Eyelid Surgery for Periorbital Lymphedema of Radiation

Abstract

OBJECTIVE: 1) To measure patients' perception of quality of life changes after rhinoplasty surgery in relation to both appearance and function of the nose. 2) To measure patients' perception of quality of life changes after rhinoplasty surgery when using the modern day structural and functional approach for shape and function of the nose. METHOD: A retrospective chart review with prospective follow-up was performed. All patients who underwent rhinoplasty or septorhinoplasty in the last 5 years by the senior author were identified. The patients who underwent any additional nasal surgery (e.g., FESS) simultaneous with rhinoplasty were excluded. 370 patients were invited to participate in the study by mail or at postoperative visits. 126 agreed to participate in the study. Each was provided with two copies of previously validated surveys (rhinoplasty outcome evaluation (ROE) and Nasal Obstruction Symptoms Evaluation (NOSE) for preoperative and postoperative evaluation. Thirteen failed to provide the postoperative questionnaires. This left 113 patients data for analysis. Data analysis was done using software program JMP, Version 8. SAS Institute Inc, Cary, NC, 1989-2010. McNemar's test was used to compare between pre-and post-operative clinical evaluations. Paired and student t-tests were used for evaluate pre-and postoperative scores for the NOSE and ROE respectively. Two group t-tests were used for comparative analysis after dividing the patients in two groups based on whether or not dorsal reduction, osteotomies, or the open vs closed approach were used. RESULTS: 113 patients participated in this study. 51.33% of the patients (58 patients) were male and 48.67% (55 patients) were female. The mean age was 47.56 years with SD 17.27 and range (18 to 91). All patients were Caucasian save one. The mean period of follow-up was 35.6 months with standard deviation (SD) of 14 months and range 11 to 64 months. Analysis of the pre-and post-operative NOSE scores showed that the median difference was -40 with quartiles being -25 and -60. Less than 10% of the patients reported worsening of the scores. The mean NOSE score preoperatively was 65, and the mean postoperative one was 24.51. The improvement in the postoperative state compared to the preoperative was significant with a p value Ͻ .0001. Analysis of the pre-and postoperative ROE scores showed that the median difference was 29.2 with quartiles being 12 and 50. Less than 10% of the patients reported worsening of the scores. The mean ROE score preoperatively was 45.3, and the mean postoperative one was 76.95. As with the NOSE, the ROE showed significant improvement postoperatively vs preoperatively (p value Ͻ .0001). There was no significant difference in improvement in scores when groups were divided based on whether dorsal reduction, osteotomies, or open vs closed approach were performed. CONCLUSION:The modern technique of rhinoplasty that includes a functional and structural approach to the nose improves the patients quality of life regarding both shape and function. Alt...