Spare roof technique in reduction rhinoplasty: Prospective study of the first one hundred patients

Abstract

Objective Assess the aesthetic and functional outcomes of the first 100 patients who underwent reduction rhinoplasty with the spare roof technique (SRT). Methods Prospective, interventional, and longitudinal study performed on consecutive patients undergoing primary rhinoplasty by SRT. All the surgical procedures were performed by the surgeon who first described this technique. The validated Portuguese version of the Utrecht Questionnaire for Outcome Assessment in Aesthetic Rhinoplasty was used. Patients completed the questionnaire presurgery and again 3 and 12 months postsurgery. In addition, a visual analogue scale (VAS) was used to score nasal patency for both sides. Results The study population included 100 Caucasian Mediterranean patients (33 males; 67 females). Mean age at surgery was 32.8 years. Analysis of the preoperative and postoperative mean aesthetic VAS scores showed a significant improvement from 3.67 to 8.1 (P < 0.001) and 8.44 (P < 0.001), respectively, 3 and 12 months postsurgery. Analysis of the five aesthetic Likert scale questions all showed a highly significant improvement after rhinoplasty. The mean preoperative aesthetic sum score was 13.9, which improved to 8.26 and 7.08, respectively, 3 and 12 months postsurgery (P < 0.001), indicating a significant improvement of subjective body image in relation to nasal appearance. Analysis of the preoperative and postoperative mean functional VAS score showed a significant improvement on both sides. Conclusion This prospective statistical study confirms that SRT significantly improved patient quality of life regarding nose function and appearance. It is a reliable technique that can help deliver consistently good results in reduction rhinoplasty in Caucasian patients with dorsal hump seeking rhinoplasty. Level of Evidence 2 Laryngoscope, 129:2702–2706, 2019

Functional and Radiological Assessment After Preservation Rhinoplasty – A Clinical Study

“…Modern rhinoplasty techniques may significantly improve patient quality of life in regard to nose function and appearance (9,10). This requires careful preoperative analysis and planning, including radiological assessment.…”

Guidelines for Dorsum Preservation in Primary Rhinoplasty

“…(7) K-area resurfacing-curving by releasing the blocking points causing a "coat-hanger effect": mainly septal remnants below the vault must be removed. (8) Cartilaginous middle third width refinement by reducing the medial part of the ULC scrolls that create an excess volume due to what we name the "scroll-windingeffect" 19 : a "W-point-shift" 19 will allow for pinching the middle third. (9) Supratip and W-ASA segment alignment.…”

120 Years of Dorsal Preservation in Rhinoplasty

“…9-14 Many techniques have been described for the reconstruction of the middle vault following iatrogenic damage in hump resection, such as spreader grafts, 15 osteotomies, and drilling and suture techniques. 10,16 The common purpose of these techniques is to close off the opening in the nasal dorsum with something other than the original dorsum. Hump resection and subsequent narrowing of the nasal vault by closure of the "open roof" can lead to narrowing of the internal nasal valve, potentially leading to nasal obstruction.…”

“…[20][21][22][23][24] Current classifications and techniques of preservation rhinoplasties are fairly mature and large case series have been published, providing the rhinoplasty community scientifically-validated evidence of successful outcomes. 10,16,21,[25][26][27][28][29][30][31] Several modifications to the key dorsal preservation techniques have been described in recent years, leading to refinements and improvements in techniques that will help improve outcomes. 23,24,[32][33][34][35] There are vastly more advanced equipment-from crystalclear endoscopes connected to high definition monitors, finer osteotomes and rongeurs, electric drills and burrs to piezoelectric instruments that allow for precision cuts required by the techniques for preservation rhinoplasty.…”