Comparative Effectiveness of Cartilage Grafts in Functional Rhinoplasty for Nasal Sidewall Collapse

Overview

The study compared patient reported outcomes across two additional grafting techniques against a control receiving spreader grafts alone. It was a prospective longitudinal study at a university tertiary care centre including all patients having functional septorhinoplasty for lateral wall insufficiency between October 2015 and March 2019. Patients completed the NOSE questionnaire and FACE-Q subscales before and after surgery.

Sections of note

• Prospective longitudinal study; 704 patients, mean age 39.0 years with standard deviation 15.4, 52.7 percent female.
• Three cohorts: spreader plus lateral crural strut grafts, 141 patients; spreader plus alar rim grafts, 104; and spreader grafts alone as control, 218.
• Median NOSE scores at the last postoperative visit improved from baseline in all cohorts, P less than 0.001.
• FACE-Q nasal satisfaction median scores also improved in all cohorts, with P values of 0.001 for alar rim, less than 0.001 for lateral crural strut and less than 0.0001 for spreader.
• No detectable difference was found in improved nasal function between the cohorts.
• No adverse aesthetic outcomes were detected in any cohort.

What it means for a patient

• All three approaches improved both breathing and appearance scores.
• Adding a second graft to spreader grafts produced no measurable extra benefit in this study.
• Adding those grafts also did not worsen appearance, which is a stated concern with rim grafts.
• Cohorts were not randomized, so graft choice reflected surgeon judgment about each nose rather than chance.

Why this paper matters

Sidewall collapse is a common cause of nasal blockage and surgeons routinely add grafts beyond spreaders to treat it. This large prospective study finds no measurable gain from doing so. Whether the added grafts help specific subgroups was not examined.

Terms

• Nasal sidewall collapse: the side of the nose falling inward on breathing in, blocking airflow.
• Spreader graft: a cartilage strip beside the septum that widens the internal breathing valve.
• Lateral crural strut graft: cartilage placed under the outer tip cartilage to stiffen the sidewall.
• Alar rim graft: a strip of cartilage supporting the nostril edge.
• NOSE: the Nasal Obstruction Symptom Evaluation questionnaire.
• FACE-Q: a validated questionnaire measuring satisfaction with facial appearance.