajo y una base nasal ancha. La longitud de la columela y punta nasal se ve disminuida debido a que los cartílagos alares son cortos, débiles y delgados, proporcionando un soporte estructural insuficiente, mala definición y proyección de la punta nasal. La principal dificultad al manejar este tipo de narices es un marco osteocartilaginoso mal estructurado y débil. En los últimos años se han desarrollado técnicas quirúrgicas para mejorar los resultados estéticos y funcionales de la rinoplastía en estos pacientes. Se realizó una revisión exhaustiva de la literatura describiendo las técnicas quirúrgicas utilizadas en este tipo de nariz.

The anatomical characteristics of patients with mestizo nose usually include an apparently large nose, a convex dorsum with a deep radix, and a wide nasal base. The length of the nasal columella and tip is decreased because the alar cartilages are short, weak and thin, providing insufficient structural support, poor definition and nasal tip projection. The main difficulty in managing this type of noses is a poorly structured and weak osteocartilaginous framework. In recent years, surgical techniques have been developed to improve the aesthetic and functional results of rhinoplasty in these patients. A comprehensive literature review was conducted describing the surgical techniques used in this type of nose.

Use of quantum molecular resonance energy for managing postrhinoseptoplasty perilesional edema and ecchymosis.

BACKGROUND: Quantum molecular resonance (QMR) technology employs nonionizing high-frequency waves ranging from 4 to 64 MHz to generate low-intensity quanta of energy that interacts with cellular components. AIMS: To evaluate the efficacy and safety of QMR treatment on postoperative perilesional edema and ecchymosis in patients with rhinoseptoplasty or revision rhinoseptoplasty. PATIENTS/METHODS: In total, 30 patients were treated with QMR stimulation therapy (QMR group) once daily for 5 days, while another 30 patients were treated with conventional icepack application (control group). The duration of perilesional edema and ecchymosis were comparatively evaluated according to anatomic regions. RESULTS: In both groups, the longest duration of postoperative edema and ecchymosis was found on the left anterior cheek, followed by the right anterior cheek, left lower eyelid, right lower eyelid, and right and left upper eyelids. The mean duration of overall postoperative perilesional edema was significantly shorter in the QMR group (2.0 ± 0.8 days) than the control group (4.6 ± 2.0 days); the mean duration of overall ecchymosis was also markedly shorter in the QMR group (2.9 ± 1.5 days) than control group (7.5 ± 2.9 days). Patient satisfaction after postoperative QMR treatment was rated as 2.2 ± 0.8, whereas patient satisfaction in control group was rated as 1.6 ± 0.9. CONCLUSION: Our clinical study demonstrated that postrhinoseptoplasty QMR treatment effectively reduces the duration of postoperative perilesional edema and ecchymosis without remarkable side effects. We suggest that QMR treatment can be considered as an alternative option for noninvasively managing postrhinoseptoplasty perilesional edema and ecchymosis.

Aplasia congénita unilateral del cartílago alar

Resumen El objetivo de este trabajo es discutir la presentación y el manejo de la aplasia congénita unilateral del cartílago alar. En este informe, presentamos el caso de un paciente sometido a rinoseptoplastia abierta primaria que presenta aplasia congénita del cartílago alar izquierdo que se repara con cartílago septal. Se discute el manejo de casos y se revisa la literatura. Las anomalías nasales congénitas son poco frecuentes. La ausencia aislada de cualquier estructura nasal específica es aún más rara. El diagnóstico preoperatorio en una nariz hispana es difícil, pero cuando se encuentra este defecto congénito, puede repararse con cartílago septal u otros tipos de cartílago, dependiendo de la disponibilidad del injerto, con buenos resultados. Se recomienda un enfoque abierto para este tipo de patología. La aplasia unilateral del cartílago alar podría reconstruirse con éxito utilizando el cartílago septal a través de un abordaje abierto.

Abstract The objective of this work is discussing the presentation and management of unilateral congenital aplasia of the alar cartilage. In this report, we present the case of a patient undergoing primary open rhinoseptoplasty presenting congenital aplasia of the left alar cartilage that is repaired with septal cartilage. Case management is discussed, and the literature is reviewed. Congenital nasal abnormalities are rare. The isolated absence of any specific nasal structure is even more rare. Preoperative diagnosis in a Hispanic nose is difficult, but when this deformed congenital is found, it can be repaired with septal cartilage or other types of cartilage, depending on the availability of the graft, with good results. An open approach is recommended for this type of pathology. Unilateral alar cartilage aplasia could be successfully reconstructed using septal cartilage through and open approach.

