Spreader Graft Versus Spreader Flap in Rhinoplasty: A Systematic Review and Meta-Analysis of Aesthetic and Functional Outcomes

Background Insufficient support of the nasal mid-vault during rhinoplasty can cause significant complications. Accordingly, surgeons recently pay much more attention to the preservation of nasal patency. The spreader graft is the gold standard technique for the reconstruction of nasal mid-vault. Objectives The objective of this study was to compare the spreader graft and spreader flap in terms of aesthetic and functional outcomes. Methods An inclusive search was performed using PubMed/Medline, Google Scholar, Cochrane Library databases up to April 2021. Multiple aesthetic and functional factors including dorsal aesthetic lines restoration, satisfaction rate, internal nasal valve angle improvement, nasal obstruction symptom evaluation (NOSE) scale, and active anterior rhinomanometry (AAR) were evaluated. Also, a meta-analysis was performed on included articles that provided adequate data for mentioned factors. Results After excluding papers that did not conform with the selection criteria, 10 articles with a total sample size of 567 cases with a mean age of 27.7 (range: 18- 65) were finally included. Analysis of the data revealed no statistically significant difference between the spreader graft and spreader flap techniques in terms of dorsal aesthetic lines restoration, internal nasal valve angle improvement, NOSE scale, and AAR. Conclusions However, in terms of satisfaction rate, the analyzes indicated that spreader graft has significantly superior aesthetic outcomes. Generally, in case of appropriately selected patients, there is no statistically significant difference between spreader graft and spreader flap techniques in terms of aesthetic and functional outcomes.

Arabic translation and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale

Background The Nasal Obstruction Symptom Evaluation (NOSE) scale has been developed and validated in English to overcome the controversies concerning other methods of evaluation of nasal obstruction. The scale is currently used worldwide and has been translated into several languages. The purpose of the present work was to translate the English (NOSE) scale into Arabic (A-NOSE) and to assess its validity and reliability in Arabic-speaking patients. Results The internal consistency and test-to-test reliability of the Arabic scale were statistically good. The differences between the scores of the patients and control subjects were statistically significant. Postoperative scores of the patients were significantly higher than preoperative scores. All participants completed the Arabic questionnaire easily and few of them required slight assistance. Conclusions The translated NOSE scale is easy to administer and can be a robust and usable outcome measure for patients with nasal obstruction. The translated scale is sensitive to changes in nasal airway patency and can be used in clinical practice and outcome research.

Assessing Patient Symptoms Due to Nasal Septal Perforation: Development and Validation of the NOSE-Perf Scale

Objective Reporting patient symptoms due to nasal septal perforation (NSP) has been hindered by the lack of a validated disease-specific symptom score. The purpose of this study was to develop and validate an instrument for assessing patient-reported symptoms related to NSP. Study Design Validation study. Setting A tertiary care center. Methods The Nasal Obstruction Symptom Evaluation (NOSE) scale was used as an initial construct to which 7 nonobstruction questions were added to measure septal perforation symptoms. The proposed NOSE-Perf instrument was distributed to consecutive patients evaluated for NSP, those with nasal obstruction without NSP, and a control group without rhinologic complaints. Questionnaires were redistributed to the subgroup with NSP prior to treatment of the perforation. Results The study instrument was completed by 31 patients with NSP, 17 with only nasal obstruction, and 22 without rhinologic complaint. Internal consistency was high throughout the entire instrument (Cronbach α = 0.935; 95% CI, 0.905-0.954). Test-retest reliability was demonstrated by very strong correlation between questionnaires completed by the same patient at least 1 week apart ( r = 0.898, P < .001). Discriminant validity was confirmed via a receiver operating characteristic ( P < .001, area under the curve = 0.700). The NOSE-Perf scale was able to distinguish among all 3 study groups ( P < .001) and between NSP and nasal obstruction ( P = .024). When used alone, the NOSE scale could not discriminate between NSP and nasal obstruction ( P = .545). Conclusions The NOSE-Perf scale is a validated and reliable clinical assessment tool that can be applied to adult patients with NSP.

