Mean Nasal Obstruction Symptom Evaluation Research Articles

The Prevalence of the Nasal Vestibular Body in Patients With Nasal Obstruction.

Background and aim Nasal obstruction is one of the most common reasons for consultation addressed by otolaryngologists. There are anatomical, physiological, and pathological etiologies. Sometimes the treatment can become a challenge for the specialist, so a detailed evaluation of the etiologies must be carried out. The involvement of the nasal vestibular body (NVB) in obstructive symptoms has been described. Therefore, we must be familiar with its anatomy, presentation, and contribution to this symptomatology. This study aimed to highlight the importance of NVB in the role of nasal obstruction and know the impact that it adds to the symptoms of patients through a validated instrument on their quality of life. Material and methods A retrospective, descriptive, and analytical study was conducted on 113 patients with nasal obstruction who attended the outpatient clinic of the Otolaryngology and Head and Neck Surgery Service in a tertiary-level hospital in Monterrey, Mexico from January 2021 to January 2023. The Nasal Obstruction Symptom Evaluation (NOSE) scale was applied to assess the impact of this symptom on the quality of life of the subjects. The causes involved in the obstructive symptoms were identified by physical examination, including NVB. Two groups were made as follows: with the presence of the NVB and with the absence of the NVB, and the means of the NOSE scale were compared. Results A total of 113 patients were included, 59 male patients (52.20%) and 54 female patients (47.80%). The presence of NBV was found in 72 patients (63.70%). Other causes of nasal obstruction were found in 35 patients (31%), with chronic rhinitis being the most frequent in 27 subjects (23.90%). The mean NOSE scale score was higher in the group with the presence of the NVB than in the group with the absence of the NVB (p<0.05). The primary outcome of this study was to know the prevalence of NVB in the Hispanic population with nasal obstruction who attends the otolaryngology clinic. The secondary outcome was to know the relationship between the presence of NVB and the NOSE scores. Conclusion In this study, we observed that NVB is frequently present in patients with nasal obstruction in northeastern Mexico. There is an association between the presence of NVB and higher scores on the NOSE scale. New research will be needed to assess the effectiveness of NVB surgery in improving nasal obstruction and to determine the impact of NVB on nasal obstruction in isolation.

Performance of the NOSE Questionnaire in Mask Selection for Home CPAP Titration.

Introduction Many patients abandon CPAP treatment because they find the mask uncomfortable. Therefore, specialists may benefit from the predictive value of airway assessment tools. Objective To identify nasal ventilation failure through the Nasal Obstruction Symptom Evaluation (NOSE) scale in patients with obstructive sleep apnea (OSA) who undergo home-based auto-adjusting CPAP titration and to determine whether there is a correlation between NOSE score and the type of mask selected. Materials and Methods In this prospective correlational study, the NOSE scale was used in terms of mask selection and titration indicators. Patients were classified based on their NOSE score: > or < 50. Results We included 303 patients; 226 men (74.5%), BMI: 33.2 ± 6.1 kg/m 2 , neck circumference (cm): 42.8 ± 3.6 and Epworth (ESS) score: 9.2 ± 5.6, mild OSA: 12 (3.9%), moderate OSA: 127 (41.9%), and severe OSA: 164 (54.1%). The mean NOSE score was 24.3 ± 22.8 and 42 patients (13.8%) had NOSE scores > 50. Indicators for both groups were: compliance (5.9 ± 1.3 vs. 5.8 ± 1.4 hours) p: 0.41, therapeutic pressure (9.1 ± 2.0 vs. 8.8 ± 1.6 cm of H 2 O) p: 0.23, residual AHI (2.3 ± 1.8 vs. 2.8 ± 2.6 events/hour) p: 0.25, and leaks (20.5 ± 10.6 vs. 21.3 ± 10.7 liters/minute) p: 0.64. According to adjusted multiple regression, a NOSE of > 50 was not a predictor of mask selection. Conclusions A > 50 NOSE score was not a predictor of mask selection, and it was not correlated to titration performance.

