Comparison of Dorsal Preservation Rhinoplasty Techniques: Functional and Aesthetic Review of Subdorsal Septal Strip Methods

Overview

Dorsal preservation lowers the bridge by removing a strip of septal cartilage from beneath it, and several ways of cutting that strip exist. The author compared two of them using patient reported outcome measures. Patients treated from 2020 to 2022 with either method were assessed on four questionnaires at 1, 3, 6 and 12 months.

Sections of note

• Design: comparative review using patient reported outcome measures, analyzed by two sample t-test.
• 71 primary rhinoplasty patients met inclusion criteria at 12 months, average age 23, 62 women and 9 men. 35 had the modified subdorsal strip method; 36 had the Z flap.
• Instruments: NOSE, SNOT-22, SCHNOS and the Epworth Sleepiness Scale.
• NOSE is reported as 9.36 before and minus 4.4 after, p less than 0.001; SNOT-22 as 23.9 before and minus 16.4 after; Epworth as 6.2 before and minus 1.6 after. These appear to mix baseline values with change values as printed.
• SCHNOS total, functional and cosmetic averaged 27.6, 8.2 and 18.7 before surgery, with reported changes of minus 5.7, minus 5.73 and minus 18.1, all p less than 0.001.
• No significant complications occurred and no difference in outcomes between the two techniques.

What it means for a patient

• Both ways of cutting the septal strip produced similar improvements in breathing and appearance at one year.
• Daytime sleepiness also improved, which is measured because nasal blockage disrupts sleep.
• Limits: 71 patients, one surgeon, no randomization stated, one year of follow up, and reported numbers that are hard to read since negative values appear on scales with a floor of zero.

Why this paper matters

Preservation rhinoplasty debates focus heavily on which septal strip technique is best, largely on theoretical grounds. Comparing two directly with validated questionnaires finds no difference. Whether they differ in hump recurrence, the main preservation failure mode, is not reported here.

Terms

• Dorsal preservation: lowering the bridge while keeping its natural surface intact.
• Subdorsal septal strip: a band of septal cartilage removed from beneath the bridge to let it settle.
• Z flap: a technique cutting the subdorsal strip in a Z shape to allow controlled repositioning.
• SNOT-22: a 22 item questionnaire measuring sinus and nasal symptoms and their impact.
• Epworth Sleepiness Scale: a questionnaire measuring daytime sleepiness.
• SCHNOS: a validated questionnaire scoring both nasal appearance and nasal blockage.