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Does Rhinoplasty Reduce Nasal Patency? Saban Celebi, Erdem Caglar, Baki Yilmaz, Omer Develioglu, Murat Topak, Halim Is and Mehmet Kulekci Ann Otol Rhinol Laryngol published online 1 May 2014 DOI: 10.1177/0003489414532783 The online version of this article can be found at: http://aor.sagepub.com/content/early/2014/05/01/0003489414532783
Published by: http://www.sagepublications.com
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532783
research-article2014
AORXXX10.1177/0003489414532783Annals of Otology, Rhinology & LaryngologyCelebi et al
Article
Does Rhinoplasty Reduce Nasal Patency?
Annals of Otology, Rhinology & Laryngology 1–4 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0003489414532783 aor.sagepub.com
Saban Celebi, MD1, Erdem Caglar, MD1, Baki Yilmaz, MD1, Omer Develioglu, MD1, Murat Topak, MD1, Halim İs, MD1, and Mehmet Kulekci, MD1
Abstract Objective: This study aimed to evaluate the effect of rhinoplasty on subjective and objective assessment of nasal patency in patients who underwent rhinoplasty for cosmetic reasons only. Setting: Tertiary referral center. Design: Prospective, clinical study. Subject and Methods: A total of 50 adult patients who underwent rhinoplasty were included in the study. Preoperative and postoperative photographs of the nasal profile (frontal, lateral, and oblique) were obtained. The visual analog scale (VAS) was used for the subjective evaluation of nasal obstruction (0 being the minimum, 10 being the maximum amount of nasal patency). Objective evaluation of nasal obstruction was performed with a peak nasal inspiratory flowmeter (PNIF). Results: Preoperative mean VAS scores and PNIF values of the patients were 7.36 ± 0.83 and 115.10 ± 17.45, respectively. Postoperative mean VAS scores and PNIF values of the patients were 7.42 ± 0.73 and 115.30 ± 16.7, respectively. There was no statistically significant difference between any of the pre- and postoperative subjective and objective parameters (P > .05). Conclusion: Reduction rhinoplasty has been shown not to reduce nasal patency. Keywords rhinoplasty, nasal patency, visual analog scale, peak nasal inspiratory flowmeter
Introduction Septorhinoplasty is the most commonly performed facial plastic surgery procedure, which aims to correct nasal shape and nasal function.1 The nasal dorsal hump is often removed during the operation.2 Removal of bony and cartilaginous nasal dorsum followed by fracturing of the nasal bone and frontal process of the maxillary bone causes medial displacement of the upper lateral cartilages, soft tissues, and mucous membranes of the lateral nasal wall.3 The nasal valve region is the narrowest place of the nose with the highest nasal resistance.4 This region is located in the maxillary aperture and its limits include the anterior ends of the inferior turbinates, the septum, and the upper lateral cartilages.5 Following the septorhinoplasty procedure, there is a potential risk of postoperative nasal obstruction.6 To overcome this potential complication, various surgical procedures including turbinoplasty, spreader graft application, and septoplasty can be performed.7 Nasal obstruction can be evaluated subjectively and objectively. Objective assessment of nasal obstruction can be performed with acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flowmetry.6,8 Peak nasal inspiratory flowmetry is an inexpensive, noninvasive, straightforward,
reproducible, portable, and highly effective method that does not require technical knowledge and equipment in assessing nasal obstruction.9 The aim of this study is to evaluate the effect of rhinoplasty on subjective and objective assessment of nasal patency in patients who underwent surgery for cosmetic reasons only (ie, patients without septal deviation and nasal obstruction).