Revision rhinoplasty with free diced cartilage grafts: Outcome evaluations with the Nasal Obstruction Symptom Evaluation (NOSE) scale

Background/Aim: The Nasal Obstruction Symptom Evaluation (NOSE) scale is a validated, reliable, and feasible instrument used to evaluate nasal obstruction severity. We aimed to assess patient satisfaction using the NOSE score after revision rhinoplasty with free diced cartilage (fDC) grafts. Methods: In this cross-sectional study, 36 patients who underwent a revision rhinoplasty procedure completed the Turkish version of the NOSE questionnaire before and six months after rhinoplasty. Pre- and postoperative NOSE scores were compared using the Mann Whitney U test. Results: The pre- and postoperative total mean NOSE scores were 68.06 and 8.47, respectively. The NOSE score significantly decreased six months after rhinoplasty surgery (P&lt;0.001). Adapting to exercise was the parameter with the highest improvement rate. Conclusion: The outcome of the NOSE questionnaires in patients with nasal deformities shows that a revision rhinoplasty surgery with the placement of fDC grafts contributes to the improvement of nasal functions. The Turkish version of the NOSE scale is a useful tool to assess patient satisfaction among the Turkish population.

Lateral Crural Repositioning: Implications on Nasal Function.

There are many concepts for surgical management of the nasal tip with varying outcomes on esthetics and nasal function. Nasal tip surgery can influence nasal function based on how the techniques can alter lateral wall integrity. A retrospective chart review of rhinoplasty patients undergoing lateral crural strut grafting (LCSG) with and without repositioning from 2009 to 2017 of the primary author (D.M.T.) was performed. Preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores were analyzed. In our study, 832 subjects were evaluated. The mean preoperative NOSE score of all subjects was 35.48. The longest follow-up mean was 652.07 days with a mean NOSE score of 7.07 (p < 0.0001). In the LCSG group, the mean preoperative NOSE score was 22.97. The longest follow-up mean was 583.29 days with a mean NOSE score of 7.22 (p < 0.0001). In the LCSG with repositioning group, the mean preoperative NOSE score was 43.42. The longest follow-up mean was 692.36 days with a mean NOSE score of 7.60 (p < 0.0001). LCSGs with or without repositioning improves nasal function showing significant improvement in NOSE scores. The use of these techniques require adhering to several technical points to maximize outcomes and to avoid deformity.

Temperature-controlled radiofrequency device treatment of septal swell bodies for nasal airway obstruction: An open-label, single arm multicenter study.

Nasal airway obstruction (NAO) is a highly prevalent disorder. Septal swell body (SSB) hypertrophy is an often overlooked contributor to NAO. SSB treatment may relieve symptoms of NAO. The objective of this study was to assess the clinical use of a temperature-controlled radiofrequency (TCRF) device to treat SSBs to improve symptoms in adults with NAO. In this prospective, multicenter, open-label, single arm study, patients with severe or extreme NAO related to SSB hypertrophy received bilateral TCRF treatment in the SSB area. The primary endpoint was improvement in Nasal Obstruction Symptom Evaluation (NOSE) Scale scores from baseline to 3 months postprocedure. A subset of study patients underwent computed tomography (CT) imaging to evaluate posttreatment changes in SSB size. Mean NOSE Scale scores significantly improved from 73.5 (SD 14.2) at baseline to 27.9 (SD 17.2) at 3 months postprocedure, a reduction of -45.3 (SD 21.4, 95% confidence interval [CI]: -50.4 to -40.1; p<0.0001); the responder rate was 95.7% (95% CI: 0.88 to 0.99; p<0.0001). CT evaluation at 3months showed statistically significant reductions in the SSB with the greatest reduction in the middle thickness (mean change -3.4 [SD 1.8] mL, 95% CI: -4.0 to -2.8; p<0.0001). Minimal adverse events with any relationship to the device or procedure were reported; none were serious in nature and no septal perforations occurred. This study demonstrates that TCRF treatment of SSB hypertrophy is well tolerated and effective at reducing both SSB size and symptoms of NAO at 3 months posttreatment.

