Comparison of Dorsal Preservation and Dorsal Reduction Rhinoplasty: Analysis of Nasal Patency and Aesthetic Outcomes by Rhinomanometry, NOSE and SCHNOS Scales

Alan MA, Kahraman ME, Yüksel F, Yücel A.

PubMed 36302983 Publisher (DOI)Free full text (PMC)

What this paper says

Comparing 15 preservation against 19 structural rhinoplasty patients over 12 months, questionnaire scores improved equally in both groups, with only the preservation group showing a significant rise in measured nasal volume.

Overview

Dorsal preservation techniques have gained popularity in recent years. This prospective study compared preservation against conventional hump reduction on nasal airflow and appearance, using patient questionnaires alongside rhinomanometry. The authors state it is the first study comparing the two techniques with rhinomanometry. Thirty four patients operated on between January 2021 and June 2022 were randomly assigned before surgery.

Sections of note

Prospective study of 34 patients; level of evidence III, described as a well designed prospective clinical trial.
Nineteen patients, 10 female and 9 male, were in the structural rhinoplasty group; 15, 7 female and 8 male, in the preservation group.
There was no significant difference in age or gender between the groups.
Assessments were the NOSE scale, the SCHNOS survey and rhinomanometry, taken before surgery and at 3 and 12 months.
NOSE, SCHNOS breathing and SCHNOS appearance scores all fell significantly in both groups at 3 and 12 months.
There was no significant difference between the groups on any questionnaire.
Mean total nasal volume at 12 months was significantly higher than before surgery in the preservation group, P equals 0.031.
No significant change was seen in the structural group and no difference between groups on rhinomanometry.

What it means for a patient

Both techniques improved breathing and appearance as reported by patients, with no measurable advantage either way.
Only the preservation group showed an increase in measured internal nasal volume, though the between group comparison found no difference.
Fifteen against 19 patients is small, so a real moderate difference could be missed.
Follow up was 12 months, which does not capture later hump recurrence.

Why this paper matters

Preservation rhinoplasty is promoted on claimed breathing advantages, and this is one of the few studies applying objective airflow measurement to that claim. It finds the two techniques equivalent on patient reported outcomes. The isolated volume finding needs larger numbers to interpret.

Terms

Dorsal preservation: lowering the natural nasal bridge instead of cutting the hump off.
Structural rhinoplasty: removing the hump and rebuilding the framework with grafts.
Rhinomanometry: a test measuring pressure and airflow through the nose.
Total nasal volume: the measured internal space of the nasal airway.
NOSE scale: the Nasal Obstruction Symptom Evaluation questionnaire.
SCHNOS: the Standardized Cosmesis and Health Nasal Outcomes Survey.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Background: Dorsal preservation techniques have been preferred and gained popularity in recent years. The current study compares the effects of dorsal preservation and dorsal reduction rhinoplasty on nasal patency and aesthetic outcomes by using Patient-Reported Outcome Measures (PROMs) and rhinomanometry. To our knowledge, this is the first study to compare dorsal preservation and dorsal reduction techniques with rhinomanometry.

Methods: This is a prospective study of 34 patients who underwent rhinoplasty between January 2021-June 2022. The patients were randomly selected preoperatively and divided into two groups as structural rhinoplasty (SR) and preservation rhinoplasty (PR). Nasal Obstruction and Symptom Evaluation (NOSE), Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) scales and rhinomanometric evaluation were performed preoperatively, at 3rd month and 12th month postoperatively.

Results: Nineteen patients (10 female, 9 male) were in SR group, 15 patients (7 female, 8 male) were in PR group. There was not significant difference in terms of age and gender between groups. In both groups, NOSE, SCHNOS-O and SCHNOS-C results were found to be significantly lower at postoperative 3rd and 12th month compared to preoperatively (p < 0.001 for the entire SR group, p = 0.001 for the entire PR group). There was no significant difference between groups in terms of PROMs. Mean total nasal volume (TNV) at 12th month were statistically higher than preoperative value in PR group (p = 0.031). Also there was no significant difference in SR group and between groups in terms of rhinomanometry results.

Conclusion: Dorsal preservation with pushdown technique provides good functional and aesthetic results comparable with structural rhinoplasty.

Level Of Evidence Iii: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . A well-designed prospective clinical trial.

Abstract as indexed by PubMed; the article is open access (PubMed Central).