Outcome Evaluation of Using Bone-Cartilaginous Units to Correct Deviated Noses in Rhinoplasty

Overview

A deviated nose creates both appearance and breathing problems and is difficult to straighten. The authors used bone-cartilaginous units taken from the patient's own septum, meaning grafts that keep bone and cartilage attached as one piece, to hold the nose straight. They retrospectively reviewed patients treated between February 2018 and March 2021, with three dimensional photographic measurement at least a year after surgery.

Sections of note

• Design: retrospective chart review, 28 patients, single center.
• Mean age 34.52 years, range 20 to 77, 61 percent female.
• Photographic measurement used Mirror software before surgery and at least one year afterward.
• Nasal deviation fell from 1.82 degrees to 0.13 degrees, p less than 0.001, though the abstract prints these values with slashes rather than decimal points.
• The ratio of middle nasal third width to palpebral fissure length fell from 1.28 to 1.19, p less than 0.001.
• NOSE scores for blockage and Rhinoplasty Outcomes Evaluation scores for satisfaction both improved significantly, p less than 0.001.
• Statistics used independent t-tests and the Wilcoxon signed-rank test.

What it means for a patient

• Keeping bone attached to cartilage makes a stiffer graft, which is the property needed to hold a nose that wants to lean back to its old position.
• Both the objective measurement and the patient questionnaires moved in the same direction, which is stronger than either alone.
• The starting deviation of under 2 degrees is small, so these were not severely crooked noses.
• Limits: 28 patients, retrospective, single group with no comparison technique, and the abstract's numbers printed in an unconventional format.

Why this paper matters

Deviated noses relapse, and preventing that requires a graft strong enough to resist the memory of the cartilage. Composite bone and cartilage grafts from the septum avoid a rib harvest. Whether the correction holds beyond one year, and how it compares with conventional spreader or extension grafts, is unanswered.

Terms

• Deviated nose: a nose whose axis leans off the facial midline.
• Bone-cartilaginous unit: a graft in which septal bone and cartilage are kept attached as one piece.
• NOSE score: a questionnaire measuring nasal blockage, where higher means worse.
• Rhinoplasty Outcomes Evaluation: a patient questionnaire scoring satisfaction with the nose.
• Palpebral fissure length: the width of the eye opening, used as a facial reference measurement.