Overall quality of life impact on candidates for septorhinoplasty according to the World Health Organization quality of life brief questionnaire (WHOQOL-Brief) / Impacto geral na qualidade de vida em candidatos à septorrinoplastia de acordo com o World Health Organization Quality of Life Brief Questionnaire (WHOQOL-Brief)

Abstract Introduction: Quality of life has been an increasingly reference measure in whole health impact of diseases and in septorhinoplasty evaluation as well. It is known that the decision for this elective surgical procedure requires the subjective perception of patients' complaints about their own health and life stage in association with the surgeon's aesthetic and functional perspective of each case. Objective: To define the quality of life of candidates for septorhinoplasty using the World Health Organization quality of life questionnaire, WHOQOL-Brief, and the prevalence of other independent variables for this population. Methods: A cross-sectional study using a sample of candidates for septorhinoplasty was performed. All patients responded to the WHOQOL-Brief during the pre-operative period. A normative population quality of life study was the reference for the sample size and means. Results: A total of 302 patients were included among the 322 eligible patients. Twenty patients did not complete the questionnaire correctly and were excluded from the study. The sample consisted of patients aged between 15 and 78 years (34.7±14 years): the most majority were Caucasian and female. Among this group, 88.1% declared symptoms of nasal obstruction and 77.4% complained of sleeping problems. It was seen that 10.9% patients chose the surgery primarily for aesthetic improvement; 37.1% chose it mainly because of functional symptoms and 52% chose it for both functional and aesthetic reasons. The physical health domain's mean was 62.2 ± 17), which is a higher mean compared to the references' standard one (Μ = 58.9± 10.5, p = 0.002). The social relationship domain mean was 70.8±18.1; that is a lower mean then general population's one (Μ = 76.2± 18.8, p < 0.001). The psychological and the environment domain means revealed no difference when comparing the sample to the norm (μ = 65.3 ±15.1 vs. μ = 65.9 ±10.8, p = 0.530 and μ = 60.3 ±13.1 vs. μ = 59.9 ± 14.9, p = 0.667). Conclusion: The WHOQOL-Brief questionnaire proved an accurate instrument to cross-check different populations in quality of life outcomes. The study provides good evidence of lower quality of life in social relations domain and high prevalence of nasal obstruction and sleeping symptoms in candidates for septorhinoplasty. This study contributes to recent literature with relevant data supporting a more integrative evaluation in this population in the preoperative period. The results may also encourage a multidisciplinary approach for chronic symptoms when associated with nasal obstruction, sleep disorders and aesthetic complaints.

Resumo Introdução: A qualidade de vida tem sido cada vez mais uma medida de referência no impacto total das doenças na saúde e também na avaliação da septorrinoplastia. Sabe-se que a decisão por esse procedimento médico eletivo requer a percepção subjetiva da queixa do paciente sobre sua própria saúde e estágio de vida em associação com a perspectiva estética e funcional do cirurgião de cada caso. Objetivo: Definir a qualidade de vida de pacientes candidatos à septorrinoplastia por meio do questionário de qualidade de vida da OMS, WHOQOL-Brief e a prevalência de outras variáveis independentes para essa população. Método: Foi feito um estudo transversal com uma amostra de candidatos à septorrinoplastia. Todos os pacientes responderam ao WHOQOL-Brief no momento pré-operatório. Um estudo normativo de qualidade de vida populacional foi a referência para o tamanho e as médias da amostra. Resultados: Foram incluídos 302 pacientes entre os 322 elegíveis. Vinte pacientes não preencheram o questionário corretamente e foram excluídos do estudo. A amostra foi composta por pacientes entre 15 e 78 anos (34,7 ± 14 anos) e a maioria era branca e do sexo feminino. Entre todos, 88,1% declararam sintomas de obstrução nasal e 77,4% declararam ter sintomas durante o sono. Observou-se que 10,9% dos pacientes optaram pela cirurgia principalmente para melhoria estética; 37,1% optaram principalmente devido a sintomas funcionais e 52% optaram por queixa funcional e estética. A média do domínio saúde física foi de 62,2 ± 17, uma média mais alta em comparação com o padrão de referências (μ = 58,9 ± 10,5, p = 0,002). A média do domínio do relacionamento social foi de 70,8 ±18,1, uma média inferior à da população geral (μ = 76,2 ± 18,8, p < 0,001). As médias dos domínios psicológico e meio ambiente não diferiram na comparação da amostra com o normativo (μ = 65,3 ±15,1 vs. μ = 65,9 ± 10,8, p = 0,530 e μ = 60,3 ±13,1 vs. μ = 59,9 ± 14,9, p = 0,667). Conclusão: O questionário WHOQOL-Brief demonstrou servir como um instrumento preciso para cruzar diferentes populações nos desfechos de qualidade de vida. O estudo fornece boas evidências de menor qualidade de vida no domínio relações sociais e alta prevalência de obstrução nasal e sintomas durante o sono em candidatos à septorrinoplastia. Este estudo contribui para a literatura recente com dados relevantes que subsidiam uma avaliação mais integrativa nessa população no momento pré-operatório. Os resultados também podem incentivar uma abordagem multidisciplinar para os sintomas crônicos quando associados, como ocorre na obstrução nasal, distúrbios do sono e queixas estéticas.

