Impact of Dorsal Preservation Rhinoplasty Versus Dorsal Hump Resection on the Internal Nasal Valve: a Quantitative Radiological Study

Abdelwahab, Mohamed; Neves, Caio Athayde; Patel, Priyesh N.; Most, Sam P.

doi:10.1007/s00266-020-01627-z

Cited by 73 publications

(48 citation statements)

References 55 publications

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“…They found that neither conventional hump resection nor LD dorsal PR technique reduced the INV dimensions. However, the PD preservation technique significantly reduced the INV dimensions (14). Our study results are in line with these: We confirmed a significant improvement of nasal function after PR as evaluated in our study by a 10-point Likert scale.…”

Section: Discussionsupporting

confidence: 92%

“…To the best of our knowledge, this is the first clinical study to evaluate the impact of PR on INV dimensions objectively in patients using a validated radiological methodology. In a recent study by Abdelwahab et al, the impact of different hump takedown techniques, namely conventional hump resection with midvault reconstruction, PD and LD procedures, on the INV dimensions was evaluated in a cadaveric study (14). They found that neither conventional hump resection nor LD dorsal PR technique reduced the INV dimensions.…”

Section: Discussionmentioning

confidence: 99%

“…Outcome measures were major and minor complications, revision rate and radiological assessment of the INV pre-and postoperatively as evaluated by cone-beam computed tomography (CT). The INV has been reported to be the point of highest resistance in the nasal airway (14). The INV is a cross-sectional area bounded medially by the dorsal septum, laterally by the caudal portion of the upper lateral cartilage, and inferiorly by the head of the inferior turbinate (15,16).…”

Section: ˚ Preoperatively (C) the Preservation Technique Included Tmentioning

confidence: 99%

“…This cross-sectional area was calculated by the same author and measurement was repeated to ensure precision. A modified coronal plane perpendicular to the nasal acoustic wave was created, by aligning the axial axis parallel to the bony dorsum on the sagittal view as previously described (14). Analyses of the INV dimensions were performed using byzz nxt software (orangedental GmbH & Co. KG, Biberach, Germany).…”

Section: ˚ Preoperatively (C) the Preservation Technique Included Tmentioning

confidence: 99%

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Functional and Radiological Assessment After Preservation Rhinoplasty – A Clinical Study

Stergiou¹,

Tremp

Finocchi³

et al. 2020

In Vivo

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Background/Aim: We hypothesized that improved functional outcome after preservation rhinoplasty can be validated by radiological analyses. Patients and Methods: In this retrospective study, five patients were included. Radiological assessment was evaluated by cone-beam computed tomography. Patient satisfaction regarding nasal function was evaluated by a Likert scale from 0 to 10 (0=poor result; 10=very satisfied). Results: After a mean follow-up of 5±1 months (range=4-6 months), significantly improved function was noted by all patients, with a mean Likert scale of 9.2±0.45 (preoperative score=2.8±0.8, p=0.0079). These results are in line with the radiological results, showing an improved internal nasal valve angle (preoperative=26.2˚±1.8v s. postoperative=32.3˚±1.2˚, p=0.02). Conclusion: Our study showed that besides nasal appearance, nasal function can also be dramatically improved after preservation rhinoplasty.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: ˚ Preoperatively (C) the Preservation Technique Included Tmentioning

confidence: 99%

Section: ˚ Preoperatively (C) the Preservation Technique Included Tmentioning

confidence: 99%

See 2 more Smart Citations

Functional and Radiological Assessment After Preservation Rhinoplasty – A Clinical Study

Stergiou¹,

Tremp

Finocchi³

et al. 2020

In Vivo

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“…24 In preliminary cadaveric studies at our center, we have found that the PD technique has a narrowing effect on the INV. 25 This is not seen with the LD operation. Whether this has clinical relevance for patients is an area of ongoing research and may have implications for the selective use of the LD over the PD technique.…”

