Outcome of Septorhinoplasty in Deviated Nose Deformity: One Year Cross-Sectional Study

To evaluate outcome of Septorhinoplasty in Deviated nose deformity using Nasal Obstruction Symptom Evaluation (NOSE) scale and Rhinoplasty outcome evaluation score (ROE). This observational study was conducted in the department of Otorhinolaryngology and Head and Neck Surgery of KLE University's Jawaharlal Nehru Medical College and KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi from January 2015 to December 2015. Forty patients were evaluated and comparisons were made for NOSE score preoperatively and postoperatively. Comparison of decrease in NOSE score with age distribution, sex distribution, type of septorhinoplasty, ROE score of patients and ROE score of surgeons were also made. ROE score of patients and ROE score of surgeons were correlated. Their statistical significance (p value) and Cohen's kappa (k) were calculated. Out of 40 patients, there were total of 16 Open Septorhinoplasty cases and 24 Close septorhinoplasty cases. NOSE score preoperatively and postoperatively showed statistically significant i.e., total score (p = 0.001). ROE score of patients and surgeons had poor correlation (k = 0.1; p = 0.2). Decrease in NOSE score postoperatively with ROE score of patients showed statistically significant (p = 0.01). There was no significance on comparison of decrease in NOSE score postoperatively with ROE score of surgeons (p = 0.09), age distribution (p = 0.1), sex distribution (p = 0.2) and septorhinoplasty (open/close) (p = 0.2). The outcome of septorhinoplasty has been validated with NOSE scale and ROE score and has been proven that there is improvement in nasal obstruction and quality of life after septorhinoplasty. The quality of life scoring is essential for patients subjected to septorhinoplasty for assessing success of the surgery.

Improved access in endonasal rhinoplasty: the cross cartilaginous approach

BACKGROUND

The popularity of open rhinoplasty has increased such that it is the first choice of approach for many surgeons undertaking primary rhinoplasty. Despite the benefits of this approach, the drawbacks are often not emphasized. We present a review, with quantitative assessment of 24 rhinoplasty patients using the cross-cartilaginous incision. This new approach optimizes access without an external scar and ligament disruption that ensues after the open approach.

METHODS

24 consecutive patients underwent primary rhinoplasty from March 2009 to April 2011 using the cross-cartilaginous approach. Preoperative measurements of defined anatomical sites of the nose were taken. Independent assessments of the postoperative results were undertaken by a surgical resident and a senior nurse using preoperative and postoperative photographs using the new Independent Rhinoplasty Outcome Score (IROS). Evaluation of patient satisfaction and postoperative patient concerns were carried out.

RESULTS

The range of preoperative measurements (average) were: radix 12-19 mm (15.0), keystone 20-34 mm (24.5), alar base 14-20 mm (17.0), nose length 48-58 mm (50.2), tip width 11-25 mm (15.9), and tip projection 21-37 mm (29.6). Three months after the operation, the patient satisfaction scores were rated 67% good to excellent, 25% were acceptable, and 8% were dissatisfied. After 3 months, 17% of patients reported swelling, 0% bruising, 8% irregularities, 8% asymmetry, and 4% airway issues. Independent assessment of the photographs showed that overall result was: 31% good, 56% average, and 13% had no improvement.

CONCLUSION

Preoperative anatomical measurement allows reliable assessment of nasal characteristics and comparison with postoperative outcomes. Our simple grading system for outcome assessment in rhinoplasty allows the assessment to be reliable and reproducible (IROS). The cross-cartilaginous approach is suitable for a majority of primary rhinoplasty patients, providing good access and visibility, although, open rhinoplasty is required for selected complex revision cases.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, IV.