Participants and Methods This prospective case controlled study was conducted at Taksim Education and Research Hospital between June 2010 and July 2012. Fifty adult patients who underwent rhinoplasty surgery (for cosmetic reasons only) were included in the study. Informed consent was obtained from all 1
Department of Otorhinolaryngology–Head and Neck Surgery, Taksim Education and Research Hospital, Istanbul, Turkey Corresponding Author: Saban Celebi, MD, Department of Otorhinolaryngology–Head and Neck Surgery, Taksim Education and Research Hospital, Istanbul, Turkey. Email: [email protected]
Downloaded from aor.sagepub.com at OhioLink on June 8, 2014
2
Annals of Otology, Rhinology & Laryngology
Table 1. Patient Demographics. Lowest Age, y Sex Female Male
18
Highest Mean ± SD / No. (%) 49
Table 2. Comparison of Preoperative and Postoperative VAS Scores and PNIF Values. Lowest
27.04 ± 6.03 31 (62.0) 19 (38.0)
participants. Ethics board approval was obtained from Dr Sadi Konuk Education and Research Hospital Ethical Board. Patients with chronic systemic diseases, allergic rhinitis, septal perforation, alar collapse, septal deviation, nasal obstruction, or history of any type of nasal surgery and those in which a spreader graft was applied were excluded. All patients underwent a full head and neck exam. Preoperative and postoperative photographs of the nasal profile (frontal, lateral, and oblique) were obtained. The visual analog scale (VAS) was used for the subjective evaluation of nasal obstruction (0 being the minimum, 10 being the maximum amount of nasal patency). Objective evaluation of nasal obstruction was performed with a peak nasal inspiratory flowmeter (PNIF). Peak nasal inspiratory flowmeter measurements were performed in a sitting position, under standardized conditions (ie, normal room temperature). Measurements were repeated 3 times and the best of 3 forced inspirations was recorded. Subjective and objective measurements were performed 1 day before the operation and at the fourth postoperative month. An open rhinoplasty procedure was performed on each patient by the same otolaryngologist (S.C.). During the operation, dorsal hump resection, removal of cartilage from the septum for use as a strut graft, application of a columellar strut, cephalic trim of lower lateral cartilage, median osteotomy, and high-low-high osteotomy (without removal of the Webster triangle) were performed. No interventions (such as septoplasty, turbinoplasty, spreader graft application, or alar button graft application) for increasing the nasal patency were made.
Statistical Analysis Descriptive statistics of the data were presented with mean, standard deviation, ratio, and frequency. KolmogorovSmirnov test was used to check for the distribution of variables. For repeated measurements, Wilcoxon’s test or paired t test was used. Analysis was performed using SPSS 21.0.
Results Fifty patients were included in this study; 31 patients were female (62%), and 19 were male (38%). The mean age of the patients was 27.04 ± 6.03 years (Table 1), ranging from 18 to 49 years.
VAS Preop Postop PNIF Preop Postop
Highest
6 5
9 9
80 80
150 150
Mean ± SD
P Value
7.36 ± 0.83 7.42 ± 0.73
.592
115.10 ± 17.45 115.30 ± 16.70
.830
Abbreviations: PNIF, peak nasal inspiratory flowmeter; VAS, visual analog scale.
The results of this study are outlined in Table 2. Preoperative mean VAS scores and PNIF values of the patients were 7.36 ± 0.83 and 115.10 ± 17.45, respectively. Postoperative mean VAS scores and PNIF values of the patients were 7.42 ± 0.73 and 115.30 ± 16.7, respectively. There was no statistically significant difference between any of the pre- and postoperative subjective and objective parameters (P > .05).
Discussion Patients undergoing septorhinoplasty have both esthetic and functional concerns. Rhinoplasty surgery has been shown to decrease the nasal airway.10,11 The nasal valve region is the place of maximum nasal flow resistance; therefore, even minor constrictions of this area with rhinoplasty can result in impairment of nasal airflow.12 Reduction rhinoplasty for cosmetic reasons was shown to decrease the minimal cross-sectional area (MCA; at the nasal valve) significantly by 22% to 25%; the MCA at the pyriform aperture decreased by 11% after osteotomies.10 Guyuron13 argued that nasal osteotomies do not affect the airway in most instances. Inadequate or excessive changing of the bone-cartilage framework by giving particular importance to the esthetic image may result in impaired function as well as impaired esthetic outcome.14 Acoustic rhinometry is a noninvasive, cheap, and objective method of evaluation of nasal obstruction.15 Acoustic rhinometry can measure the cross-sectional area of the anterior part of the nasal cavity; however, it has some limitations for evaluation of the posterior part of the nasal cavity.16 The advantage of peak nasal inspiratory flowmetry over acoustic rhinometry is that it is portable, is easier to use, is cheaper, and can evaluate left and right nasal cavities together or separately.9 In our study, we have shown that nasal patency is not affected subjectively or objectively following an esthetic rhinoplasty operation. Other studies have shown parallel results with our study.6,7,17 However, in these studies, procedures such as septoplasty, spreader graft application, or turbinoplasty have been performed to increase nasal patency.6,7,17 On the other
Downloaded from aor.sagepub.com at OhioLink on June 8, 2014
