Analysis of the operative utilization of concurrent rhinoplasty and endoscopic sinus surgery

Quality of Life Improvement in Concurrent Septorhinoplasty and Endoscopic Sinus Surgery

OBJECTIVES

Septorhinoplasty (SRPL) and functional endoscopic sinus surgery (FESS) are two frequently performed surgeries to improve quality of life (QoL) in patients with nasal symptoms. It has been demonstrated as a safe combination regarding complication rates, but patient satisfaction in concurrent surgery has not been adequately studied yet.

METHODS

Patients undergoing sole FESS due to chronic rhinosinusitis (n = 57), sole SRPL (n = 148), and concurrent surgery (n = 62) were prospectively evaluated for their disease-specific QoL before and one year after surgery. Each procedure was performed by the same surgeon (OCB). For SRPL, the patient-reported outcome measures Rhinoplasty Outcomes Evaluation (ROE) and Functional Rhinoplasty Outcome Inventory (FROI-17) were utilized, and for chronic rhinosinusitis, the Sino-Nasal Outcome Test-22 (SNOT22).

RESULTS

All three groups showed significant improvement in the postoperative QoL measurements (all p < 0.01). The postoperative improvements were slightly smaller in the concurrent surgery group compared with the single surgery groups measured with ROE (combined: +55.2 ± 9.3, single: +58.8 ± 9.8, p = 0.02), FROI total score (combined: +47.6 ± 5.2, single: +49 ± 5.4; p = 0.08) and SNOT22 (combined: +33.1 ± 6.7, single +34.5 ± 7, p = 0.26).

CONCLUSIONS

SRPL, FESS, and combined surgery improve disease-specific QoL. When applicable, surgeons may offer the benefits of a combined procedure without compromising the QoL gain.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:1239-1245, 2024.

Clinical Efficacy Analysis of Functional Rhinoplasty Assisted by Nasal Endoscopy

OBJECTIVE

To analyze the clinical effect of endoscopy-assisted functional rhinoplasty.

METHODS

Endoscopy-assisted functional rhinoplasty was performed in all patients. Deviated nasal septum was corrected, nasal septum cartilage graft was prepared through open access under the assistance of endoscopy, the nasal frame structure was adjusted with the endoscopy-assisted rhinoplasty combined with middle and inferior turbinoplasty, and the patient's nasal ventilation function and external nose cosmetology were restored. Visual Analogue Scale (VAS), Nasal Obstruction Symptom Evaluation (NOSE), nasal acoustic reflex, and nasal resistance were examined preoperatively and 6 months postoperatively. Rhinoplasty Outcome Evaluation (ROE), nasal appearance deviation value, and morphological measurement of the external nose were used to assess the external nasal appearance. Finally, postoperative satisfaction was used for overall evaluation.

RESULTS

In terms of nasal ventilation evaluation, the VAS and NOSE scores of nasal obstruction decreased significantly at 6 months after the operation compared with that before the operation (1.96 ± 0.84 vs 6.68 ± 1.28, 4.25 ± 1.80 vs 12.25 ± 2.50; P < .05). Among the objective indexes, MCA1, MCA2 and NV5 were significantly increased whereas RT, MCA1a/MCA1b, MCA2a/MCA2b, MD1a/MD1b, and MD2a/MD2b were significantly decreased compared with those before the operation (P < .05). The MD1 and MD2 levels before and after operation had no significant differences (P > .05). In the evaluation of external nose morphology, postoperative ROE was significantly increased, and the deviation value of nasal appearance was significantly decreased [(16.93 ± 2.61 vs 10.64 ± 3.01), (1.46 ± 1.11 mm vs 5.72 ± 2.30 mm), P < .05]. In terms of postoperative patient satisfaction: 26 cases (92.9%) were very satisfied with nasal ventilation function, 2 cases (7.1%) were satisfied with nasal ventilation function, 24 cases (85.7%) were very satisfied with nasal appearance, and 4 cases (14.3%) were satisfied with nasal appearance.

CONCLUSIONS

Nasal endoscopy-assisted functional rhinoplasty can improve the nasal ventilation function and external nasal morphology at the same time. Moreover, its clinical effect is good, and the patient satisfaction is high.

Outcomes of Concurrent Functional Endoscopic Sinus Surgery and Rhinoplasty: A Meta-analysis

INTRODUCTION

Chronic rhinosinusitis (CRS) and functional nasal airway obstruction are common but distinct medical problems which affect quality of life. In certain instances, patients often benefit from concomitant functional septorhinoplasty, or elect for cosmetic rhinoplasty, in addition to functional endoscopic sinus surgery (FESS) and prefer combining procedures. Determining outcomes of combined surgery is important when discussing risks and benefits with patients.

METHODS

A thorough literature search of articles published in PubMed, Ovid MEDLINE, and Cochrane databases. Patients were categorized as either having FESS or rhinoplasty alone or combined. Binary random-effects models were applied to calculate odds ratios (ORs) for outcomes including complications, recurrence, and satisfaction.

RESULTS

Of the 55 screened articles, 6 were included in the analysis, and of these, 6 (405 patients), 2 (90 patients), 4 (290 patients), and 3 (190 patients) provided data for postoperative complications, recurrence of CRS symptoms, revision rates, and patient satisfaction, respectively. Major complications were observed in 11 (5.8%) total combined cases, 0 (0%) FESS cases, and 6 (3.5%) rhinoplasty cases with no statistical difference between combined cases and rhinoplasties (OR 1.37, 95% CI 0.45-4.16, p = 0.58). Recurrence of CRS symptoms was noted in 35.6% combined cases and 28.9% FESS cases (OR 1.42, 95% CI 0.55-3.64, p = 0.47). There was no observed difference in revision rates between combined and isolated rhinoplasties (OR 1.00, 95% CI 0.43-2.32, p = 1). Lastly, 91.6% of patients were satisfied with results of combined cases compared to 87.4% of patients in standalone cases (OR 1.57, 95% CI 0.61-4.03, p = 0.35).

CONCLUSION

Aggregate evidence demonstrates similar risk in complication rates in combined surgical cases compared to stand-alone rhinoplasty. There appears to be no significant difference in recurrence of symptoms, revision rates or patient satisfaction.