Matched Cohort Comparison of Dorsal Preservation and Conventional Hump Resection Rhinoplasty

Patel PN, Kandathil CK, Abdelhamid AS, Buba CM, Most SP.

PubMed 36316459 Publisher (DOI)Free full text (PMC)

What this paper says

Comparing matched groups of preservation and conventional hump removal patients, breathing and appearance scores were equivalent except for a small short term appearance advantage to preservation that disappeared by long term follow up.

Overview

Structural preservation techniques minimize disruption of the bridge lines and are claimed to offer appearance and breathing advantages over conventional hump resection. This retrospective matched cohort study compared patient reported outcomes between the two. Patients having preservation surgery were matched to patients having conventional resection on age, gender and preoperative questionnaire scores.

Sections of note

Retrospective matched cohort analysis; level of evidence III.
Outcomes were the SCHNOS breathing and appearance scores and functional and cosmetic visual analog scales.
There were no significant differences in bridge height between groups.
Radix grafting was more common in the preservation group.
Bridge onlay grafting and middle vault reconstruction such as autospreader flaps were more common in the conventional group.
Within both groups, scores improved significantly at both short and long term follow up.
Postoperative breathing and appearance survey scores were similar between groups at both time points.
Cosmetic visual analog scores at short term follow up were higher in the preservation group, 8.92 against 8.20, P equals 0.03, but the difference was not significant at long term follow up.

What it means for a patient

Both approaches improved breathing and appearance by similar amounts.
The one advantage found for preservation was on a single appearance scale early on, and it did not last.
The conventional group needed more grafting to rebuild the middle of the nose, which preservation avoids.
The authors conclude the patient reported benefit of preservation may be minimal when conventional surgery includes proper middle vault reconstruction.

Why this paper matters

Preservation rhinoplasty is promoted on advantages over conventional hump removal, and this is a direct matched comparison of patient reported outcomes. It finds those advantages largely absent. Whether preservation offers benefits the questionnaires do not capture is unresolved.

Terms

Structural preservation rhinoplasty: keeping the natural bridge lines while structuring the rest of the nose.
Conventional hump resection: cutting the hump away and rebuilding the roof of the nose.
Matched cohort: comparison groups deliberately matched on key characteristics.
SCHNOS: the Standardized Cosmesis and Health Nasal Outcomes Survey.
Autospreader flap: the patient's own upper cartilages folded inward to keep the airway open.
Radix grafting: adding material at the root of the nose between the eyes.

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

Abstract

Background: Structural preservation techniques (SPR) minimize disruption of the dorsal aesthetic lines, with potential aesthetic and functional benefits over conventional hump resection techniques (CHR). The goal of this study is to compare patient reported outcomes between these techniques.

Methods: This study was a retrospective matched cohort analysis of patients undergoing rhinoplasty with dorsal hump reduction using patient-reported outcomes measures: Standardized Cosmesis and Health Nasal Outcomes Survey (obstructive: SCHNOS-O, cosmetic: SCHNOS-C) and visual analog scale (functional: VAS-F, cosmetic: VAS-C). A cohort of patients undergoing SPR were matched to a cohort undergoing CHR based on age, gender, and preoperative SCHNOS scores. Intraoperative techniques and patient-reported outcomes were compared between groups.

Results: There were no significant differences in the dorsal height between groups. While radix grafting was more common in SPR, dorsal onlay grafting and midvault reconstructive techniques (e.g. autospreader flaps) were more common in CHR. Within both groups, post-operative SCHNOS and VAS improved significantly at short- and long-term follow-up. There were no differences between SCHNOS or VAS scores preoperatively. Post-operative SCHNOS-O and SCHNOS-C scores were similar between groups at both short-term and long-term follow-up. Post-operative VAS-F scores were not different; however, VAS-C scores at short-term follow-up were statistically greater in the SPR group compared to the CHR group (8.92 vs 8.20, p = 0.03). At long-term follow-up, the difference was not significant.

Conclusion: While there are theoretical functional and aesthetic benefits of SPR techniques, the patient reported benefits may be minimal when compared to CHR techniques with appropriate midvault reconstruction.

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 .

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