Columellar strut grafts versus septal extension grafts during rhinoplasty for airway function, patient satisfaction and tip support.

Autor: Lathif A; Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, 67 Burton Street, Darlinghurst, Sydney, NSW 2010, Australia. Electronic address: adil.lathif@unsw.edu.au., Alvarado R; Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, 67 Burton Street, Darlinghurst, Sydney, NSW 2010, Australia., Kondo M; Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, 67 Burton Street, Darlinghurst, Sydney, NSW 2010, Australia., Mangussi-Gomes J; Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, 67 Burton Street, Darlinghurst, Sydney, NSW 2010, Australia., Marcells GN; Bondi Junction Private Hospital, Bondi Junction, NSW, Australia., Harvey RJ; Rhinology and Skull Base Research Group, Applied Medical Research Centre, University of New South Wales, 67 Burton Street, Darlinghurst, Sydney, NSW 2010, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
Jazyk: angličtina
Zdroj: Journal of plastic, reconstructive & aesthetic surgery : JPRAS [J Plast Reconstr Aesthet Surg] 2022 Jul; Vol. 75 (7), pp. 2352-2358. Date of Electronic Publication: 2022 Feb 24.
DOI: 10.1016/j.bjps.2022.02.017
Abstrakt: Importance: Different techniques exist to provide tip support in rhinoplasty. There is little evidence to provide a consensus on the most effective choice.
Objective: Evaluating columellar strut graft (CSG) and septal extension grafts (SEG) for their influence on airway function, patient satisfaction and tip support.
Design, Settings and Participants: A retrospective cohort study was undertaken on 165 adult patients who underwent open rhinoplasty with either a CSG or SEG, from February 2012 to August 2019 in a single tertiary facial-plastic practice in Sydney, Australia. Operations were for both cosmetic and functional indications, and both primary and revision cases were assessed. Airway testing and patient-reported outcomes (PROMs) were performed preoperatively and at least 6 months following the procedure. Photographic tip analysis was taken from approximately 4 and 12-month postoperative photographs.
Main Outcomes and Measures: Nasal peak inspiratory flow (NPIF) and total nasal airway resistance (NAR) were the primary airway functional outcomes. The primary PROMs analysed were a visual analogue scale (VAS) for nasal obstruction and 13-point Likert scale for global cosmesis, the Nose Outcome Symptom Evaluation (NOSE), and the nasal obstruction score. Tip support was determined by the nasolabial angle (NLA) and Simon's ratio as assessed by Rhinobase developed by Apaydin et al. on lateral Frankfort plane photographs. Data normalised as an improvement over preoperative baseline, accounting for individual variability.
Results: A total of 165 patients was assessed (35.2 ± 12.9 yrs, 72% female), 100 (61%) of which received SEG. There were similar nasal airway assessments between CSG and SEG groups, with ΔNPIF (20.0 ± 42.1 L/min v 19.9 ± 44.9 L/min, p = 0.983) and Δ "obstructed" NAR (-1.13 ± 1.90 v -1.02 ± 4.33 Pa/cm3/s, p = 0.849). Amongst PROMs, a greater cosmetic outcome was seen in the SEG group (7.20 ± 2.97 v 5.69 ± 3.45, p < 0.01) with all other assessments similar between CSG and SEG techniques. Photographic analysis of tip projection showed reduced NLA distortion in the SEG.
Conclusion and Relevance: While greater patient-perceived cosmesis was seen in patients with a SEG, there were similar airflow and patient-reported nasal function between groups. Photographic analysis of tip projection showed SEG patients additionally benefited from less NLA distortion and greater tip maintenance.
Competing Interests: Declaration of Competing Interest Richard J. Harvey is consultant with Medtronic, Stryker, Novartis, Meda and NeilMed pharmaceuticals. Research grant funding was received from Glaxo-Smith-Kline and Stallergenes. He has been on the speakers’ bureau for Glaxo-Smith-Kline, Meda Pharmaceuticals and Seqirus. All other authors have no disclosures or conflicts of interest.
(Copyright © 2022 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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