Assessment of Different Middle Vault Reconstruction Techniques in Rhinoplasty from Multiple Patient-Reported Outcome Measures

Overview

The study compared four ways of handling the middle third of the nose using multiple patient reported questionnaires, covering both structural and dorsal preservation approaches. Outcomes were assessed before surgery and at 2 and 12 months afterward using the NOSE scale, the Rhinoplasty Outcomes Evaluation and the Standardized Cosmesis and Health Nasal Outcomes Survey.

Sections of note

• Comparative study of 129 patients across four techniques.
• The techniques were spreader graft, L-strut graft, dorsal preservation with a high strip, and dorsal preservation with a low strip.
• Assessments were at baseline, 2 months and 12 months.
• All techniques produced significant improvement on all questionnaires, P less than 0.001.
• The exception was dorsal preservation with a high strip, which did not improve NOSE scores.
• Between the short term and longer term assessments, no significant differences were seen in the dorsal preservation groups.
• The structural technique groups did show differences between those time points.
• The authors state they detected no difference in the improvement of patient reported outcomes for preservation techniques from 2 months to 1 year.

What it means for a patient

• Three of the four techniques improved both breathing and appearance scores; the high strip preservation technique did not improve breathing.
• Results after preservation techniques were stable from 2 months onward, while structural techniques continued to change.
• Group sizes for each technique are not stated, so the comparisons rest on unknown numbers.
• This is a comparative study without randomization, so technique choice reflected the individual nose.

Why this paper matters

The middle third is where hump removal risks narrowing the airway, and the choice of reconstruction method is claimed to matter for breathing. This study compares four options with three validated questionnaires out to a year. The one technique that failed to improve breathing scores is the finding needing further examination.

Terms

• Middle vault: the middle third of the nose between the bony bridge and the tip.
• Spreader graft: a cartilage strip beside the septum that widens the internal breathing valve.
• L-strut graft: an L-shaped cartilage support for the bridge and base of the nose.
• Dorsal preservation: lowering the natural bridge instead of cutting the hump off.
• High and low strip: where the strip of septum is removed to allow the bridge to settle.
• NOSE: the Nasal Obstruction Symptom Evaluation questionnaire.