3
Celebi et al hand, rhinoplasty has been suggested to have the potential to decrease the airway dimensions and cause nasal obstruction.10,11 We believe that possible reasons for this include not paying special attention to the nasal valve region, over-resection of lower lateral cartilages, and performing low to low lateral osteotomy. Over-resection of lower lateral cartilages has been shown to cause nasal valve collapse.18 To our knowledge, our study is the first to evaluate nasal patency after esthetic rhinoplasty in patients without a deviated nasal septum. According to our results, rhinoplasty for esthetic purposes in patients without a nasal septal deviation does not result in a subjective or objective worsening in the nasal airway. We speculate that there are 3 reasons for this: the preservation of the Webster triangle11 with high to low osteotomy, proper amount of resection of the lower lateral cartilage, and application of strut graft to our patients. High to low osteotomy has been shown to cause the least narrowing of the nasal passage13 when compared with other types of osteotomies. No study has ever evaluated the effect of nasal tip rotation on the nasal airway; however, structured nasal tip refinement has been shown to have a significant effect on objective measurement with a PNIF.19 The effect of application of a strut graft on the nasal patency in rhinoplasty has been shown in 1 recent study by Pousti et al.20 The authors have demonstrated in a group of cases of rhinoplasty with or without septoplasty that placing a columellar strut has a significant effect at both MCA1 and MCA2 levels. One limitation of our study is that although we did not intend to include patients with a septoplasty procedure, a strut graft had to be harvested from the nasal septum. As suggested by Pousti et al,20 it is likely that even a minor intervention to the septum may have offered some small improvement in nasal patency that would be offset by any decrease in PNIF values as the result of osteotomies. Another limitation of our study is that we had to exclude patients receiving a spreader graft, although many cosmetic rhinoplasty patients present with a pinched middle vault. However, spreader graft application would increase nasal patency21,22 and cause a bias in interpreting our study’s results.
Conclusion Our study has shown that in patients with purely cosmetic concerns without preoperative breathing impairment, patients can be reassured that breathing will not likely change after a noncomplicated cosmetic rhinoplasty including osteotomies. Our results cannot be extended to those patients who have both cosmetic and functional concerns. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Xavier R. Does rhinoplasty improve nasal breathing? Facial Plast Surg. 2010;26:328-332. 2. Jang YJ, Kim JH. Classification of convex nasal dorsum deformities in Asian patients and treatment outcomes. J Plast Reconstr Aesthet Surg. 2011;64:301-306. 3. Adamson P, Smith O, Cole P. The effect of cosmetic rhinoplasty on nasal patency. Laryngoscope. 1990;100:357-359. 4. Haight JSJ, Cole P. The site and function of the nasal valve. Laryngoscope. 1983;93:49-55. 5. Webster RC, Davidson TM, Smith RC. Curved lateral osteotomy for airway protection in rhinoplasty. Arch Otolaryngol. 1977;103:454. 6. Erdogan M, Cingi C, Seren E, et al. Evaluation of nasal airway alterations associated with septorhinoplasty by both objective and subjective methods. Eur Arch Otorhinolaryngol. 2012;270:99-106. 7. Zoumalan RA, Constantinides M. Subjective and objective improvement in breathing after rhinoplasty. Arch Facial Plast Surg. 2012;14:423-428. 8. Pawar SS, Garcia GJ, Kimbell JS, Rhee JS. Objective measures in aesthetic and functional nasal surgery: perspectives on nasal form and function. Facial Plast Surg. 2010;26:320-327. 9. Ozkul HM, Balikci HH, Gurdal MM, et al. Normal range of peak nasal inspiratory flow and its role in nasal septal surgery. J Craniofac Surg. 2013;24:900-902. 10. Grymer LF. Reduction rhinoplasty and nasal patency: change in the cross-sectional area of the nose evaluated by acoustic rhinometry. Laryngoscope. 1995;105:429-431. 11. Grymer LF, Gregers-Petersen C, Baymler Pedersen H. Influence of lateral osteotomies in the dimensions of the nasal cavity. Laryngoscope. 1999;109:936-938. 12. Wittkopf M, Wittkopf J, Ries WR. The diagnosis and treatment of nasal valve collapse. Curr Opin Otolaryngol Head Neck Surg. 2008;16:10-13. 13. Guyuron B. Nasal osteotomy and airway changes. Plast Reconstr Surg. 1998;102:856-863. 14. Tahamiler R, Yener M, Canakcioglu S. Detection of nasal cycle in daily activity by remote evaluation of nasal sound. Arch Otolaryngol Head Neck Surg. 2009;135:137-142. 15. Chandra RK, Patadia MO, Raviv J. Diagnosis of nasal airway obstruction. Otolaryngol Clin N Am. 2009;42:207-225. 16. Hilberg O. Objective measurement of nasal cavity dimensions using acoustic rhinometry: methodological and clinical aspects. Allergy. 2002;57:5-39. 17. Edizer DT, Erisir F, Alimoglu Y, Gokce S. Nasal obstruction following septorhinoplasty: how well does acoustic rhinometry work? Eur Arch Otorhinolaryngol. 2012;270:609-613. 18. Cummings CW, Fredrickson JM, Harker LA, Krause CJ, Richardson MA, Schuller DE. Otolaryngology Head and Neck Surgery. 3rd ed. St Louis, MO: Mosby-Year Book; 1998. 19. Timperley D, Stow N, Srubiski A, Harvey R, Marcells G. Functional outcomes of structured nasal tip refinement. Arch Facial Plast Surg. 2010;12(5):298-304.