A Comparison of Symptom Improvement and Outcomes After Septoplasty Alone Versus Septoplasty With Turbinoplasty.

Background Various causes can lead to nasal obstruction, with the most frequent anatomical cause being deviated nasal septum. It seriously affects patients' quality of life. As a result, septoplasty is performed to enhance the nasal airways. This study aimed to compare the improvement of nasal symptoms following septoplasty with or without turbinoplasty and evaluate the surgical outcomes in both different groups. Methodology A retrospective study was conducted at a tertiary hospital among patients who had undergone septoplasty with or without turbinoplasty between 2020 and 2022. Data regarding demographics, clinical features, surgical data, and complications were collected from patient files. The Nasal Obstruction Symptom Evaluation (NOSE) scale score was assessed through structured interviews. Results In our analysis of 209 patients who underwent surgery for deviated nasal septum, septoplasty was done in 110 (52.6%) patients, whereas the remaining 99 (47.4%) underwent septoplasty with turbinoplasty. The mean NOSE score was found to be 32.94 ± 35.67%. Patients who underwent septoplasty alone significantly showed higher mean scores (56.36 ± 34.62%) compared to those who underwent septoplasty with turbinoplasty (11.14 ± 18.93%) (p < 0.001). The long-term complications showed revision surgery was done in 13 patients, which was comparatively more often done in patients who underwent a septoplasty. Other long-term complications were found to be significantly higher in patients who underwent septoplasty (76.9%) compared to those who underwent septoplasty with turbinoplasty (23.1%). Conclusions Patients who underwent additional turbinoplasty experienced an improvement in nasal symptoms than those who underwent septoplasty alone. In addition, more long-term complications were noted in patients who underwentseptoplasty alone.

Wedge resection combined with 3D-printed polycaprolactone mesh for caudal septal deviation

BackgroundBiocompatibility and stability of three-dimensional printed polycaprolactone mesh grafts for nasal surgery are proven in both animal and human models. However, their safety and durability as batten grafts for caudal septal deviation has not been documented. This study was designed to investigate the efficacy and safety of three-dimensional printed polycaprolactone mesh batten graft in septoplasty using the wedge resection technique for the correction of caudal septal deviation.MethodsThis retrospective study reviewed the medical records of 20 patients aged ≥ 18 years with caudal septal deviation who underwent septoplasty with wedge resection and three-dimensional printed polycaprolactone mesh graft from a tertiary medical center in South Korea, between December 1, 2019 and May 31, 2021. Those without nasal obstruction before surgery or with a short follow-up period (< 28 days) were excluded from the survey analysis.ResultsOf the 20 patients (mean age, 48.0 [range, 19–65] years), 17 (85.0%) were male, and three (15.0%) were female. A significant change was noted in the mean nasal obstruction symptom evaluation score (68.2 vs. 15.0, P < .001) in the 17 patients included in the analysis. Postoperative endoscopic evaluation revealed a straight septum in 19/20 (95.0%) patients, and no complications were noted in the postoperative follow-up period of up to 364 days.ConclusionsThe three-dimensional printed polycaprolactone nasal mesh is safe and provides adequate support to resist the intrinsic memory of the cartilage of the caudal septum. In addition to nasal surgeries, it has great potential as a graft in other reconstructive surgeries.Trial registration Retrospectively registered.

Effects of seasonal conditions on septorhinoplasty patients

Our study aims to investigate the seasonal effects on the breath and quality of life (QoL) of patients who underwent septorhinoplasty (SRP). A total of 52 patients who underwent SRP between 2018-2023 were included in the study. Two groups those who operated in the winter (winter group, n=26) and those who performed in the summer (summer group, n=26) were evaluated with the NOSE (Nasal Obstruction Symptom Evaluation) scale to reveal the QoL after surgery. Compared with the summer group, NOSE scores in the winter group showed a statistically significant difference (p&lt;0.05). Septorhinoplasty is a surgical procedure expected to increase the QoL of patients regardless of the season and climate. The low mean NOSE score observed in the winter showed that the postoperative patient comfort was significantly higher compared who underwent surgery in the summer. Therefore, encouraging patients to undergo surgery intensively during the winter months in SRP will be positive for postoperative QoL. Future studies may reveal more illuminating results for increasing patient comfort by considering different surgical techniques, climates, and months.