Efficiency of modified Goldman’s technique in open pediatric septoplasty

Background Performing nasal surgery on children has been the subject of controversy among surgeons. Specifically, the indications for and timing of septoplasty in children have been debated for the last several decades. In this study, we access the efficacy of the modified Goldman’s technique in dealing with caudal septal deviation in pediatric population suffering from severe nasal obstruction and its effect on nasal functions postoperatively. In this study, 30 pediatric patients suffering from deviated nasal septum who are candidate for septoplasty were included and underwent open septoplasty using modified Goldman’s technique. They were subjected to detailed assessment protocol preoperatively including NOSE scale, anterior rhinomanometry, and CT scans. Follow-up assessment was done at second week postoperative including anterior rhinoscopy and nasal endoscopy and 3 months postoperative including NOSE scale and anterior rhinomanometry. Results There was a statistically significant decrease of the NOSE scale severity to none in 90% of cases. Three months postoperative, all of the patients performed postoperative anterior active rhinomanometry with statistically significant decrease in the postoperative total nasal resistance values with inspiratory values ranging from 0.1 to 0.5 Pa/cm3/s with mean of 0.26 Pa/cm3/s and expiratory nasal resistance values ranging from 0.1 to 0.6 Pa/cm3/s with mean of 0.31 Pa/cm3/s. Conclusions Open septoplasty in children using the modified Goldman’s technique has enabled accurate and conservative approach for correction of nasal septal deviation especially those located in the caudal septal region. The technique also offers a significant reduction of the nasal symptoms postoperatively with marked improvement of the nasal resistance and quality of life in severe cases of deviated nasal septum.

Nasal airway function after Le Fort I osteotomy with maxillary impaction: A prospective study using the Nasal Obstruction Symptom Evaluation scale

Background This study evaluated changes in nasal airway function following Le Fort I osteotomy with maxillary impaction according to the Nasal Obstruction Symptom Evaluation (NOSE) scale.Methods This cohort study included 13 patients who underwent Le Fort I osteotomy with maxillary impaction. Nasal airway function was evaluated based on the NOSE scale preoperatively and at 3 months postoperatively. The change in the NOSE score was calculated as the preoperative score minus the postoperative score. If the normality assumptions for changes in the NOSE score were not met, a nonparametric test (the Wilcoxon signed-rank test) was used. Differences in NOSE score changes according to patient characteristics and surgical factors were evaluated using the Kruskal-Wallis test and the Mann-Whitney test.Results Patients ranged in age from 18 to 29 years (mean±standard deviation [SD], 23.00±3.87 years). Three were men and 10 were women. Eleven patients (84%) had an acquired dentofacial deformity with skeletal class III malocclusion. The preoperative NOSE scores ranged from 40 to 90 (mean±SD, 68.92±16.68), and the postoperative NOSE scores ranged from 25 to 80 (53.84±18.83). The cohort as a whole showed significant improvement in nasal airway function following maxillary impaction (P=0.028). Eleven patients (84%) had either improved (n=8) or unchanged (n=3) postoperative NOSE scores. However, nasal airway function deteriorated in two patients. Patient characteristics and surgical factors were not correlated with preoperative or postoperative NOSE scores.Conclusions Nasal airway function as evaluated using the NOSE scale improved after maxillary impaction.

COMPARATIVE STUDY ON IMPROVEMENT OF NASAL SYMPTOMS FOLLOWING SEPTOPLASTY WITH PARTIAL INFERIOR TURBINECTOMY VS SEPTOPLASTY ALONE IN ADULTS WITH DEVIATED NASAL SEPTUM