Extracorporeal Septoplasty-A Well Proven Technique for Treatment of Crooked Noses.

Crooked noses (noses with complex septal and pyramidal deviations) are an important challenge for both plastic surgeons and otolaryngologists. Extracorporeal septoplasty, described by Gubisch constitutes an effective solution to this problem. The article describes a series of 7 cases (5 males and 2 females) in which this method was used during open rhinoseptoplasty. The technique we used is described in detail. All the patients showed improvement of the nose appearance and good nasal air flow. Hypertrophy of the right inferior turbinate complicated one case, but was resolved with electro cauterization. Although the learning curve is slow and it claims the surgeon's imagination, the method is sometimes the only solution in complex cases of septal deviation. Our short series demonstrates that good indication and careful dissection are prerequisites for success in difficult cases.

Does pediatric septoplasty compromise midfacial growth? A systematic review.

OBJECTIVE: Septal deviation is an important cause of impaired nasal breathing among pediatric patients. A widespread solution to septal deviation is septoplasty. However, there are certain controversies surrounding the effect of this technique on pediatric patients and its influence on the growth centers of the nose. The objective of this review is to study if there is a strong and valid evidence in the literature that supports a detrimental effect of pediatric septo- and rhinoseptoplasty in facial growth DATA SOURCES: Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database. REVIEW METHODS: The outcome assessed was the midfacial growth after pediatric septoplasty. RESULTS: Eight publications met the inclusion criteria. None found major disturbances in facial growth. Only minor nasal anomalies were reported by 4 authors. CONCLUSION: Septoplasty in pediatric patients does not seem to affect midfacial growth according to available evidence. However, due to their design, the degree of recommendation of these studies was not superior to level C.

[Topic of the article: extracorporeal rhinoseptoplasty technique of the open approach]. / Ékstrakorporal'naia rinoseptoplastika iz otkrytogo rinoplasticheskogo dostupa.

In this article were represented a clinical examination and assessment of the effectiveness of the open extracorporeal rhinoseptoplasty technique perfomed in W. Gubisch modification. For the analysis of the results, patients were divided on the basis of the indications for extracorporeal rhinoseptoplasty in major groups. Performed clinical example of multiple fractures of cartilage department of the septum.

[Functional activity of neutrophils and local manifestations of oxidative stress in the mucous membrane of the nasal cavity in the early postoperative period]. / Funktsional'naia aktivnost' neitrofilov i lokal'nye proiavleniia okislitel'nogo stressa v slizistoi obolochke polosti nosa v rannem posleoperatsionnom periode.

The purpose of the study was to study the factors of antimicrobial, antioxidant defense, variability of nasal secretion lipid peroxidation in patients with curvature of the nasal septum in the early postoperative period. METHODS: microbiological, immunological (assessment of the activity and intensity of phagocytosis, nitrous tetrazolium reduction test) biochemical (study of content diene conjugates, ketodienes, conjugated trines and Schiff bases in the lipid extract of neutrophilic granulocytes), statistical. RESULTS: The dynamics of the content, functional and biochemical activity of neutrophilic granulocytes in nasal washings in individuals who underwent rhinosurgical intervention testifies to the presence of qualitative and quantitative changes in neutrophilic granulocytes of the nasal secretion, recorded in reactions of oxygen-dependent metabolism, free radical oxidation and antioxidant protection.

Cambio de imagen facial en base a rinoseptoplastía y cirugía ortognática: resultados preliminares / Facial makeover based in rhinoplasty and orthognathic surgery. preliminary results

RESUMEN Introducción: La cirugía ortognática y la rinoplastia son procedimientos consolidados con altas tasas de éxito. La sinergia entre ambos procedimientos ha sido presentada en diferentes investigaciones pero aún no es un procedimiento estándar para pacientes con deformidades faciales. Objetivo: Analizar una serie de casos tratados con cirugía ortognática y rinoplastia y discutir las opciones y fundamentos de la técnica combinada. Material y método: 14 pacientes operados de forma consecutiva fueron incluidos en el estudio. Se identificaron sujetos según el tipo de deformidad facial, el tipo de deformidad nasal y los tipos de cirugías realizadas. El seguimiento mínimo de cada sujeto fue de 12 meses. Resultados: El 50% de los sujetos presentaba deformidad facial de clase III, seguido de deformidades de clase II y I. Las deformidades nasales, de la punta y del puente nasal fueron más prevalentes, siendo el ancho nasal también una deformidad común. En la etapa intraoperatoria, después de realizar la cirugia ortognática, fue necesario realizar un análisis nuevo respecto de la morfologia nasal debido a los cambios que generaba el movimiento maxilar en la condición nasal. Conclusión: La cirugía combinada es sinérgica y viable de ser realizada con bajo número de complicaciones; protocolos y nuevos criterios de análisis son necesarios para obtener mayor predictibilidad en los resultados estéticos.

