Quality of life after primary septorhinoplasty in deviated- and non-deviated nose measured with ROE, FROI-17 and SF-36

Does a closed reduction improve aesthetical and functional outcome after nasal fracture?

BACKGROUND AND PURPOSES

How closed reduction (CR) to repair a nasal fracture affects the patient's quality of life (QoL) has not been investigated. Here, we assessed QoL before and after CR using disease-specific questionnaires and compared the QoL scores of patients with nasal fractures with normative scores from a reference cohort.

METHODS

This was a prospective study of 96 patients with nasal fractures undergoing CR. Patients were interviewed about aesthetic, functional, and QoL issues before and after surgery using the Functional Rhinoplasty Outcome Inventory (FROI-17) and the Rhinoplasty Outcome Evaluation (ROE). Photographs of the nasal area were taken before and after surgery and reviewed. Data were compared with those from a reference cohort (n = 1000).

RESULTS

Most fractures were type I (80.6%) and most were caused by sport-related accidents (36.5%). The ROE scores increased from 67.3 preoperatively to 73.4 postoperatively (p = 0.001). The FROI-17 also improved, indicating the overall effect of the nose on QoL (p = 0.002). Compared with the reference cohort, patients felt more affected by nasal symptoms before surgery (- 9.37, p = 0.02) than by more general aspects. ROE scores returned to normative values after surgery (p < 0.001). The postoperative cohort had lower scores for the FROI-17 item overall effects of the nose on QoL than the reference cohort did, although the nasal symptom score remained higher in patients than in reference controls.

CONCLUSIONS

This study showed that CR can improve the aesthetical but not the functional outcome of the nose.

How to predict the outcome of septorhinoplasty? A normative study of ROE and FROI-17 scores

Objective

Normative values of patient-reported outcome instruments are needed to identify good candidates for rhinoplasty. Rhinoplasty Outcome Evaluation (ROE) and Functional Rhinoplasty Outcome Inventory-17 (FROI-17) are disease-specific questionnaires that evaluate quality of life in patients undergoing rhinoplasty.

Methods

The reference cohort contained 1,000 participants, selected from a non-probability panel. Normative ROE and FROI-17 scores from this reference cohort were compared with ROE and FROI-17 scores from a patient cohort before (n = 104) and 6 (n = 55) and 12 months (n = 32) after septorhinoplasty.

Results

Mean FROI-17 scores (± SD) were: overall score, 20.8 ± 17; nasal symptoms, 16.8 ± 7; general symptoms, 24.8 ± 22; and self-confidence, 16.4 ± 21. The ROE total score was 73.1 ± 16. Normative values differed significantly from the preoperative ROE and FROI-17 scores of septorhinoplasty patients (p < 0.01). Except for the FROI-17 general score at 12 months postoperatively (p = 0.004), there were no significant differences between normative ROE/FROI-17 and septorhinoplasty scores postoperatively, indicating that they returned to normalcy.

Conclusions

Normative scores for ROE and FROI-17 provide a reference point from which to identify patients who are most likely to benefit from rhinoplasty.

Evaluation of Aesthetic and Functional Outcomes After Open Rhinoplasty: A Quasi-experimental Study by the Aid of ROE and RHINO Questionnaires

BACKGROUND AND AIMS

Rhinoplasty is one of the common plastic surgery procedures which has a high rate in Iran. There are several tools for assessing the outcomes and quality of life after this surgical procedure which rhinoplasty outcome evaluation (ROE) questionnaire and rhinoplasty health inventory and nasal outcomes are two of them. The aim of this study was to investigate the aesthetic and functional outcomes of rhinoplasty by the aid of ROE and RHINO scales in patients who presented to a referral center in Iran.

MATERIALS AND METHODS

This prospective, quasi-experimental study was performed on patients who referred to the plastic surgery clinic of Imam Khomeini hospital complex during 2017 to 2019 and underwent open rhinoplasty. ROE and RHINO questionnaires were filled by patients before and 6 months after the surgery. Surgical outcomes and aesthetic satisfaction rate were evaluated in different age groups, genders and educational levels. The data were analyzed by version 21 of SPSS software.

