Reza Vaezeafshar1, Sami P Moubayed1, Sam P Most1. 1. Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, California.
Abstract
IMPORTANCE: Lateral wall insufficiency (LWI) is classified by the zone in which it occurs. Multiple techniques for treating LWI are described in the literature and are used, but no treatment approach has been widely adopted. OBJECTIVE: To establish an algorithm for treatment of LWI by evaluating subjective and objective outcomes of patients who underwent LWI repair and comparing these results with those of a control group who received no specific LWI repair. DESIGN, SETTING, AND PARTICIPANTS: This case-control study was conducted in a tertiary referral center. In group 1, there were 44 patients who underwent septorhinoplasty to repair LWI between February 1, 2014, and May 31, 2016. In group 2, there were 44 age- and sex-matched patients who underwent cosmetic septorhinoplasty without LWI repair. Data analysis was conducted from February 1, 2014, to May 31, 2016. INTERVENTION: Open septorhinoplasty. MAIN OUTCOMES AND MEASURES: Nasal Obstruction Symptom Evaluation (NOSE) scores and LWI grades. RESULTS: Forty-four patients (8 men and 36 women, with a mean [SD] age of 46 [16] years) who underwent open septorhinoplasty to repair LWI and 44 age- and sex-matched patients (composed of 8 men and 36 women, with a mean [SD] age of 41 [12] years) were included in the study. The mean (SD) preoperative NOSE scores were 69.4 (22) in group 1 and 20.5 (20.8) in group 2 (P < .001). The NOSE scores in both groups significantly improved after surgery (44.7 [95% CI, -28.9 to -49.9; P < .001] and -14.5 [95% CI, -2.7 to -18.5; P = .02]), although the improvement in group 2 was not clinically significant. The mean preoperative LWI grades were higher in group 1 than in group 2 for each zone (P < .001 and P = .001) but were similar between groups for each zone after surgery. Postoperative LWI scores significantly decreased in group 1 to levels similar to that of group 2. A positive linear correlation was noted between NOSE scores and LWI grades, with the strongest correlation between preoperative zone 1 LWI grades and NOSE scores (R = 0.68). Lateral crural strut grafts were used for zone 1 LWI and alar rim grafts were used for zone 2 LWI. CONCLUSIONS AND RELEVANCE: The LWI grading system enables surgeons to localize LWI, tailor the surgical treatment to the patient, and monitor improvements in the postoperative period. LEVEL OF EVIDENCE: 3.
IMPORTANCE: Lateral wall insufficiency (LWI) is classified by the zone in which it occurs. Multiple techniques for treating LWI are described in the literature and are used, but no treatment approach has been widely adopted. OBJECTIVE: To establish an algorithm for treatment of LWI by evaluating subjective and objective outcomes of patients who underwent LWI repair and comparing these results with those of a control group who received no specific LWI repair. DESIGN, SETTING, AND PARTICIPANTS: This case-control study was conducted in a tertiary referral center. In group 1, there were 44 patients who underwent septorhinoplasty to repair LWI between February 1, 2014, and May 31, 2016. In group 2, there were 44 age- and sex-matched patients who underwent cosmetic septorhinoplasty without LWI repair. Data analysis was conducted from February 1, 2014, to May 31, 2016. INTERVENTION: Open septorhinoplasty. MAIN OUTCOMES AND MEASURES: Nasal Obstruction Symptom Evaluation (NOSE) scores and LWI grades. RESULTS: Forty-four patients (8 men and 36 women, with a mean [SD] age of 46 [16] years) who underwent open septorhinoplasty to repair LWI and 44 age- and sex-matched patients (composed of 8 men and 36 women, with a mean [SD] age of 41 [12] years) were included in the study. The mean (SD) preoperative NOSE scores were 69.4 (22) in group 1 and 20.5 (20.8) in group 2 (P < .001). The NOSE scores in both groups significantly improved after surgery (44.7 [95% CI, -28.9 to -49.9; P < .001] and -14.5 [95% CI, -2.7 to -18.5; P = .02]), although the improvement in group 2 was not clinically significant. The mean preoperative LWI grades were higher in group 1 than in group 2 for each zone (P < .001 and P = .001) but were similar between groups for each zone after surgery. Postoperative LWI scores significantly decreased in group 1 to levels similar to that of group 2. A positive linear correlation was noted between NOSE scores and LWI grades, with the strongest correlation between preoperative zone 1 LWI grades and NOSE scores (R = 0.68). Lateral crural strut grafts were used for zone 1 LWI and alar rim grafts were used for zone 2 LWI. CONCLUSIONS AND RELEVANCE: The LWI grading system enables surgeons to localize LWI, tailor the surgical treatment to the patient, and monitor improvements in the postoperative period. LEVEL OF EVIDENCE: 3.
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Authors: Cherian K Kandathil; Emily A Spataro; Katri Laimi; Sami P Moubayed; Sam P Most; Mikhail Saltychev Journal: JAMA Facial Plast Surg Date: 2018-07-01 Impact factor: 4.611