Downloaded from aor.sagepub.com at OhioLink on June 8, 2014
4
Annals of Otology, Rhinology & Laryngology
20. Pousti SB, Touisserkani S, Jalessi M, et al. Does cos metic rhinoplasty affect nose function? ISRN Otolaryngol. 2011;2011:615047. 21. Kim YH, Kim BJ, Jang TY. Use of porous high-density polyethylene (Medpor) for spreader or extended septal graft in
rhinoplasty: aesthetics, functional outcomes, and long-term complications. Ann Plast Surg. 2011;67:464-648. 22. Huang C, Manarey CR, Anand VK. Endoscopic placement of spreader grafts in the nasal valve. Otolaryngol Head Neck Surg. 2006;134:1001-1005.
Downloaded from aor.sagepub.com at OhioLink on June 8, 2014
Does Rhinoplasty Reduce Nasal Patency? Saban Celebi, Erdem Caglar, Baki Yilmaz, Omer Develioglu, Murat Topak, Halim Is and Mehmet Kulekci Ann Otol Rhinol Laryngol published online 1 May 2014 DOI: 10.1177/0003489414532783 The online version of this article can be found at: http://aor.sagepub.com/content/early/2014/05/01/0003489414532783
Published by: http://www.sagepublications.com
Additional services and information for Annals of Otology, Rhinology & Laryngology can be found at: Email Alerts: http://aor.sagepub.com/cgi/alerts Subscriptions: http://aor.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> OnlineFirst Version of Record - May 1, 2014 What is This?
Downloaded from aor.sagepub.com at OhioLink on June 8, 2014
532783
research-article2014
AORXXX10.1177/0003489414532783Annals of Otology, Rhinology & LaryngologyCelebi et al
Article
Does Rhinoplasty Reduce Nasal Patency?
Annals of Otology, Rhinology & Laryngology 1–4 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0003489414532783 aor.sagepub.com
Saban Celebi, MD1, Erdem Caglar, MD1, Baki Yilmaz, MD1, Omer Develioglu, MD1, Murat Topak, MD1, Halim İs, MD1, and Mehmet Kulekci, MD1
Abstract Objective: This study aimed to evaluate the effect of rhinoplasty on subjective and objective assessment of nasal patency in patients who underwent rhinoplasty for cosmetic reasons only. Setting: Tertiary referral center. Design: Prospective, clinical study. Subject and Methods: A total of 50 adult patients who underwent rhinoplasty were included in the study. Preoperative and postoperative photographs of the nasal profile (frontal, lateral, and oblique) were obtained. The visual analog scale (VAS) was used for the subjective evaluation of nasal obstruction (0 being the minimum, 10 being the maximum amount of nasal patency). Objective evaluation of nasal obstruction was performed with a peak nasal inspiratory flowmeter (PNIF). Results: Preoperative mean VAS scores and PNIF values of the patients were 7.36 ± 0.83 and 115.10 ± 17.45, respectively. Postoperative mean VAS scores and PNIF values of the patients were 7.42 ± 0.73 and 115.30 ± 16.7, respectively. There was no statistically significant difference between any of the pre- and postoperative subjective and objective parameters (P > .05). Conclusion: Reduction rhinoplasty has been shown not to reduce nasal patency. Keywords rhinoplasty, nasal patency, visual analog scale, peak nasal inspiratory flowmeter
Introduction Septorhinoplasty is the most commonly performed facial plastic surgery procedure, which aims to correct nasal shape and nasal function.1 The nasal dorsal hump is often removed during the operation.2 Removal of bony and cartilaginous nasal dorsum followed by fracturing of the nasal bone and frontal process of the maxillary bone causes medial displacement of the upper lateral cartilages, soft tissues, and mucous membranes of the lateral nasal wall.3 The nasal valve region is the narrowest place of the nose with the highest nasal resistance.4 This region is located in the maxillary aperture and its limits include the anterior ends of the inferior turbinates, the septum, and the upper lateral cartilages.5 Following the septorhinoplasty procedure, there is a potential risk of postoperative nasal obstruction.6 To overcome this potential complication, various surgical procedures including turbinoplasty, spreader graft application, and septoplasty can be performed.7 Nasal obstruction can be evaluated subjectively and objectively. Objective assessment of nasal obstruction can be performed with acoustic rhinometry, rhinomanometry, and peak nasal inspiratory flowmetry.6,8 Peak nasal inspiratory flowmetry is an inexpensive, noninvasive, straightforward,