ABSTRACT Introduction: Orthognathic surgery and rhinoplasty are procedures with high success rate. The synergy between both surgeries has been showed in the past by researches but still they are not standardized procedures for the treatment of patients with facial deformities. Aim: To analyze a case series treated with orthognathic surgery and rinoplasty in the same surgical time, discussing surgical options and techniques in the combined procedure. Material and method: 14 patients were treated consecutively and were included in this research. Subjects were selected by facial deformity, nasal deformity and type of surgery. Minimal follow up was for 12 months to observe results. Results: 50% of subjects showed class III facial deformity, follow by class II and class I facial deformity. In nasal deformities, tip and nasal bridge were more prevalent, being the nasal width a common deformity; in the intraoperative time, after orthognathic surgery, it was necessary to make a new analysis and approach to nasal morphology because the new conditions related to movement of the maxilla. Conclusion: Orthognathic and nasal surgery are good complement and it is possible to do with few complications; surgical protocol and criteria for the analysis are necessaries to obtain more predictability in the esthetic results.

The Pillars of the Nose-Crura Shortening for Over Projected Nose.

BACKGROUND: The over projected nose, commonly referred to as the "Pinocchio" nose is a significant challenge to the rhinoplasty surgeon. Firstly, we speak about a very large nose, and secondly, we speak about the correction of nasal cartilages (alar and triangular). Surgical correction of the over projected nose is the most difficult and least predictable component of rhinoplasty surgery. AIM: By performing rhinoseptoplasty we aimed to achieve an ideal landmarks position according to concepts of nasal projection as well as by making preoperative analyses to determine the ideal position for the nasal tip after having understood and defined the ideal position for the nasion. METHODS: We performed a retrospective study of patients who were admitted to ENT University Clinic, University Campus "St. Mother Theresa" Skopje, the Republic of Macedonia in the period 2011-2019. A total of 70 patients were enrolled in the study; 46 women (33%) and 24 men (33%). Operative technique rhinoseptoplasty was realised in 70 patients. All of the 70 (100%) patients underwent preoperative and postoperative evaluation during this period regularly to record the effects of various approaches on nasal projection, rotation, need for revision, and patient satisfaction. RESULTS: All patients used one or more of the preferred methods to treat over projection. Patients who had undergone 2 previous rhino/septoplasty procedures were excluded from the study, and hence, a total of 70 patients were evaluated. Full-transfixion incisions were made in all patients. From 2011 to 2019, in 72 cases, 1 or more of the preferred methods were used to treat over projection. CONCLUSION: The crural anatomy of the nasal tip relates to the size and shape of the lower lateral cartilages (LLC) and their relationship with the caudal septum and upper lateral cartilages (ULC). Modification of nasal tip rotation and projection should attempt to preserve or reconstruct major tip mechanisms.

Revision rhinoplasty: physician-patient aesthetic and functional evaluation / Revision rhinoplasty: physician-patient aesthetic and functional evaluation

Abstract Introduction: Approximately 5-15% of patients submitted to rhinoplasty operations undergo revision surgery. Those patients have varied functional and aesthetic complaints that should receive a detailed assessment that includes all the expectations the patient had before the previous procedure. Objective: To draw the profile of the main aesthetic-functional complaints reported by patients to be submitted to revision rhinoplasty and to correlate them with the internal and external objective nasal evaluation performed by the surgeon. Methods: A prospective study was conducted with 43 patients to be submitted to revision rhinoplasty and their respective surgeons, by applying a questionnaire about the patients' epidemiological questions and subjective aesthetic-functional complaints as well as the respective functional deformities observed by the surgeons. Subsequently, these data were correlated with the purpose of observing the frequency of congruent reports between physicians and patients. Results: The presence of drooping tip and residual bridge hump were the patients' main complaints, confirmed by the surgeons. The correlation between subjective obstructive symptoms and the intranasal evaluation performed by surgeons was shown to be present in 87.5% of the cases. Among the patients with respiratory symptoms, the main deformity identified was residual septal deviation in 56.25% of the cases. Conclusion: The drooping tip followed by residual hump were the main complaints reported by the patients and confirmed by the objective examination by the physicians. The presence of nasal obstructive complaints in 37.2% of the patients shows that greater attention needs to be paid to functional deformities during the first surgical procedure. The differences observed between patients' complaints and surgeons' evaluations confirm the need for detailed assessment and clarification to the patients regarding their expectations and actual surgical possibilities.