RESULTS

ROE score increased from 51.27 ± 10.54 to 79.6 ± 9.67 (P < 0.001). In addition, RHINO score increased from 64.13 ± 11.43 to 83.36 ± 11.03 (P < 0.001). The most common satisfaction factors among patients in this study were "nose feels more natural" in 62% of patients and "tip rotation is good" in 32% of patients. Furthermore, the most common causes of dissatisfaction in patients were "nose too wide" in 25% of patients and "tip bulbous" in 25% of patients.

CONCLUSION

ROE and RHINO scales are effective for assessing rhinoplasty outcomes. The satisfaction rate of rhinoplasty is high in Iran and is related to the natural shape of the nose in addition to the tip rotation.

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 .

Evaluation of the relationship between patient expectation, patient expectation coverage rates and patient satisfaction in open primary septorhinoplasty surgery: a prospective randomized study

PURPOSE

The aim of this study was to evaluate the relationship between preoperative patient expectation and postoperative patient expectation coverage rates and patient satisfaction.

METHODS

183 patients who underwent SRP for various reasons were divided into 6 groups according to surgical indication and the postoperative Rhinoplasty Outcome Evaluation Scale (ROE). The groups were evaluated in terms of preoperative expectation levels and postoperative expectation coverage rate.

RESULTS

When the patients were evaluated in terms of preoperative expectation levels, a significant difference was determined between the patients who underwent surgery for cosmetic reasons (86.15 ± 8.61) and those with functional reasons (79.24 ± 6.62) (p < 0.001). Similarly, the lowest patient expectation coverage rates were in the patient group with cosmetic reasons for the operation. When patients were grouped according to the ROE scores in the postoperative period and surgical indication, expectation was higher in the groups that were not satisfied with the results (Groups 2, 4 and 6). The highest expectation levels among the groups were seen in the dissatisfied patients who had undergone surgery for cosmetic reasons (92.17 ± 4.96). A strong positive correlation was found between expectation coverage rates and patient satisfaction (r 0.907, p < 0.001).

CONCLUSION

Determination and rationalization of the expectations of patients in the preoperative period is one of the factors that will increase the satisfaction of the patients about the surgical procedure.

Anthropometric Evaluation of Photographic Images Before and After Functional Nasal Surgery in Patients With Deviated Noses

BACKGROUND

Numerous techniques for correction of deviated noses have been described. Nevertheless, surgical management is challenging even for experienced rhinosurgeons. Often, a "residual deformity" after functional septorhinoplasty (SRP) due to a deviated pyramid syndrome may remain.

OBJECTIVE

Therefore, the purpose of this study was to determine how frequent functional SRP in patients with a deviated nose results in "successful" straightening of the external nose based on standardized angle measurements. Possible influences having a positive or negative effect on the surgical success were identified.

METHODS

Photo documentation of 607 patients with deviated noses (304 women, 303 men, median age 30 years) before and after nasal surgery were retrospectively analyzed using standardized angle measurements. The pre- and postoperative photos of the faces were anthropometrically measured. The median follow-up was 6 months.

RESULTS

A "straight" deviated nose (I-type) was present in 225 patients (37%), a C-shaped nose (C-type) in 382 patients (63%). More than 75% of the patients presented a facial asymmetry. Based on angle measurements alone, a total of 452 (75%) noses were straightened or postoperatively improved. 155 noses (25%) still showed a biometric deviation. The I- or C-type had no relevant influence on outcome.

CONCLUSION

A purely biometric analysis of crooked noses is difficult and its importance is limited due to commonly pre-existing facial asymmetries. The risk of a "residual deviation" after rhinoplasty in patients with deviated noses must not be underestimated. This fact should be addressed as part of the informed consent. In particular, it should be mentioned that the surgical outcome can remain well below the patient's aesthetic expectations. Not rarely, a revision surgery may be necessary.

The Effect on Patient Satisfaction of the Postoperative Nasal Topographic, Demographic, and Functional Results of Open and Closed Septorhinoplasty Techniques

AIM

To evaluate the contribution to patient satisfaction of the newly reshaped topographic anatomy of the nose, demographic, and functional results in the postoperative period of septorhinoplasty surgery.