reproducible, portable, and highly effective method that does not require technical knowledge and equipment in assessing nasal obstruction.9 The aim of this study is to evaluate the effect of rhinoplasty on subjective and objective assessment of nasal patency in patients who underwent surgery for cosmetic reasons only (ie, patients without septal deviation and nasal obstruction).
Participants and Methods This prospective case controlled study was conducted at Taksim Education and Research Hospital between June 2010 and July 2012. Fifty adult patients who underwent rhinoplasty surgery (for cosmetic reasons only) were included in the study. Informed consent was obtained from all 1
Department of Otorhinolaryngology–Head and Neck Surgery, Taksim Education and Research Hospital, Istanbul, Turkey Corresponding Author: Saban Celebi, MD, Department of Otorhinolaryngology–Head and Neck Surgery, Taksim Education and Research Hospital, Istanbul, Turkey. Email: [email protected]
Downloaded from aor.sagepub.com at OhioLink on June 8, 2014
2
Annals of Otology, Rhinology & Laryngology
Table 1. Patient Demographics. Lowest Age, y Sex Female Male
18
Highest Mean ± SD / No. (%) 49
Table 2. Comparison of Preoperative and Postoperative VAS Scores and PNIF Values. Lowest
27.04 ± 6.03 31 (62.0) 19 (38.0)
participants. Ethics board approval was obtained from Dr Sadi Konuk Education and Research Hospital Ethical Board. Patients with chronic systemic diseases, allergic rhinitis, septal perforation, alar collapse, septal deviation, nasal obstruction, or history of any type of nasal surgery and those in which a spreader graft was applied were excluded. All patients underwent a full head and neck exam. Preoperative and postoperative photographs of the nasal profile (frontal, lateral, and oblique) were obtained. The visual analog scale (VAS) was used for the subjective evaluation of nasal obstruction (0 being the minimum, 10 being the maximum amount of nasal patency). Objective evaluation of nasal obstruction was performed with a peak nasal inspiratory flowmeter (PNIF). Peak nasal inspiratory flowmeter measurements were performed in a sitting position, under standardized conditions (ie, normal room temperature). Measurements were repeated 3 times and the best of 3 forced inspirations was recorded. Subjective and objective measurements were performed 1 day before the operation and at the fourth postoperative month. An open rhinoplasty procedure was performed on each patient by the same otolaryngologist (S.C.). During the operation, dorsal hump resection, removal of cartilage from the septum for use as a strut graft, application of a columellar strut, cephalic trim of lower lateral cartilage, median osteotomy, and high-low-high osteotomy (without removal of the Webster triangle) were performed. No interventions (such as septoplasty, turbinoplasty, spreader graft application, or alar button graft application) for increasing the nasal patency were made.
Statistical Analysis Descriptive statistics of the data were presented with mean, standard deviation, ratio, and frequency. KolmogorovSmirnov test was used to check for the distribution of variables. For repeated measurements, Wilcoxon’s test or paired t test was used. Analysis was performed using SPSS 21.0.
Results Fifty patients were included in this study; 31 patients were female (62%), and 19 were male (38%). The mean age of the patients was 27.04 ± 6.03 years (Table 1), ranging from 18 to 49 years.