Section: Management Of the Bony Pyramidmentioning

confidence: 92%

A Review and Modification of Dorsal Preservation Rhinoplasty Techniques

Patel

Abdelwahab

Most

2020

Facial Plastic Surgery & Aesthetic Medicine

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Importance: Although conventional hump resections are a hallmark of rhinoplasty, there has been a rekindled interest in dorsal preservation (DP) techniques as a means for addressing the dorsal hump, with claims of superior functional and aesthetic results. As such, an understanding of DP, including technical considerations and outcomes, is imperative. Observations: DP allows for mobilization of the osseocartilaginous nasal vault as a single unit and thereby prevents disruption of the natural keystone area. The osseous nasal vault is managed with a transverse osteotomy and either a bilateral single lateral osteotomy (pushdown procedure) or bilateral bony wedge resections (letdown procedure) to allow for descent of the nasal dorsum. A variety of approaches to the septum exist, each differentiated by the location of cartilage resection: subdorsal, high-septal, midseptal, or inferior septum. These techniques result in pleasing dorsal aesthetic lines but may be limited by a higher rate of dorsal hump recurrence. Patency of the internal nasal valve (INV) is theoretically improved with DP. Robust series with patientreported outcomes are lacking, although several reports and early experience at our center with a newly described high-septal resection technique do suggest positive functional and cosmetic outcomes with DP. Conclusions and Relevance: With the recent revitalized interest in DP, an understanding of the potential benefits, techniques, and challenges associated with this surgery is helpful. Maintenance of the dorsum as a single unit has implications for maintaining structural integrity at the nasal keystone, pleasing dorsal aesthetic lines, and the patency of the INV. As surgeons continue to develop and employ these techniques, critical assessment of patient-reported outcomes and objective nasal measurements, with an emphasis on comparison with standard hump takedown techniques, will be valuable.

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Effect of Lateral Crural Procedures on Nasal Wall Stability and Tip Aesthetics in Rhinoplasty

et al. 2021

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Objectives/Hypothesis: To evaluate the lateral nasal wall stability, nasal function, and cosmesis when creating an aesthetically pleasing nasal tip subunit utilizing lateral crus (LC) altering procedures.Study design: Retrospective cohort. Methods: In this retrospective cohort study, cosmetic rhinoplasty patients undergoing LC procedures with available lateral wall insufficiency (LWI) scores were included. An LWI grading system was used to evaluate internal (zone 1) and external (zone 2) nasal valves objectively. Secondarily, Nasal Obstruction Symptom Evaluation (NOSE) Score, Visual Analog Scale (VAS) and Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) results were evaluated. Based on the LC intervention, the cohort was divided into six groups: lateral cural strut graft (LCSG), mini-LCSG, lateral crural overlay (LCO) with and without additional support, cephalic trimming, and cephalic turn-in flaps.Results: Subjects undergoing LCO with and without support, LCSG, and mini-LCSG showed significant improvement in zone 1 LWI (P = .042, P = .041, P < .001, and P < .001, respectively), while cephalic trimming and turn-in/hinged flaps had no effect. Subjects undergoing LCO with support and LCSG showed significant improvement in zone 2 LWI (P = .022, P = .004), while LCO without support, mini-LCSG, cephalic trimming, and turn-in flaps showed no effect on LWI. The SCHNOS-C and VAS-C showed significant improvement in all subgroups (P < .05) when comparing pre-to postoperative values. Alar-spanning sutures did not significantly change zone 1 scores but did conceal zone 2 improvements in LCSG and LCO with support groups.Conclusions: Selected LC procedures are robust techniques for improving tip cosmesis independently without compromising nasal lateral wall stability. Some LC procedures can improve nasal valves patency in tip surgery.

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Impact of Dorsal Preservation Rhinoplasty Versus Dorsal Hump Resection on the Internal Nasal Valve: a Quantitative Radiological Study

Cited by 73 publications

References 55 publications

Functional and Radiological Assessment After Preservation Rhinoplasty – A Clinical Study

Functional and Radiological Assessment After Preservation Rhinoplasty – A Clinical Study

A Review and Modification of Dorsal Preservation Rhinoplasty Techniques

Effect of Lateral Crural Procedures on Nasal Wall Stability and Tip Aesthetics in Rhinoplasty

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