METHOD

A total of 370 patients applied with open and closed septorhinoplasty techniques for various reasons were grouped according to the postoperative Rhinoplasty Outcome Evaluation (ROE) Scale results; Group 1 (open rhinoplasty satisfied group, ROE ≥12 points, n:194), Group 2 (open rhinoplasty dissatisfied group, ROE <12 points, n:23), Group 3 (closed rhinoplasty satisfied group, ROE ≥12 points, n:137), Group 4 (closed rhinoplasty dissatisfied group, ROE <12 points, n:16). The groups were evaluated in respect of the effect on patient satisfaction of functional and demographic variables and satisfaction with the topographic outcome of the nose.

RESULTS

The effect of the topographic surgical results was evaluated on patient satisfaction. A correlation was determined between nasal topographic satisfaction and patient satisfaction (r:0.228, P = 0.009). In the subgroup analyses, the only factor among the topographic factors which had an effect on satisfaction was the nasal tip (r:0.187, P = 0.024). Although 30.7% (n:39) of patients dissatisfied with the surgery reported that they were not satisfied with the nasal base results, no correlation was determined between nasal base and satisfaction (r:0.091, P = 0.463). The strongest correlations of patient satisfaction were determined to be with subjective (NOSE score [r:0.530, P < 0.001]) and objective (high nasal resistance levels [r:0.579, P < 0.001]) functional results.

CONCLUSION

The 2 basic components of postoperative satisfaction with SRP surgery were shown to be functional healing and cosmetic outcomes. Of the surgical topographic results, nasal tip and nasal base were the parts determined to require the most attention.

Patient Satisfaction following Structural versus Preservation Rhinoplasty: A Systematic Review

Recently, dorsal preservation rhinoplasty has been gained acceptance among facial plastic surgeons. Despite this, there is limited literature on patient satisfaction following preservation rhinoplasty. This systematic review aims to evaluate all studies quantifying patient satisfaction and to compare results between structural and dorsal preservation rhinoplasty. OVID Medline, EMBASE, and PubMed databases were searched. All studies from the years 2010 to 2020 evaluating satisfaction in patients receiving either structural or dorsal preservation rhinoplasty were included. Data regarding study demographics as well as patient satisfaction results were extracted from included studies. Descriptive results and analysis were calculated. A total of 2,172 articles were initially identified, of which 29 articles were included in the final analysis. Of the 29 articles, 25 were focused on structural rhinoplasty and 4 were focused on preservation rhinoplasty. Of the 25 structural rhinoplasty articles, 17 used the Rhinoplasty Outcome Evaluation (ROE) questionnaire to evaluate patient satisfaction and 5 used the FACE-Q scale. Among the 25 structural rhinoplasty studies, 14 (56%) reported statistically significant improvements in patient satisfaction evaluation scores after rhinoplasty. Among the four preservation rhinoplasty studies, one (25%) study reported significant improvements in satisfaction scores after rhinoplasty. Despite this, most studies included a statement that satisfaction improved in patients following rhinoplasty. Literature in this review supports both structural and preservation rhinoplasty, resulting in high satisfactory results for patients following surgery. More research must be conducted to further quantify satisfaction following preservation rhinoplasty and prospectively compare satisfaction between the two rhinoplasty techniques.

Impact of Le-Fort I osteotomy on anatomical and functional aspects of the nasal airway and on quality of life

OBJECTIVES

Orthognathic surgery is a well-established procedure for skeletal deformities. Beneficial influences to the posterior airway space (PAS) have been described, but little is known about the subjective aesthetical and functional nasal aspects after orthognathic surgery. The aim of this study was to evaluate nasal airflow by anterior rhinomanometry and volumetric changes in the nasal airway space after mono- or bimaxillary surgery using cone-beam computed tomography (CBCT) and a new segmentation software. Furthermore, changes of patient's quality of life (QoL) should be assessed.

METHODS

Ten patients (9 skeletal class malformation III, 1 skeletal class malformation I) were included. CBCT images, rhinological inspections and anterior rhinomanometries were performed before (T0) and after surgery (T1). All patients completed the FROI-17, the ROE and the SF-36 questionnaires.