Outcomes of external septorhinoplasty in a Turkish male population / Resultados de rinosseptoplastia externa em uma população turca do sexo masculino

Abstract Introduction The first and one of the most important steps in facial plastic surgery is accurate preoperative facial analysis and recording of data that may help the surgeon to check the outcomes of his/her techniques, promoting a surgeon's professional development. Objective To evaluate the esthetic outcomes of external septorhinoplasty relevant to ethnic facial harmony and to investigate the relationship of the columellar incision scar with the type of skin and columellar incision type in a Turkish population. Methods In total, 28 consecutive adult male patients with a mean age of 32.14 ± 10.66 years (range: 18-61 years) were included the study. Primary outcomes were preoperative and postoperative photogrammetric facial analyses of the patients including measurement of nasofrontal angle, nasolabial angle and nasal projection ratios (Gode) assessed according to the data derived from the Rhinobase program. Results were compared to facial proportions of the Turkish population. Columellar incision scar scores related to the Fitzpatrick skin type classification of the patients and columellar incision types used for the external approach were secondary outcomes of the study. Results Mean preoperative and postoperative nasofrontal angles were 148.04° ± 8.18° and 144.50° ± 7.15°, respectively, while mean preoperative and postoperative nasolabial angles were 87.59° ± 14.01° and 98.50° ± 9.71°, respectively. Mean preoperative and postoperative nasal tip projection ratios were 0.56 ± 0.05 and 0.60 ± 0.06, respectively. The differences between pre- and postoperative measurements were all significantly different and were in accordance with Turkish nasal harmony. Columellar inverted "V" incisions were performed in 15 (53.6%) patients while "V" incisions were used in 13 (46.4%) patients. Fitzpatrick skin Type 4 was seen in 46.42% of the patients, Fitzpatrick Type 3 in 46.42% and Fitzpatrick Type 2 in 7.14% of the patients. No significant difference was seen between columellar scar scores according to skin type and columellar incision type used for external septorhinoplasty. Conclusions This study demonstrated that outcomes for nasofrontal angle, nasolabial angle and nasal tip projection ratios analyzed using the Rhinobase program in patients who underwent external septorhinoplasty were similar to reference values for the Turkish population.

