Features of Importance in the Nasal Exam in Rhinoplasty

Overview

No standard exists for what a rhinoplasty consultation examination should cover. The authors sent an online questionnaire to board-certified facial plastic and plastic surgeons experienced in rhinoplasty. For each of seven deformities, respondents ranked the three most important anatomic regions to examine, then chose up to three features within each region.

Sections of note

• Seven categories: dorsal hump, crooked nose, boxy tip, pinched tip, droopy tip, saddle nose, and nonallergic nasal obstruction.
• Regions offered for ranking: nasal bones, midvault cartilage, skin, radix, facial profile, lip, tip, septum, internal nasal valve, nostrils, and inferior and middle turbinates.
• 13 facial plastic surgeons and 8 plastic surgeons were invited; all 21 completed the questionnaire.
• Agreement was measured with Normalized Attention Scores.
• All cases showed high agreement; the dorsal hump case had the greatest variability.
• The abstract does not list which regions were ranked highest for each deformity.

What it means for a patient

• A thorough consultation should include a physical examination of specific structures, not only photographs and a discussion of looks.
• Surgeons broadly examine the same things for the same complaint, which supports asking what a surgeon checked and why.
• This is expert opinion from 21 surgeons, not evidence that examining a given structure changes the surgical result.

Why this paper matters

It is a first attempt to define a consensus examination for rhinoplasty, which could feed training and checklists. The survey is small, the invited group self-selected, and the link between examination findings and outcomes remains untested.

Terms

• Radix: the root of the nose, the depression between the brows.
• Midvault: the middle third of the nose, formed by the upper lateral cartilages and septum.
• Internal nasal valve: the narrowest part of the airway, inside the middle third.
• Saddle nose: a collapsed bridge from loss of septal support.
• Normalized Attention Score: the measure used here to quantify agreement between respondents.