Comparison of Nasal Obstruction Symptom Evaluation Score Outcomes After Autologous Cartilage Grafts and Latera Nasal Implants.

To compare quantitative Nasal Obstruction Symptom Evaluation (NOSE) scores for ACG and Latera implants for nasal valve repair. Retrospective chart review of patients who underwent ACG or Latera placement between January 2016 through May 2019 by a single surgeon. Patients who had completed NOSE surveys pre- and post-operatively were identified and eligible for inclusion. Data regarding baseline demographic characteristics, adjunctive surgical procedures, NOSE scores at 1, 3, and 6-month post-operative visits, complications, and total operative time were collected. Unpaired t-tests and linear mixed models were performed to analyze differences between study groups. There were 24 and 39 patients who underwent ACG and Latera, respectively, who met eligibility criteria. There were no differences in demographic characteristics or pre-operative baseline NOSE scores (ACG: 65.1 and Latera: 64.4; P = .92) between groups. Mean operative times were not significantly different between groups (ACG: 113 minutes and Latera: 102 minutes; P = .76). Within each group, NOSE scores were significantly improved at each post-operative visit compared to pre-operative baselines. Between groups, mean NOSE scores were lower at each post-operative visit for ACG compared to Latera (1-month ACG: 21.7 and Latera: 45.9, P = .002 ; 3-month ACG: 14.5 and Latera: 39.9, P = .034; 6-month ACG: 8.4 and Latera: 44.2, P = .003). Both ACG and Latera offer significant improvements in patient-reported nasal obstruction severity; however, ACG may yield more favorable subjective symptom scores.

Long-term outcomes following repair of nasal valve collapse with temperature-controlled radiofrequency treatment for patients with nasal obstruction.

Long-term outcomes following repair of nasal valve collapse with temperature-controlled radiofrequency treatment for patients with nasal obstruction.

Is septoplasty required whenever anterior septal deviation is present?

Post-operative success and patient satisfaction were assessed following septoplasty for mild to severe anterior septal deviation. The study included patients with an anterior nasal septal deviation in the form of a 'C' shape and close to the nasal valve in the anterior septal area. Deviation severity was classified as severe (group 1), moderate (group 2) or mild (group 3). Open or closed septoplasty procedures were performed. All patients were surveyed twice using the Nasal Obstruction Symptom Evaluation scale and the 36-Item Short Form Health Survey. The mean Nasal Obstruction Symptom Evaluation score for group 1 was 15.58 ± 2.34 prior to surgery and 6.61 ± 3.29 following surgery. The corresponding pre- and post-surgery scores in group 2 were 11.9 ± 2.82 and 6.3 ± 3.03, respectively. In group 3, these values were 8.28 ± 2.63 and 7.12 ± 3.18, respectively. The mean 36-Item Short Form Health Survey physical function value for groups 1 and 2 increased after surgery; in group 3, this value decreased after surgery, but the result was not statistically significant. Septoplasty is very successful for treating moderate or advanced deviations, but great care should be taken when employing septoplasty for mild deviations.

Normative Values of the Nasal Obstruction Symptom Evaluation Scale.

Background: The Nasal Obstruction Symptom Evaluation (NOSE) scale is widely used by clinicians in evaluation of nasal airway obstruction (NAO). Objective: To determine normative values for the NOSE scale among both symptomatic and asymptomatic members of the general U.S. population. Methods: A survey of NAO symptoms in adults of age 18 years and older was performed. The distribution of NOSE scores among the general population was estimated. Influence of features including age, gender, race, location, and symptomatology on NOSE scores was evaluated. Results: Surveys were completed by 2333 participants. Mean NOSE score was 11 (standard deviation [SD] 11) in the asymptomatic, and 28 (SD 22) in the symptomatic population (p < 0.0001). Increasing age was associated with an increase in scores until 45 years, after which it was associated with decreasing scores. No significant differences were found related to other investigated demographics. Conclusions: Normative ranges for the NOSE scale are established, and are largely consistent with values in the existing literature. NOSE scores do not appear to be influenced by gender, race, or geography, although age should be considered in their interpretation.