VAS Preop Postop PNIF Preop Postop
Highest
6 5
9 9
80 80
150 150
Mean ± SD
P Value
7.36 ± 0.83 7.42 ± 0.73
.592
115.10 ± 17.45 115.30 ± 16.70
.830
Abbreviations: PNIF, peak nasal inspiratory flowmeter; VAS, visual analog scale.
The results of this study are outlined in Table 2. Preoperative mean VAS scores and PNIF values of the patients were 7.36 ± 0.83 and 115.10 ± 17.45, respectively. Postoperative mean VAS scores and PNIF values of the patients were 7.42 ± 0.73 and 115.30 ± 16.7, respectively. There was no statistically significant difference between any of the pre- and postoperative subjective and objective parameters (P > .05).
Discussion Patients undergoing septorhinoplasty have both esthetic and functional concerns. Rhinoplasty surgery has been shown to decrease the nasal airway.10,11 The nasal valve region is the place of maximum nasal flow resistance; therefore, even minor constrictions of this area with rhinoplasty can result in impairment of nasal airflow.12 Reduction rhinoplasty for cosmetic reasons was shown to decrease the minimal cross-sectional area (MCA; at the nasal valve) significantly by 22% to 25%; the MCA at the pyriform aperture decreased by 11% after osteotomies.10 Guyuron13 argued that nasal osteotomies do not affect the airway in most instances. Inadequate or excessive changing of the bone-cartilage framework by giving particular importance to the esthetic image may result in impaired function as well as impaired esthetic outcome.14 Acoustic rhinometry is a noninvasive, cheap, and objective method of evaluation of nasal obstruction.15 Acoustic rhinometry can measure the cross-sectional area of the anterior part of the nasal cavity; however, it has some limitations for evaluation of the posterior part of the nasal cavity.16 The advantage of peak nasal inspiratory flowmetry over acoustic rhinometry is that it is portable, is easier to use, is cheaper, and can evaluate left and right nasal cavities together or separately.9 In our study, we have shown that nasal patency is not affected subjectively or objectively following an esthetic rhinoplasty operation. Other studies have shown parallel results with our study.6,7,17 However, in these studies, procedures such as septoplasty, spreader graft application, or turbinoplasty have been performed to increase nasal patency.6,7,17 On the other
Downloaded from aor.sagepub.com at OhioLink on June 8, 2014
3
Celebi et al hand, rhinoplasty has been suggested to have the potential to decrease the airway dimensions and cause nasal obstruction.10,11 We believe that possible reasons for this include not paying special attention to the nasal valve region, over-resection of lower lateral cartilages, and performing low to low lateral osteotomy. Over-resection of lower lateral cartilages has been shown to cause nasal valve collapse.18 To our knowledge, our study is the first to evaluate nasal patency after esthetic rhinoplasty in patients without a deviated nasal septum. According to our results, rhinoplasty for esthetic purposes in patients without a nasal septal deviation does not result in a subjective or objective worsening in the nasal airway. We speculate that there are 3 reasons for this: the preservation of the Webster triangle11 with high to low osteotomy, proper amount of resection of the lower lateral cartilage, and application of strut graft to our patients. High to low osteotomy has been shown to cause the least narrowing of the nasal passage13 when compared with other types of osteotomies. No study has ever evaluated the effect of nasal tip rotation on the nasal airway; however, structured nasal tip refinement has been shown to have a significant effect on objective measurement with a PNIF.19 The effect of application of a strut graft on the nasal patency in rhinoplasty has been shown in 1 recent study by Pousti et al.20 The authors have demonstrated in a group of cases of rhinoplasty with or without septoplasty that placing a columellar strut has a significant effect at both MCA1 and MCA2 levels. One limitation of our study is that although we did not intend to include patients with a septoplasty procedure, a strut graft had to be harvested from the nasal septum. As suggested by Pousti et al,20 it is likely that even a minor intervention to the septum may have offered some small improvement in nasal patency that would be offset by any decrease in PNIF values as the result of osteotomies. Another limitation of our study is that we had to exclude patients receiving a spreader graft, although many cosmetic rhinoplasty patients present with a pinched middle vault. However, spreader graft application would increase nasal patency21,22 and cause a bias in interpreting our study’s results.