BACKGROUND: Nasal obstruction is a common presenting symptom which otolaryngologists encounter in daily clinical practice. One of the most common cause of nasal obstruction is deviated nasal septum(DNS). DNS to one side is associated with overgrowth of inferior turbinate on the contralateral side. Septoplasty alone or septoplasty with inferior turbinate reduction is the mode of treatment but that depends upon the decision of the operative surgeon. In this study we aim to collect data and come to a conclusion as to which surgery is benecial for the patients. AIMS AND OBJECTIVES: (1) To compare the symptomatic improvement of nasal symptoms following septoplasty with partial inferior turbinectomy versus septoplasty alone by NOSE Scale. (2) To corroborate the subjective ndings of NOSE Scale by rhinomanometry and nasal endoscopy. METHODOLOGY: A prospective and comparative study was done on 60 patients over a period of 1 year in a tertiary care centre. Patients were alternatively divided into two surgical groups Group A- septoplasty with partial inferior turbinectomy and Group B- septoplasty alone. Nasal Obstruction Symptom Evaluation(NOSE) was used for subjective evaluation of nasal symptoms. Rhinomanometry was used as a tool for objective evaluation of symptoms. Data was analysed using tables, graph and percentage and test of signicance. Post operative improvement RESULTS: following both group A septoplasty with partial inferior turbinectomy and group B Septoplasty alone was signicant at post op 1,3 and 6 months respectively. When both groups were compared those undergoing partial inferior turbinectomy with septoplasty had highly signicant results by NOSE scale as well as rhinomanometry and endoscopy. This study showed tha CONCLUSION: t hypertrophied turbinate need to be addressed in chronic cases of nasal obstruction with deviated nasal symptom with contralateral turbinate hypertrophy. Thus we can conclude that partial inferior turbinectomy should be done in addition to septoplasty as it is a highly effective modality for treatment of nasal obstruction in patients of nasal obstruction in patients with deviated nasal septum.

Preliminary Three-Dimensional Volumetric Analysis of New Technique of Open Septal Reduction using Polydioxanone Plates for Nasoseptal Fracture

Objectives: In this study, we designed a new technique for open septal reduction using a polydioxanone (PDS) plate and compared it with closed reduction. Design, Setting, Participants: This study included nineteen consecutive patients with nasoseptal fracture: ten receiving open reduction with a PDS plate (PDS group) and nine undergoing closed reduction (CR group). Open septal reduction was performed after closed reduction for nasal bone fracture. A mucoperichondrial flap was unilaterally elevated, and the deviated septal cartilage was reduced. The PDS plate was inserted horizontally above the vomerine suture. Surgical outcome was analyzed with three-dimensional volumetry and with a quality-of-life scale for nasal obstruction (NOSE scale). Results: Complications included one case of septal perforation in the CR group and one case of PDS exposure and septal hematoma in the PDS group. In the 3D volumetric analysis of the PDS group, the median value of the nasal cavity change significantly differed between 1.14 mL (interquartile range; 0.46 to 2.4) at the preoperative CT scan and 0.33 mL (interquartile range; -0.22 to 1.29) at the postoperative CT scan (**p = 0.0039). The NOSE scale revealed significant improvement in nasal obstruction postsurgically (median value, 42.5 to 7.5; *p = 0.0139) in the PDS group. Conclusion: PDS plates potentially present a new concept of open septal reduction in terms of septal reinforcement compared with the subtractive approach of open septal reduction.

Assessment of Screening for Nasal Obstruction among Sleep Dentistry Outpatients with Obstructive Sleep Apnea

Oral appliances (OA), a common treatment modality for obstructive sleep apnea (OSA), are not suitable for patients with nasal obstruction. Rhinomanometry, the gold standard technique to assess nasal airway resistance, is not readily available in sleep dentistry clinics. We demonstrate the use of a portable lightweight peak nasal inspiratory flow (PNIF) rate meter to objectively assess nasal airflow and utilized the Nasal Obstruction Symptom Evaluation (NOSE) scale to subjectively assess nasal obstruction in 97 patients with OSA and 105 healthy controls. We examined the correlations between the following variables between the groups: demographics, body mass index, PNIF, NOSE scale scores, apnea–hypopnea index (AHI), minimum SpO2 (SpO2min), Mallampati classification, and Epworth Sleepiness Scale (ESS) scores. Patients with OSA had significantly lower PNIF values and higher NOSE scores than controls. In the patient group, PNIF was not significantly correlated with AHI, SpO2min, Mallampati classification, or NOSE or ESS scores. Lower PNIF values and higher NOSE scores suggested impaired nasal airflow in the OSA group. As daytime PNIF measurement bears no relationship to AHI, this cannot be used alone in predicting the suitability of treatment for OSA with OA but can be used as an adjunct for making clinical decisions.