A Minimally Invasive Nasal Endoscopic Approach to Distraction Osteogenesis Maxillary Expansion to Restore Nasal Breathing for Adults with Narrow Maxilla.

Background: Patients with narrow high-arch palate present with limited response to standard septal, turbinate, and valve procedures for nasal obstruction. Objective: To measure the effectiveness of minimally invasive nasal endoscopic (MINE) Lefort I osteotomy among subjects with narrow high-arched palate in managing nasal obstruction. Methods: Prospective cohort study was performed where subjects with narrow high-arched palate underwent MINE distraction osteogenesis maxillary expansion (DOME) from August 2019 to January 2021. Nasal obstruction symptom evaluation (NOSE) score, mean time to opioid cessation, and mean duration of cranial nerve V2 hypoesthesia were evaluated. Results: Among 12 subjects, the. mean NOSE score decreased from 58.89 to 15.83 (p = 0.004). There were no complaints of lip mobility or deformity. Conclusion: MINE-DOME can reduce nasal obstruction in a certain phenotype of patients and further improve patient-centric outcomes by limiting the approach to the Lefort I osteotomy to an endoscopic nasal approach.

Comparison between botulinum toxin and steroid septal injection in the treatment of allergic rhinitis.

ObjectiveTo compare the effects of botulinum toxin and steroid septal injections in treating allergic rhinitis (AR) by evaluating improvements in the rhinitis control assessment test (RCAT), visual analog scale (VAS), nasal obstruction symptom evaluation (NOSE) scores, and active anterior rhinomanometry (RMM) measurements.MethodsThis prospective, single‐blinded cohort study was conducted at the Department of Otolaryngology, Taipei City Hospital between January 2017 and December 2018. Ninety‐five patients were randomized to receive botulinum toxin, dexamethasone, or normal saline (group A, group B, and placebo, respectively). The main outcome measures were pretreatment subjective nasal symptoms (RCAT, VAS, and NOSE) and active anterior RMM measurements. All measurements were repeated during posttreatment 1, 2, and 3 months.ResultsNo significant difference was observed in pretreatment questionnaire scores and RMM values between the study and placebo groups. The mean posttreatment RCAT, VAS, and NOSE scores after 1 and 2 months significantly improved in the treatment groups compared to placebo. The VAS and NOSE at posttreatment 2 months and RCAT, VAS, and NOSE at posttreatment 3 months were significantly different comparing group A to group B. All RMM parameters showed better values in group A than in group B at 1, 2, and 3 months posttreatment, with significant differences in four parameters in posttreatment 3 months.ConclusionsBotulinum toxin septal injection is a safe treatment option for AR and improves subjective nasal symptoms for 3 months. Botulinum toxin A injection tended to be more effective than steroid septal injection in terms of duration and degree.Level of Evidence: 2b, individual cohort study.

Caudal Extension Graft of the Lower Lateral Cartilage: Technique and Aesthetic and Functional Results.

Here we describe a new technique to deal with alar retraction, a highly undesirable imperfection of the nose. The procedure involves placing a caudal extension graft below the vestibular portion of the lower lateral cartilage (LLC) after its detachment from the vestibular skin. The graft is fixed to the cartilage and, subsequently, to the vestibular tissue. The present retrospective study included 20 patients, 11 females and 9 males, with a mean age of 28.90 years. Follow-up ranged from 1 to 18 months. Surgery improved alar notching to a smoother dome shape and nostril exposure was reduced in every patient. The caudal extension graft of the LLC contributed to rise in overall patient satisfaction, as revealed by the postoperative increase of the Rhinoplasty Outcomes Evaluation (ROE) mean score from 40.0 to 79.17 (p < 0.0001). It also contributed to and improved functional outcomes, as indicated by the decrease of the Nasal Obstruction Symptom Evaluation (NOSE) mean score from 52.75 to 13.25 (p = 0.0001). Sex did not affect the mean ROE and NOSE scores. Thus, increased patient satisfaction measured by the ROE is present in both sexes and at both age groups but it is better detected in the first year after surgery. Functional improvements analyzed with NOSE are best detected in patients aged ≥ 30 years and in follow-ups of 11 months. The caudal extension graft of the LLC technique described herein effectively and safely corrects alar retraction and the collapse of the nasal valve while filling the soft triangle.

