Surgical Algorithms in Rhinoplasty: A Scoping Review of the Current Status

Overview

An algorithm defines a set sequence for approaching a problem. This scoping review set out to define the role of surgical algorithms in rhinoplasty. The authors searched PubMed and MEDLINE, Web of Science and Google Scholar, plus citation searching. Eligible studies were published in English, involved human subjects aged 15 or over, and presented algorithms for primary cosmetic rhinoplasty.

Sections of note

• Scoping review; the journal assigns level of evidence III.
• A total of 514 studies contained the key search terms and 39 were evaluated for data extraction.
• The majority of algorithms came from United States based publications, 22 of 39.
• Twenty three used a flow chart format and 15 were text based.
• Algorithms relating to tip shape or position were the most frequent, 19 of 39.
• Next most common were algorithms for the crooked nose and for dorsal height.
• Only 7 of the 39 described outcomes from using the algorithm.
• The authors conclude very few algorithms have been published and a minority report outcomes.

What it means for a patient

• Published decision frameworks for rhinoplasty exist but are few, and most have never been tested.
• The tip is the area most often addressed by such frameworks.
• A scoping review maps what has been published; it does not judge whether any algorithm works.
• Restricting inclusion to English language publications may have missed work published elsewhere.

Why this paper matters

Rhinoplasty decisions are largely made case by case on surgeon judgment, and algorithms are the attempt to make them systematic and teachable. This review documents how thin that literature is. Whether following an algorithm improves results is unanswered in nearly all of them.

Terms

• Surgical algorithm: a defined sequence of decisions guiding how to approach an operation.
• Scoping review: a structured survey mapping what literature exists on a topic.
• Primary cosmetic rhinoplasty: a first operation on a nose done for appearance.
• Dorsal height: the height of the nasal bridge.
• Data extraction: pulling defined information from each included study for analysis.