Guidelines for Dorsum Preservation in Primary Rhinoplasty

Overview

The authors state the rapid growth of preservation rhinoplasty publications has made decision making confusing and that guidelines are needed based on benefit versus risk and on revision rates. The study analyses 352 consecutive primary rhinoplasties performed over three years from 2016 to 2019, correlating nasal profile type, technique used, whether a septoplasty was done, and the revisions that followed.

Sections of note

• 352 consecutive primary rhinoplasties, 2016 to 2019, 1 year follow up; 35 revisions, 9.94 percent.
• Techniques: full dorsum preservation, preservation plus resurfacing, bony cartilaginous disarticulation, traditional rhinoplasty.
• Of 129 straight noses, 88 had full preservation with 5.68 percent revisions; 32 had hump resurfacing with none.
• Of 71 tension noses, 33 had full preservation with 6 revisions, 18.18 percent; 32 had bony cap resurfacing with 1, 3.13 percent.
• Of 109 kyphotic noses, 64 had preservation plus resurfacing with 10 revisions, 15.63 percent; 27 had cartilage only preservation with 2, 7.41 percent.
• In the 43 difficult noses, revisions were equal between the resurfacing and cartilage only subgroups.
• The revision rate rose by a factor stated as 2.50 when a septoplasty was added.
• Recommended guidelines: full preservation for straight noses, resurfacing or Cottle variations for tension noses, cartilage only preservation for kyphotic noses, traditional rhinoplasty for difficult noses.

What it means for a patient

• Roughly one in ten patients needed a second operation within the year covered.
• The best technique differed by nose shape, with revision rates varying more than threefold for the same shape.
• Adding septum surgery was associated with a higher revision rate.
• This is one consecutive series with one year follow up and no randomization.

Why this paper matters

Patient selection is the central unresolved problem in dorsal preservation, and this series ties technique choice to nose shape using revision rate as the outcome. Whether the recommended matching holds in other hands is untested.

Terms

• Dorsum preservation: lowering the natural nasal bridge instead of cutting the hump off.
• Tension nose: a narrow, overprojected nose with a tall septum.
• Kyphotic nose: a nose with a pronounced angled hump on the bridge.
• Resurfacing: shaving down the bony cap of the hump rather than removing the whole bridge.
• Septoplasty: surgery to straighten the central partition of the nose.
• Revision rate: the proportion of patients needing a further operation.