Evaluating current functional airway surgery during rhinoplasty: a survey of the American Society of Plastic Surgeons

Overview

Rhinoplasty literature is dominated by shape and technique, with far less written about assessing and treating the nasal airway at the same operation. The authors surveyed the membership of the American Society of Plastic Surgeons to find out what surgeons actually do, and whether experience, case volume or training changed their answers.

Sections of note

• Web-based survey sent to all 4,383 listed members. 671 responded, a 21 percent response rate.
• Results were analysed against surgeon experience, annual rhinoplasty volume and postgraduate training.
• Surgeons who performed a preoperative internal nasal exam were more satisfied with their results (p = 0.016).
• The same group reported lower rates of nasal obstruction after surgery (p = 0.054), a difference that did not reach the usual threshold for significance.
• Performing inferior turbinate reduction correlated with satisfaction with the airway (p less than 0.001).
• 85 percent of respondents were satisfied with their airway management and 87 percent wanted more instructional courses. Level of evidence 5.

What it means for a patient

• Practice varies widely between surgeons in how the airway is assessed and treated during a nose job.
• An examination of the inside of the nose before surgery is a reasonable thing to expect at consultation.
• The findings describe surgeon opinion, not measured patient breathing, so they do not show which technique breathes best.
• Only one in five members replied, so the responses may over-represent surgeons already interested in the topic.

Why this paper matters

It documents a gap between the cosmetic and functional halves of rhinoplasty within one of the two specialties that perform it. Surgeons themselves reported wanting more training. What the survey cannot show is whether the practices linked to surgeon satisfaction actually produce better breathing for patients.

Terms

• Nasal airway: the passage air travels through inside the nose.
• Functional rhinoplasty: nasal surgery aimed at breathing rather than appearance.
• Inferior turbinate: the lowest of the ridged structures on the side wall inside the nose, which can swell and block airflow.
• Turbinate reduction: surgery to shrink that structure and widen the airway.
• Nasal obstruction: the sensation of a blocked or restricted nose.
• Level of evidence 5: the weakest tier, covering expert opinion and survey data.