Conclusion Our study has shown that in patients with purely cosmetic concerns without preoperative breathing impairment, patients can be reassured that breathing will not likely change after a noncomplicated cosmetic rhinoplasty including osteotomies. Our results cannot be extended to those patients who have both cosmetic and functional concerns. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Xavier R. Does rhinoplasty improve nasal breathing? Facial Plast Surg. 2010;26:328-332. 2. Jang YJ, Kim JH. Classification of convex nasal dorsum deformities in Asian patients and treatment outcomes. J Plast Reconstr Aesthet Surg. 2011;64:301-306. 3. Adamson P, Smith O, Cole P. The effect of cosmetic rhinoplasty on nasal patency. Laryngoscope. 1990;100:357-359. 4. Haight JSJ, Cole P. The site and function of the nasal valve. Laryngoscope. 1983;93:49-55. 5. Webster RC, Davidson TM, Smith RC. Curved lateral osteotomy for airway protection in rhinoplasty. Arch Otolaryngol. 1977;103:454. 6. Erdogan M, Cingi C, Seren E, et al. Evaluation of nasal airway alterations associated with septorhinoplasty by both objective and subjective methods. Eur Arch Otorhinolaryngol. 2012;270:99-106. 7. Zoumalan RA, Constantinides M. Subjective and objective improvement in breathing after rhinoplasty. Arch Facial Plast Surg. 2012;14:423-428. 8. Pawar SS, Garcia GJ, Kimbell JS, Rhee JS. Objective measures in aesthetic and functional nasal surgery: perspectives on nasal form and function. Facial Plast Surg. 2010;26:320-327. 9. Ozkul HM, Balikci HH, Gurdal MM, et al. Normal range of peak nasal inspiratory flow and its role in nasal septal surgery. J Craniofac Surg. 2013;24:900-902. 10. Grymer LF. Reduction rhinoplasty and nasal patency: change in the cross-sectional area of the nose evaluated by acoustic rhinometry. Laryngoscope. 1995;105:429-431. 11. Grymer LF, Gregers-Petersen C, Baymler Pedersen H. Influence of lateral osteotomies in the dimensions of the nasal cavity. Laryngoscope. 1999;109:936-938. 12. Wittkopf M, Wittkopf J, Ries WR. The diagnosis and treatment of nasal valve collapse. Curr Opin Otolaryngol Head Neck Surg. 2008;16:10-13. 13. Guyuron B. Nasal osteotomy and airway changes. Plast Reconstr Surg. 1998;102:856-863. 14. Tahamiler R, Yener M, Canakcioglu S. Detection of nasal cycle in daily activity by remote evaluation of nasal sound. Arch Otolaryngol Head Neck Surg. 2009;135:137-142. 15. Chandra RK, Patadia MO, Raviv J. Diagnosis of nasal airway obstruction. Otolaryngol Clin N Am. 2009;42:207-225. 16. Hilberg O. Objective measurement of nasal cavity dimensions using acoustic rhinometry: methodological and clinical aspects. Allergy. 2002;57:5-39. 17. Edizer DT, Erisir F, Alimoglu Y, Gokce S. Nasal obstruction following septorhinoplasty: how well does acoustic rhinometry work? Eur Arch Otorhinolaryngol. 2012;270:609-613. 18. Cummings CW, Fredrickson JM, Harker LA, Krause CJ, Richardson MA, Schuller DE. Otolaryngology Head and Neck Surgery. 3rd ed. St Louis, MO: Mosby-Year Book; 1998. 19. Timperley D, Stow N, Srubiski A, Harvey R, Marcells G. Functional outcomes of structured nasal tip refinement. Arch Facial Plast Surg. 2010;12(5):298-304.
Downloaded from aor.sagepub.com at OhioLink on June 8, 2014
4
Annals of Otology, Rhinology & Laryngology
20. Pousti SB, Touisserkani S, Jalessi M, et al. Does cos metic rhinoplasty affect nose function? ISRN Otolaryngol. 2011;2011:615047. 21. Kim YH, Kim BJ, Jang TY. Use of porous high-density polyethylene (Medpor) for spreader or extended septal graft in
rhinoplasty: aesthetics, functional outcomes, and long-term complications. Ann Plast Surg. 2011;67:464-648. 22. Huang C, Manarey CR, Anand VK. Endoscopic placement of spreader grafts in the nasal valve. Otolaryngol Head Neck Surg. 2006;134:1001-1005.
Downloaded from aor.sagepub.com at OhioLink on June 8, 2014