The Rhinoplasty Health Care Monitor: Using Validated Questionnaires and a Web-Based Outcome Dashboard to Evaluate Personal Surgical Performance.

Background: Self-assessment provides valuable feedback in the life-long process of mastering rhinoplasty. This study presents a method to measure and evaluate data-based performance of a single surgeon using a web-based dashboard. Methods: In this prospective analytic cohort study, all patients referred to the senior author for functional-aesthetic (revision) rhinoplasty between April 2014 and September 2020 are included. Patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale, Utrecht Questionnaire (UQ), and visual analog scales before and after rhinoplasty. Questionnaire scores were exported to a customized web-based dashboard: the rhinoplasty health care monitor. Supported by real-time graphic output, this monitor automatically analyzes functional and aesthetic outcomes. Results: Of 603 referred patients, 363 were eligible for rhinoplasty. Mean NOSE scale scores decreased from 66.6 ± 23.5 to 23.2 ± 24.0 (p < 0.001), and mean UQ scores decreased from 12.2 ± 6.3 to 7.1 ± 3.9 (p < 0.001) 1 year after surgery. The rhinoplasty health care monitor visualizes numerous outcome parameters that help the surgeon to analyze results, identify learning needs, and detect trends in performance development. Conclusions: This automated outcome dashboard transparently measures individual surgeon performance. Gauging performance provides means to enhance surgical development and, consequently, patient satisfaction.

Validation of the Nasal Obstruction Symptom Evaluation Scale in Pediatric Patients.

The Nasal Obstruction Symptom Evaluation (NOSE) is a disease specific quality of life instrument developed and validated in adults. The objective of this study is to evaluate the validity of the NOSE scale for pediatric nasal obstruction. We also examined the effect of septoplasty with bilateral inferior turbinate reduction in this population. A validation study at a tertiary care children's hospital. Thirty-eight pediatric patients who underwent septoplasty and bilateral inferior turbinate reduction between 2014 and 2018 were included. Patients were administered the NOSE instrument on the day of their clinic evaluation, the day of surgery, and at their 6 to 8-week post-operative appointment. A sample of 40 pediatric patients with non-rhinologic complaints was also included. Confirmatory factor analysis was performed to evaluate the factorial validity of the NOSE instrument. Of the 78 patients included, the mean age was 15.4 years (SD 3.4). In the confirmatory factor analysis, factor loadings were all significant and ranged from 0.95 to 0.99. Internal consistency reliability using Omega and maximal reliability H indices were well above recommended standards (Omega=0.983 and maximal H=0.988). Test-retest reliability was also adequate. Mean NOSE scores significantly improved following surgery (from 96.7 [SD 6.2] to 8.8 [SD 7.8]; mean difference=-87.9; 95% CI: -84.5, -91.3; P < .001). Similar improvements were observed across age groups. The NOSE scale is a valid and reliable quality of life instrument for pediatric patients with nasal obstruction. Nasal septoplasty with bilateral turbinate reduction substantially improved symptoms of nasal obstruction. 4 Laryngoscope, 131:E2594-E2598, 2021.

Evaluation of the use of Different Spreader Techniques in Primary Open Septorinoplasty in Terms of Nasal and Olfactory Functions.