Resumo Introdução O primeiro e um dos mais importantes passos na cirurgia plástica facial é a análise pré-operatória facial precisa e o registro de dados que podem ajudar o cirurgião a verificar os resultados de suas técnicas, promovendo seu desenvolvimento profissional. Objetivo Avaliar os resultados estéticos da rinosseptoplastia externa relevantes para a harmonia étnica facial e investigar a associação da cicatriz de incisão columelar com o tipo de pele e o tipo de incisão columelar em uma população turca. Método No total, 28 pacientes adultos consecutivos com média de idade de 32,14 ± 10,66 anos (intervalo: 18-61 anos) foram incluídos no estudo. Os desfechos primários foram as análises faciais fotogramétricas pré-operatórias e pós-operatórias dos pacientes, incluindo a medida do ângulo nasofrontal, ângulo nasolabial e razões da projeção nasal (Gode), avaliados de acordo com os dados derivados do programa Rhinobase. Os resultados foram comparados às proporções faciais da população turca. Os escores de cicatriz de incisão columelar relacionados com a classificação de Fitzpatrick do tipo de pele dos pacientes e os tipos de incisão columelar usados para a abordagem externa foram os desfechos secundários do estudo. Resultados Os ângulos nasofrontais pré- e pós-operatórios médios foram 148,04 ± 8,18° e 144,50 ± 7,15°, respectivamente, enquanto os ângulos nasolabiais pré- e pós-operatórios médios foram 87,59 ± 14,01° e 98,50 ± 9,71°, respectivamente. As razões médias da projeção nasal pré- e pós-operatória foram de 0,56 ± 0,05 e 0,60 ± 0,06, respectivamente. As diferenças entre as medidas pré- e pós-operatórias foram todas significativamente diferentes e estavam de acordo com a harmonia nasal turca. A incisão columelar em "V" invertido foi utilizada em 15 (53,6%) pacientes e a incisão em "V" foi utilizada em 13 (46,4%) pacientes. Pele Fitzpatrick tipo 4 foi observada em 46,42% dos pacientes, Fitzpatrick tipo 3 em 46,42% e Fitzpatrick tipo 2 em 7,14% dos pacientes. Não foi observada diferença significativa entre os escores de cicatriz columelar de acordo com o tipo de pele e o tipo de incisão columelar utilizados na rinosseptoplastia externa. Conclusões Este estudo demonstrou que os desfechos para ângulo nasofrontal, ângulo nasolabial e razões de projeção nasal analisados pelo programa Rhinobase em pacientes submetidos à rinosseptoplastia externa foram semelhantes aos valores de referência para a população turca.

Evaluation and Treatment of Nasal Obstruction Developed after Rhinoplasty / 대한이비인후과학회지

Nasal airway obstruction is one of the most frequent causes of revision rhinoplasty despite the golden rule that nasal function should not be sacrificed because of cosmetic reason. Nasal function is jeopardized due to diverse reasons including inaccurate diagnosis or inadequate surgical technique. Detailed and thorough evaluation of the nose with review of previous operative technique is necessary to find out exact causes of obstruction. Septum, middle vault, tip, nostril, and nasal mucosa are common anatomic areas of obstruction after rhinoplasty. They are often weakened, damaged, or even destroyed losing their original shape, strength, or position. Changes in these anatomic structures are strongly related to static and/or dynamic obstruction. In this article, authors reviewed the common locations, anatomic causes, and treatment strategies of nasal obstruction after rhinoplasty.

An initial survey of septorhinoplasty in crooked nose deformities

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> Crooked  nose  deformity  is  a  commonly  seen  reason  for  septorhinoplasty  in  the otolaryngology clinic. The purpose of this study is to initially determine the different etiologies of  patients  with  crooked  nose  deformities  who  underwent  septorhinoplasty,  and  to  describe the different types of crooked nose by their level of deviation and surgical management in our institution.<br /><strong>METHODS:</strong><br /> <strong>  Design:</strong> Case Series<br />  <strong> Setting:</strong> Tertiary Public University Hospital<br /> <strong> Participants:</strong> A chart review of all patients with a crooked nose deformity who were admitted  at the otorhinolaryngology ward of the National University Hospital and underwent septorhinoplasty from January 2012 to January 2015 was conducted, and data consisting of age, sex, etiology of crooked nose deformity, level of deviation, cartilage source, and surgical intervention were obtained and analyzed.<br /><strong>RESULTS:</strong> A total of 21 patients underwent septorhinoplasty for crooked nose deformity  in  the study period. The most common etiology for crooked nose was physical violence (13/21 or 62%), followed by sports injury (4/21 or 19%), vehicular accidents (2/21 or 9%), and accidental fall (1/21 or 5%). There were more upper and middle third deviations than lower third deviations. Sixteen out of 21patients  (76%) underwent  open  rhinoplasty,  while  the  rest underwent an endonasal approach. Twelve (57%) underwent intervention  on  the  nasal  fracture after at least a year (old or  neglected  fracture) as compared to the 9 (43%) who had  immediate intervention after less than two weeks. Thirteen used septal cartilage, while 4 used conchal cartilage, and 1 used tragal cartilage. The most common grafts used were spreader  and camouflage, followed closely by dorsal onlay, and columellar strut grafts.<br /><strong>CONCLUSION:</strong> The majority of crooked nose deformities that were subjected to septorhinoplasty in our department were secondary to old nasal bone fractures caused by physical violence. Upper and middle  third level deviations were more common, and most underwent open rhinoplasty with autologous cartilage grafts. Future studies may increase our understanding of, and improve our techniques in septorhinoplasty for crooked nose deformities in Filipino noses in particular, and Asian noses in general. </p>

