Clinical Outcomes in Dorsal Preservation Rhinoplasty: A Meta-Analysis

Overview

Dorsal preservation rhinoplasty tries to keep as much of the natural nasal anatomy as possible when reducing a hump, but its clinical outcomes were unclear. This meta analysis, registered in advance on the PROSPERO database, investigated rates of complications and revisions. PubMed, Embase and Scopus were searched, and pooled incidence was calculated using a random effects model.

Sections of note

• Meta analysis of 22 studies covering 5,660 patients.
• Postoperative hump recurrence occurred in 4.18 percent, 95 percent confidence interval 2.41 to 6.40 percent.
• Revision rhinoplasty was needed in 3.48 percent, 95 percent confidence interval 1.77 to 5.74 percent.
• Postoperative nasal deviation occurred in 1.13 percent, 95 percent confidence interval 0.37 to 2.28 percent.
• Infection occurred in 1.89 percent, 95 percent confidence interval 0.35 to 4.62 percent.
• The authors describe all four rates as low.
• The review was prospectively registered, which reduces the risk of selective reporting.

What it means for a patient

• About one patient in 24 had the hump return, and about one in 29 needed further surgery.
• The nose becoming crooked after surgery, a specific concern with this technique, occurred in about one patient in 89.
• The included studies were largely single surgeon series rather than randomized trials.
• No comparison against conventional hump removal is provided, so these rates stand alone.

Why this paper matters

Hump recurrence is the most cited reason surgeons abandon dorsal preservation, and until this review the rate rested on individual series. Pooling 5,660 patients puts a figure on it. Whether that rate compares favourably with conventional hump reduction is not established here.

Terms

• Dorsal preservation rhinoplasty: lowering the natural nasal bridge instead of cutting the hump off.
• Hump recurrence: the bump on the bridge becoming visible again after surgery.
• Revision rhinoplasty: a further operation to correct the result of previous surgery.
• Random effects model: a statistical method that allows for real differences between studies.
• PROSPERO: a public register where systematic reviews are recorded before they begin.