A Staging System for Revision Rhinoplasty: A Review

Overview

Rhinoplasty has a revision rate of 5 to 15 percent, and cases range from minor corrections done in the office to major reconstructions needing several operations. No uniform scale existed for describing them. The authors borrow the structure of the TNM cancer staging system, which was built to aid planning, indicate prognosis, evaluate results and let clinicians exchange information.

Sections of note

• The article is a proposal and review, not a study of patients.
• Stated revision rate for rhinoplasty is 5 to 15 percent.
• The proposed system is called PGS, with three components.
• P stands for problem, the specific anatomic anomaly the patient presents with.
• G stands for graft, based on the number of grafts required. S stands for the number of previous surgical procedures.
• A fourth category, E for patient expectations, is added after the PGS stage has been determined. Prognosis is framed as what surgery can and cannot achieve, rather than survival.

What it means for a patient

• The system is intended to make plain, before surgery, how complex a revision will be and therefore what is realistically achievable.
• Number of previous operations is treated as a factor in its own right, because each one removes tissue and adds scar.
• Expectations are staged separately from the anatomy, acknowledging that they affect the outcome independently.
• This is a proposal. No patients were staged, no outcomes were measured, and whether the system predicts results is untested.

Why this paper matters

Revision rhinoplasty results cannot be compared between surgeons without a shared way to describe how difficult each case was, which is why published series are hard to interpret. A standardised staging system addresses that. Whether the PGS grade actually tracks outcome, and whether surgeons apply it consistently, remains to be shown.

Terms

• Revision rhinoplasty: an operation to correct the result of previous nasal surgery.
• Staging system: a standard way of classifying how severe or complex a case is.
• TNM system: the standard cancer staging system, based on tumour, nodes and metastasis.
• Prognosis: the expected outcome of a condition or treatment.
• Anatomic anomaly: a structural abnormality in the nose.
• Graft: a piece of tissue, usually cartilage, added to support or reshape an area.