Resumo: Introdução: As rinoplastias possuem índice de revisão em torno de 5% a 15% dos pacientes operados. Tais pacientes possuem queixas funcionais e estéticas variadas e a avaliação detalhada é de extrema importância, tendo em vista todas as expectativas em torno de um procedimento já anteriormente realizado. Objetivo: Traçar o perfil das principais queixas estético-funcionais referidas pelo paciente a ser submetido à rinoplastia revisional e correlacioná-las a avaliação nasal objetiva interna e externa realizada pelo cirurgião. Método: Foi realizado um estudo prospectivo com 43 pacientes a serem submetidos à rinoplastia revisional e com seus respectivos cirurgiões, através da aplicação de questionário acerca de questões epidemiológicas e queixas estético-funcionais subjetivas dos pacientes e as respectivas deformidades funcionais observadas pelos cirurgiões. Após, esses dados foram correlacionados com a finalidade de observar a frequência de relatos concomitantes entre os médicos e pacientes. Resultados: A presença de ponta caída e giba óssea residual foram as principais queixas dos pacientes confirmadas pelos cirurgiões. Já a correlação entre sintomas subjetivos obstrutivos e a avaliação intranasal realizada pelos cirurgiões demonstrou estar presente em 87,5% dos casos. Dentre os pacientes com sintomas respiratórios, a principal deformidade encontrada foi o desvio septal residual em 56,25% dos casos. Conclusão: A ponta caída seguida de giba óssea residual foram as principais queixas relatadas pelos pacientes e confirmadas ao exame objetivo pelos médicos. A presença de 37,2% dos pacientes com queixas obstrutivas nasais demonstra que maior atenção deve ser dada a deformidades funcionais já durante o primeiro procedimento cirúrgico. As diferenças observadas entre as queixas dos pacientes e avaliações dos cirurgiões comprovam a necessidade da avaliação pormenorizada e esclarecimento ao paciente com relação as suas expectativas e reais possibilidades cirúrgicas.

Rinoseptoplastía: experiencia de 3 años en la Pontificia Universidad Católica de Chile / Rhinoseptoplasty: three-year experience at the Pontificia Universidad Católica de Chile

RESUMEN Introducción: La rinoseptoplastía es una cirugía compleja y desafiante. Permite resolver problemas estéticos y funcionales de la nariz. Objetivo: Describir la experiencia en rinoseptoplastías realizadas en el Comité de Nariz en nuestro centro. Material y método: Estudio descriptivo de pacientes sometidos a rinoseptoplastía entre 2013 y 2015. Resultados: Se operaron 265 pacientes en 3 años, 164 (61,8%) fueron mujeres y la edad promedio fue de 29 años (rango 13-73). Las cirugías fueron principalmente primarias (secundarias: 2,6%). El abordaje más utilizado fue abierto (92,5%). Se realizó trabajo de punta nasal en 253 (95,5%) pacientes; resección del dorso osteocartilaginoso en 252 (95,1%), y aumento de éste en sólo 5 (1,9%). Las osteotomías fueron frecuentes: paramedianas en 229 (86,4%), percutánea lateral bilateral en 217 (81,9%) y percutánea lateral unilateral en 17 (6,4%). El vástago columelar fue el injerto de punta más frecuentemente utilizado, en 241 (90,9%) pacientes, seguido del escudo en 69 (26,0%). En el dorso, se utilizaron autoespaciadores en 124 (46,7%) pacientes, y espaciadores en 109 (41,1%). Conclusiones: El abordaje abierto fue el más frecuente, demostrando ser favorable en nuestro centro por la exposición y aprendizaje de nuestros residentes. Se constató 2,6% de cirugías secundarias. Se destaca el uso de vástago columelar para otorgar soporte a la punta nasal dada la alta prevalencia de nariz hispana en nuestro centro.

