The Impact of Scroll Ligament Preservation on Nasal Airway Patency in Rhinoplasty: An Objective Study with Rhinomanometry and Acoustic Rhinometry

Agdoğan Ö, Ersözlü T.

PubMed 39227471 Publisher (DOI)Free full text (PMC)

What this paper says

Measured by instruments six months after surgery, 31 patients whose scroll ligaments were preserved breathed better than before, while 30 whose ligaments were cut had higher airway resistance and lower airflow.

Overview

The scroll ligaments join the tip cartilages to the upper lateral cartilages and support the internal nasal valve; conventional rhinoplasty often cuts them. The Turkish authors retrospectively compared patients operated between May 2018 and October 2019 with bilateral scroll ligament preservation (n = 31) against bilateral sacrifice (n = 30), selected for minimal septal deviation and no prior nasal surgery, using computerised rhinomanometry and acoustic rhinometry before and 6 months after surgery.

Sections of note

Preservation group: significant postoperative improvement in rhinomanometry, indicating more airflow and less resistance.
Sacrifice group: deterioration, with increased resistance and decreased airflow.
Measurements were objective instrument readings, not questionnaires.
Patients with significant septal deviation were excluded so the ligament effect could be isolated.
Level of Evidence IV; described as double-blind and retrospective.

What it means for a patient

Cutting the scroll ligaments measurably worsened breathing in this study; keeping them improved it.
This supports asking a surgeon whether their technique preserves the scroll area.
Sixty-one patients and six months of follow-up is a modest evidence base.

Why this paper matters

It is one of the few studies to test a preservation principle with objective airflow instruments rather than patient questionnaires. Limits: retrospective, small groups, 6-month follow-up, single centre.

Terms

Scroll ligament (scroll area): the fibrous junction where the lower lateral cartilage overlaps the upper lateral cartilage.
Internal nasal valve: the narrowest part of the airway, between septum and upper lateral cartilage.
Rhinomanometry: measurement of airflow and pressure through the nose during breathing.
Acoustic rhinometry: measuring airway cross-section by sound reflection.
Airway resistance: how hard the nose makes it to move air; higher means more blocked.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Background: Rhinoplasty is a critical surgical intervention aimed at enhancing nasal form and function. However, traditional approaches often compromise the integrity of nasal scroll ligaments, vital for the functionality of the internal nasal valve, leading to potential postoperative nasal dysfunction. Despite the importance of scroll ligaments in maintaining nasal structure and function, the literature lacks objective, quantifiable evidence of their role. This study sought to objectively compare nasal functionality and anatomy between patients undergoing rhinoplasty with bilateral preservation of scroll ligaments and those with bilateral sacrifice of these ligaments, employing computerized rhinomanometric and acoustic rhinometric measurements as evaluative tools.

Methods: This retrospective, double-blind study was conducted at Tekirdağ Namık Kemal University's Plastic Reconstructive and Aesthetic Surgery and Ear, Nose, and Throat Clinics. The study population comprised patients who underwent rhinoplasty between May 1, 2018, and October 1, 2019. Patients were rigorously selected based on their medical history, including previous nasal surgeries, aesthetic dissatisfaction, and minimal nasal septum deviation. They were then categorized into two distinct groups: one undergoing rhinoplasty with an emphasis on preserving the scroll ligaments (n = 31) and the other where these ligaments were intentionally sacrificed (n = 30). A comprehensive analysis involving preoperative and six-month postoperative computerized rhinomanometry and acoustic rhinometry measurements was conducted to assess the surgical impact on nasal functionality and structure. The statistical comparison focused on evaluating the changes in air pressure and airflow rates, aiming to delineate the functional outcomes attributable to the differing surgical techniques.

Results: Our findings reveal a stark contrast in postoperative nasal functionality between the two groups. In the group with preserved scroll ligaments, there was a significant improvement in postoperative computerized rhinomanometric measurements, indicating enhanced nasal airflow and reduced airway resistance. Conversely, the group with sacrificed scroll ligaments exhibited deteriorated postoperative outcomes, with increased nasal airway resistance and decreased airflow. These differences underscore the pivotal role of scroll ligaments in maintaining nasal airway patency and functionality.

Conclusion: The study unequivocally demonstrates that the preservation of scroll ligaments during rhinoplasty significantly benefits nasal airway function, as evidenced by improved postoperative rhinomanometry and acoustic rhinometry measurements. This objective data provide a compelling argument for the functional importance of scroll ligaments, advocating for surgical techniques that prioritize their preservation. By highlighting the positive correlation between ligament preservation and enhanced nasal functionality, this research contributes valuable insights into rhinoplasty practices, suggesting a paradigm shift towards approaches that safeguard nasal structural integrity for optimal functional outcomes.

Level Of Evidence Iv: 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).