Does the Supine Position Affect the Nasal Profile in Rhinoplasty Patients? A Comparison of Nasal Anthropometric Measurements in Different Body Positions

Overview

Surgeons see the patient sitting up in clinic but operate with them lying flat, and the profile looks different in the two positions. It has not been clear whether that is an optical illusion or real movement of the skin and soft tissue. This retrospective study measured the nose in both positions using imaging.

Sections of note

• 103 patients undergoing primary rhinoplasty were enrolled.
• Each had lateral cephalography in the erect position and facial computed tomography in the supine position, both preoperatively.
• Four parameters were measured on each: the nasofrontal, nasolabial and nasomental angles, and Simon's ratio.
• The nasofrontal angle was greater on the supine CT than on the upright cephalogram, P below 0.01.
• That difference was not related to age, sex, or body mass index, P above 0.05 for each.
• No significant difference between positions in the nasolabial angle, nasomental angle, or Simon's ratio, P above 0.05.
• The authors conclude the supine position does affect the nasal profile, especially at the radix. Level of evidence 2.

What it means for a patient

• The area between the brow and the bridge looks different when you lie down, so a surgeon judging it during surgery is not seeing what you see in a mirror.
• The angle at the tip and the relationship to the chin did not change measurably.
• The effect was independent of age, sex and body weight.
• Limits: the two positions were captured with different imaging methods, cephalography versus CT, which is a source of measurement difference; and this is a single-center retrospective study.

Why this paper matters

Judgments made during surgery are made in a position the patient will never be seen in, and this identifies which measurement is affected. The radix is a common site of over or under correction. Using two different imaging modalities means the size of the true positional effect remains uncertain.

Terms

• Supine: Lying flat on the back.
• Nasofrontal angle: The angle between the forehead and the bridge of the nose.
• Radix: The root of the nose, the deepest point between the eyes.
• Cephalography: A standardized side X-ray of the head.
• Simon's ratio: A profile ratio comparing nasal and lip dimensions.