ABSTRACT Introduction: Rhinoseptoplasty is a complex and challenging surgery. It addresses nasal aesthetics and functionality. Aim: To describe the experience in rhinoseptoplasty performed by the Nose Committee at our medical center. Material and method: Descriptive study, of the all rhinoseptoplasties performed by the Nose Committee between 2013 and 2015. Results: 265 patients underwent surgery in the 3-year period; 164 (61.8%) were women and the mean age was 29 years (range 13-73). Most were primary surgeries (secondary: 2.6%). An external approach was most commonly used (92.5%). Nasal tip surgery was performed in 253 (95.5%) patients; osteocartilaginous dorsum reduction in 252 (95,1%), and augmentation in only 5 (1,9%). Osteotomies were frequent: paramedian in 229 (86.4%), bilateral percutaneous lateral osteotomies in 217 (81.9%) and unilateral percutaneous lateral in 17 (6.4%). Regarding nasal tip grafts, columellar strut was most often used, in 241 (90,9%) patients, followed by the shield graft in 69 (26,0%). For the dorsum, autospreaders were used in 124 (46.7%), and spreader grafts in 109 (41.1%). Conclusions: Open rhinoseptoplasty was the most commonly used approach. This has shown favorable for residents due to better exposition of nasal anatomy. Only 2.6% were secondary rhinoseptoplasties. We emphasize the use of the columellar strut for nasal tip support as we frequently encounter hispanic noses at our center.

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

OBJECTIVE: Evaluate the impact of endoscopic partial inferior turbinectomy (EPIT) associated with primary rhinoseptoplasty on quality-of-life outcomes (QOL), complications, and surgical duration. STUDY DESIGN: Randomized clinical trial. METHODS: Individuals with nasal obstruction aged ≥ 16 years who were candidates for functional and aesthetics primary rhinoseptoplasty were evaluated from March 2014 through May 2015. Eligible participants were randomly allocated to rhinoseptoplasty with or without EPIT (excision of one-third of the inferior turbinates). RESULTS: Fifty patients were studied. Most were Caucasian and had moderate/severe allergic rhinitis symptoms. Mean age was 36 ( ± 14.5) years. Rhinoseptoplasty was associated with improvement in all QOL scores irrespective of turbinate intervention (P < 0.001). Analysis of covariance was conducted to control for potential confounders. There was no difference between the groups in absolute score changes for Nasal Obstruction Symptom Evaluation-Portuguese (NOSE-p) (-50.5 vs. -47.6; P = 0.723), Rhinoplasty Outcome Evaluation (ROE) (47 vs. 44.8; P = 0.742), and all World Health Organization Quality of Life Scale-Abbreviated (WHOQOL-bref) score domains (P > 0.05). There were no differences between the groups regarding presence of the complications. Surgical duration was higher in the EPIT group (212 minutes ± 7.8 vs. 159.1 ± 5.6; P ? 0.001). CONCLUSIONS: Turbinate reduction through EPIT during primary rhinoseptoplasty did not improve short-term general and specific QOL outcomes. The use of EPIT increases surgical time considerably without improving QOL scores. There was no difference in postoperative incidence of complications, suggesting that EPIT is a safe technique. LEVEL OF EVIDENCE: 1b. Laryngoscope, 128:57-63, 2018.

Outcomes of septorhinoplasty: a new approach comparing functional and aesthetic results.

The aim of this study was to compare objective and subjective functional results of septorhinoplasty with subjective aesthetic results. A prospective study was performed including global and subgroup analyses (primary versus secondary septorhinoplasty). Three instruments were used to evaluate pre- and postoperative results: rhinomanometry for the objective functional analysis, the Nasal Symptom Obstruction Evaluation (NOSE) scale for the subjective functional analysis, and the Rhinoplasty Outcome Evaluation (ROE) scale for the subjective aesthetic analysis. A septorhinoplasty was performed in all cases. Thirty-five patients were included (22 female), of whom 74% underwent primary septorhinoplasty. The correlation between rhinomanometry, NOSE and ROE scores was analysed. Mean resistance of the two nasal cavities was 4.9 (standard deviation (SD) 8.35) sPa/ml before surgery and 0.8 (SD 0.7) sPa/ml after surgery. NOSE and ROE scores were, respectively, 72.5/100 (SD 21.7) and 7.5/24 (SD 11.3) before surgery and 22/100 (SD 20.6) and 18/24 (SD 17.3) after surgery. Patients complaining of postoperative nasal obstruction had a worse aesthetic evaluation. Correction of the functional disease appears to be as important as aesthetic correction. This study comparing functional and aesthetic results after septorhinoplasty could provide a basis for future studies.