RESULTS

A significant postoperative gain for nasal airway volume compared with the baseline was shown (p < 0.014). No statistically significant differences between pre- and postoperative flow rates were found (p = 0.114). Pre- and postoperative cohorts did not differ in responses of disease-specific (ROE and FROI-17) and generic QoL questionnaires (SF-36).

CONCLUSION

Maxillary relocation surgery leads to a significant increase in nasal airway space. Subjectively, orthognathic patients did not experience any functional but psychosocial aspects after bimaxillary surgery.

Systematic Review of Quality-of-Life Measurement After Aesthetic Rhinoplasty

INTRODUCTION

The assessment of outcomes in aesthetic rhinoplasty is highly relevant because patient satisfaction and improved health-related quality of life (QoL) are the predominant factors in determining success. The patient-reported outcome measures (PROMs) employed in rhinoplasty research studies are remarkably diverse, thus yielding difficulties with data analysis. The aim of this article is to provide a comprehensive review of the literature to reveal the relevance of the QoL assessment for rhinosurgeons.

METHODS

A systematic literature search with the terms "Rhinoplasty" and "Quality of Life" was conducted using PubMed/MEDLINE, Google Scholar and Cochrane databases. Primarily, all publications related to QoL following aesthetic rhinoplasty between 2002 and 2017 were identified. As a secondary selection, we focused on articles with a prospective study design, a significant cohort size (at least 50 patients) and a follow-up period of at least 6 months after aesthetic rhinoplasty.

RESULTS

A total of 62 PROM studies assessing QoL following aesthetic rhinoplasties were obtained. We ascertained an increasing publication rate of QoL articles over the last 15 years. Only 17 studies satisfied comprehensive inclusion criteria of a high qualitative study selection. The Rhinoplasty Outcome Evaluation was the most frequently used QoL questionnaire of the secondary selection (70.6%). The total number of 16 various questionnaires exhibit high heterogeneity.

CONCLUSION

Our data strengthen the increasing importance of the assessment of QoL after rhinoplasty. Despite a lack of reliable publications with considerable heterogeneity and large variability in outcomes, functional-aesthetic rhinoplasty leads to a significant improvement of patient's health-related QoL.

LEVEL OF EVIDENCE II

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 .

One-Piece Nasal Osteotomy for the Correction of a Centrally Deviated Nose

BACKGROUND

A severely crooked nose due to trauma or other causes is difficult to correct. Although various nasal osteotomy techniques have been suggested, satisfactory outcomes have not always been achieved especially in centrally deviated noses. Definite correction of the midline and shape of the bony framework is necessary. We aimed to investigate a novel one-piece nasal bone osteotomy approach consisting of transverse osteotomy continued with bilateral lateral osteotomies for the correction of a centrally deviated nose.

METHODS

This retrospective chart review included 66 consecutive patients who underwent corrective rhinoplasty with nasal bone osteotomy for a deviated nose. Group 1 was treated with one-piece osteotomy, and group 2 was treated with conventional lateral and/or medial osteotomy. Available preoperative and postoperative three-dimensional facial bone computed tomography images were used to quantify nasal landmarks through three-dimensional reconstruction. Patient satisfaction was evaluated using a rhinoplasty outcome evaluation questionnaire.

RESULTS

Measurements of nasal landmark angles toward the longitudinal facial midline plane showed a statistically narrowed postoperative angle in group 1 (subnasale landmark: preoperative angle 1.66 ± 0.29° [group 1] vs. 0.76 ± 1.09° [group 2]; postoperative angle 0.96 ± 0.77° [group 1] vs. 0.31 ± 0.29° [group 2]). The questionnaire scores revealed higher satisfaction (3.11 ± 2.38 vs. 1.157 ± 1.147) and a higher proportion of 4-point scores in group 1.

CONCLUSIONS

This is the first study to introduce the one-piece nasal osteotomy technique for centrally deviated noses. The technique consists of transverse osteotomy with bilateral osteotomies in one stage, thus the name "one-piece." Considering anatomic variances in Asian rhinoplasty, a deviated nose should be effectively corrected to obtain satisfactory outcomes. We demonstrated the efficacy and satisfactory outcomes of this new technique.

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 .