Comparative analysis between three lines reduce tension septorhinoplasty and nasal septum submucous resection / 中国基层医药

Objective To evaluate the advantages of nasal septum deviation with three lines reduce tension septorhinoplasty under endoscopy.Methods Three lines reduce tension septorhinoplasty of 48 cases were compared with nasal septum submucous resection(Killian) of 43 cases.Results Followed-up for 3 months to 1 year postoperation,study group were remedied and no clinical symptoms,no complications,control group had septal perforation of 1 case,nasal synechia of 2 cases,saddle nose of 1 case.The incidence of two groups postoperative complications had statistically significant difference.Conclusion Compared with Killian,three lines reduce tension septorhinoplasty was easy to stuty and have the advantages of micro-invasion,safety and efficiency,and was favorable recovery nasal cavitysinuses physiological functions.

Effectiveness of Decortication Septorhinoplasty via External Approach

The purpose of this article is to describe an alternative approach to the nasal septum and the advantages offered by the decortication septorhinoplasty in correcting difficult nasal deformities. Using the Decortication septorhinoplasty approach, the entire cartilagenous septum can be exposed so that each specific deformity can be visualized and corrected appropriately. Retracting the lateral crura laterally, a midline plane is dissected, and the anterior septal angle and dorsal margin of the septal cartilage is identified. The elevation of the mucoperichondrium is started at the area of the anterior septal angle. After anterior approach, scissors are inserted between the septal cartilage and the upper lateral cartilage and their junction is sharply divided. Elevation of the rest of the mucoperichondrium is completed as a skeletonized single unit. Sculpting the entire cartilagenous and/or bony vault, as well as correcting difficult septal malalignments, can be carried out under better direct vision with great precision, accuracy, and predictability. From January 2000 till March 2001 the decortication approach is used for correcting difficult nasal deformity in 24 patients. Of these, 5 are secondary cleft lip nose, 10 are deviated nose, 5 are traumatic saddle nose, and 4 are hump nose. The mean follow up period is 12 months, ranging from 5 to 20 months. The patients are overall satisfied with the aesthetic and functional results. The disadvantage and complication of the Decortication septorhinoplasty is the same as compared to the conventional open rhinoplasty. The decortication approach is most suited for correction of deformities at the dorsal aspect of the nasal septum that causes a twisted nose deformity, of deformities at the anterior septal angle causing an asymmetric tip, and of deformities along the caudal aspect of the quadrangular cartilage producing columellar distortion, and of relational deformities between anterior nasal spine and septum. The decortication technique has provided a effective avenue for the correction of severe nasal deformities.

Simultaneous septorhinoplasty / 中华医学美学美容杂志

Objective To introduce a new septorhinoplastic method for twisted nose, humped nose and hawk nose as well as deviation of nasal septum, and to evaluate its operative method and effect. Methods The incision of cleft between lateral nasal cartilage and greater alar cartilage was employed in all patients. The method of unilateral mucoperiosteal flap osteotomy was used to correct nasal pyramid deformity, and swinging-door operation was performed to correct the deviation of nasal septum simultaneously. Results The operative results of 36 cases were effective and satisfactory. Postoperative follow-up ranged from one year to fifteen years. Based on the results of follow-up in the 32 cases, no recurrence and complications were found in all the cases. Conclusion This new method for septorhinoplasty avoids the detachment and move of nasal bone and nasal septum cartilage and injury of nasal mucoperiosteum, and maintains the blood supply of nasal bone and nasal septum cartilage. It corrects extero-nasal deformity as well as deviation of nasal septum. The operation is effective in nose aesthetic and ventilatory function.