In this study, the authors aimed to investigate the use of spreader and determine the efficacy and superiority of different spreader techniques in septorhinoplasty in terms of nasal and olfactory functions. A total of 60 patients who had undergone septorhinoplasty with the open technique were included in the study. In addition to open septorhinoplasty, 20 patients also underwent bilateral spreader graft placement and 20 bilateral spreader flap placement. For the remaining 20 patients, open septorhinoplasty was performed without spreader grafts or flaps. The patients completed the Nasal Obstruction Symptom Evaluation (NOSE) scale consisting of five questions, and the Brief Smell Identification Test was used to detect olfactory dysfunction. The preoperative mean NOSE score of all patients was 10.87 (1-18), while the postoperative mean value was 1.83 (0-10). The preoperative mean olfactory score was 6.23 ± 2.20 in all patients while it was 7.33 ± 1.75 postoperatively. There was a statistically significant difference between the preoperative and postoperative NOSE and olfactory scores in all patients, but no statistically significant difference was observed between the three groups. Spreader graft or flap techniques used in septorhinoplasty are safe in terms of nasal obstruction and olfactory function, and there is no statistically significant difference between them.

Does inferior turbinate outfracture provide additional benefit when combined with inferior turbinate radiofrequency ablation?

To evaluate, both subjectively and objectively, whether turbinate outfracture provides any additional benefit in the treatment of inferior turbinate hypertrophy when combined with radiofrequency ablation. The study was conducted on 58 patients diagnosed with inferior turbinate hypertrophy. The patients were randomly divided into two groups according to the treatment they receive. Group A consisted of patients undergoing radiofrequency ablation and Group B included patients undergoing turbinate outfracture in combination with radiofrequency ablation. For the purposes of objective evaluation, all patients underwent acoustic rhinometry and anterior rhinomanometry preoperatively and at 6months postoperatively. In addition, for subjective evaluation, the patients completed the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire. Postoperative changes in objective and subjective parameters in both groups versus the preoperative period and their differences were compared statistically. In Group A, mean postoperative minimal cross-sectional area (MCA) and nasal volume (NV) values and NOSE scores were significantly greater compared to those obtained in the preoperative period. Similarly, Group B showed significantly greater mean postoperative MCA, NV and NOSE score values compared to the preoperative period. In Group A and B, mean postoperative total nasal resistance (TNR) value was significantly lower in comparison to the preoperative period. The differences in mean preoperative and postoperative MCA, NV, TNR and NOSE scores were significantly greater in Group B versus Group A. The addition of turbinate outfracture to inferior turbinate radiofrequency ablation treatment provides both objective and subjective benefits in the resolution of nasal obstruction.

The Effectiveness of Skeletal Reconstruction in Severe Post-Rhinoplasty Nasal Deformity.

Revision rhinoplasty in patients with multiple prior surgeries is among the most challenging procedures in facial plastic surgery. Evaluating patient satisfaction in this unique patient population is important in determining which technique is effective. The aim of this study was to determine the outcomes of total nasal skeletal reconstruction in patients with severe post-rhinoplasty deformity due to multiple previous revision surgeries. A retrospective medical record analysis of ambulatory surgery and hospital databases was performed relating to rhinoplasty patients between April 2014 and December 2018. Patient demographics, surgical technique, and functional and aesthetic outcome assessment data were retrieved. Patients' functional satisfaction was measured with the Nasal Obstruction Symptom Evaluation (NOSE) instrument, and the Rhinoplasty Outcome Evaluation (ROE) instrument was used to evaluate cosmetic results. A total of 253 revision rhinoplasties were extracted. Of these, 25 patients were revision cases with total skeletal reconstruction. The patients had undergone a mean of 3.2 previous rhinoplasties. Mean [standard deviation] preoperative ROE and NOSE scores were 6.36 [3.69] and 80.33 [12.02], respectively. Septum, tip, dorsum, and side walls were reconstructed in all cases. The mean postoperative ROE and NOSE scores after 1 year were 17.27 [4.67] and 53.33 [19.80], respectively, which represented a statistically significant improvement (P < 0.001). Having the knowledge and experience to perform total nasal skeletal reconstruction by rebuilding an unsalvageable nose leads to long-standing satisfactory functional and aesthetic results.