Functional Outcomes of Septal Extension Grafting in Aesthetic Rhinoplasty: A Cohort Analysis

Overview

Septal extension grafts are widely used to control the position of the nasal tip, and a concern is that a graft placed alongside the septum narrows the airway and blocks breathing. This retrospective cohort study compared breathing outcomes in cosmetic rhinoplasty patients with and without such a graft. Patients were grouped by which questionnaire they had completed and then matched to patients without a graft on preoperative score, age and gender.

Sections of note

• Retrospective cohort analysis with matched controls.
• Grafts were placed in 79 patients; 77 completed the NOSE survey and 37 the SCHNOS functional domain, before and after surgery.
• Matching criteria were preoperative NOSE or SCHNOS functional score, age and gender.
• NOSE, SCHNOS functional and functional visual analog scores did not differ significantly between graft and no graft groups.
• The same held when patients were split into cosmetic surgery alone versus combined functional and cosmetic surgery.
• On multivariate regression accounting for surgical techniques, there was still no difference in those scores.
• The side of postoperative nasal obstruction did not correlate with the side the graft was placed on.

What it means for a patient

• A graft used to set tip position did not, in this series, come at the cost of breathing.
• Patients who complained of a blocked side were not more likely to be blocked on the graft side.
• The study is retrospective from one centre, so surgeon technique and patient selection are not controlled.
• The abstract does not state the follow up interval at which the postoperative surveys were completed.

Why this paper matters

Septal extension grafts have become a default way to hold the nasal tip in position, and the trade off against airflow has been argued rather than measured. This cohort applies validated questionnaires to that question. Whether other graft configurations carry the same result is not addressed.

Terms

• Septal extension graft: cartilage attached to the septum to set the position and projection of the nasal tip.
• NOSE: the Nasal Obstruction Symptom Evaluation, a validated questionnaire on blocked breathing.
• SCHNOS: the Standardized Cosmesis and Health Nasal Outcomes Survey, with separate appearance and breathing sections.
• Side to side configuration: a graft laid against one flat face of the septum rather than sandwiching it.
• Multivariate regression: a statistical method that adjusts for several factors at once.