Functional and Aesthetic Outcomes of Let Down Dorsal Preservation Rhinoplasty

Overview

Preservation rhinoplasty is re-emerging but lacks outcome data. The study measured change in patient reported nasal appearance, breathing and sleep, and compared two ways of handling the septal cartilage within the let down technique: the modified subdorsal strip method and the subdorsal Z-flap. Four validated instruments were used before and after surgery.

Sections of note

• Study of 52 patients, 40 women and 12 men, aged 15 to 69.
• Assessment tools were the NOSE scale, the SNOT-22, the SCHNOS survey and the Epworth Sleepiness Scale.
• Patients were assessed at 1, 3, 6 and 12 months after surgery.
• The majority reported significant improvement on NOSE, SNOT-22, SCHNOS and Epworth scores by paired t-test.
• The exception was Epworth sleepiness scores at 6 and 12 months, which were not significantly improved.
• No significant difference was found between the modified subdorsal strip method and the Z-flap technique.
• The authors conclude both cartilage techniques achieve significant improvement in appearance, breathing and sleep.

What it means for a patient

• Both breathing and appearance scores improved and held through a year.
• Daytime sleepiness improved early but the improvement was not significant at 6 and 12 months.
• The two septal techniques performed equivalently, so the choice between them did not affect reported outcomes.
• Fifty two patients with no comparison against conventional hump removal limits what can be concluded about preservation itself.

Why this paper matters

Preservation rhinoplasty spread ahead of its outcome evidence, and this study supplies patient reported data out to a year across four instruments. It also compares two of the competing septal methods directly. Comparison against conventional hump reduction remains the missing piece.

Terms

• Let down technique: lowering the nasal framework after removing a wedge of bone at each side.
• Modified subdorsal strip method: removing a strip of septum just below the bridge so it can settle.
• Subdorsal Z-flap: a Z-shaped cut in the septum below the bridge, used to reposition it.
• NOSE scale: the Nasal Obstruction Symptom Evaluation questionnaire.
• SNOT-22: the Sino Nasal Outcome Test, a 22 item symptom questionnaire.
• Epworth Sleepiness Scale: a questionnaire measuring daytime sleepiness.