Difference in Perception of Nasal Aesthetic Appearance Between Surgeons and Rhinoplasty Patients: A Single-Center Perspective.

BACKGROUND: Patient satisfaction is an essential outcome measure after a rhinoplasty. Yet it is not known whether the opinions of rhinoplasty patients and surgeons on nasal aesthetic appearance differ. OBJECTIVES: The aim of this study was to determine the differences between patients and surgeons in their perception of nasal aesthetic appearance. METHODS: A retrospective cohort of 300 patients seen in consultation for cosmetic, functional, or combined cosmetic and functional rhinoplasty at a single tertiary care center from June 2017 to June 2020 was studied. Based on preoperative patient images, 6 surgeons with varying levels of expertise assessed nasal aesthetics utilizing a modified Standardized Cosmesis and Health Nasal Outcomes Survey for nasal cosmesis (SCHNOS-C). These scores were then compared to the patient-reported SCHNOS-C scores. RESULTS: The cosmetic, functional, and combined subgroups consisted of 100 patients each. The mean [standard deviation] age was 35.4 [13.7] years and 64% were women. The modified SCHNOS-C scores were well-correlated among the 6 surgeons but showed only weak correlations of 0.07 to 0.20 between patient-reported scores and scores assessed by the surgeons. Compared with the surgeon's scores, patients in the cosmetic subgroup perceived their nasal aesthetic problems to be more severe whereas the those in the functional subgroup perceived their nasal aesthetic problems to be milder compared with the surgeons' assessment. CONCLUSIONS: Our findings suggest that patients and surgeons perceive nasal cosmesis differently. This difference should be considered carefully when planning rhinoplasty or assessing its outcome.

Matched Cohort Comparison of Dorsal Preservation and Conventional Hump Resection Rhinoplasty.

BACKGROUND: Structural preservation techniques (SPR) minimize disruption of the dorsal aesthetic lines, with potential aesthetic and functional benefits over conventional hump resection techniques (CHR). The goal of this study is to compare patient reported outcomes between these techniques. METHODS: This study was a retrospective matched cohort analysis of patients undergoing rhinoplasty with dorsal hump reduction using patient-reported outcomes measures: Standardized Cosmesis and Health Nasal Outcomes Survey (obstructive: SCHNOS-O, cosmetic: SCHNOS-C) and visual analog scale (functional: VAS-F, cosmetic: VAS-C). A cohort of patients undergoing SPR were matched to a cohort undergoing CHR based on age, gender, and preoperative SCHNOS scores. Intraoperative techniques and patient-reported outcomes were compared between groups. RESULTS: There were no significant differences in the dorsal height between groups. While radix grafting was more common in SPR, dorsal onlay grafting and midvault reconstructive techniques (e.g. autospreader flaps) were more common in CHR. Within both groups, post-operative SCHNOS and VAS improved significantly at short- and long-term follow-up. There were no differences between SCHNOS or VAS scores preoperatively. Post-operative SCHNOS-O and SCHNOS-C scores were similar between groups at both short-term and long-term follow-up. Post-operative VAS-F scores were not different; however, VAS-C scores at short-term follow-up were statistically greater in the SPR group compared to the CHR group (8.92 vs 8.20, p = 0.03). At long-term follow-up, the difference was not significant. CONCLUSION: While there are theoretical functional and aesthetic benefits of SPR techniques, the patient reported benefits may be minimal when compared to CHR techniques with appropriate midvault reconstruction. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Safety and Efficacy of Spreader Grafts and Autospreaders in Rhinoplasty: A Systematic Review and Meta-analysis.

BACKGROUND: The aim of this study was to systematically evaluate the evidence of surgical outcomes and complications of spreader grafts and autospreader flaps in the context of middle vault reconstruction after dorsal hump removal. MATERIAL AND METHODS: A systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Inclusion and exclusion criteria were based on the population, intervention, comparison, and outcome (PICO) framework. Medline (via PubMed), EMBASE, Cinahl, Scopus, and Web of Science were searched for Clinical and observational studies published in peer-reviewed academic journals with abstracts available that reported rhinoplasty employing either spreader graft or autospreader flap techniques and were published prior to March, 2021. RESULTS: Fifty-two of 1129 relevant studies were included in the qualitative analysis. Thirty-four studies (65.4%) were related to spreader graft (SG), 10 (21.1%) studies of autospreader flap (AF) alone and 8 (13.5%) studies involving both grafts. Meta-analysis was performed on 17 studies reporting change in NOSE scores, with pooled effect of - 23.9 (95% CI, - 26.7 to - 21.1) points. High heterogeneity with I2 = 99%. Summary data showed no differences between groups, AF group versus no graft (p = 0.7578), AF versus SF group (p = 0.9948), and SG group versus no graft (p = 0.6608). CONCLUSION: Based on available data, change in NOSE scores after rhinoplasty was similar in procedures that used spreader graft only or autospreader flap only. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Global Practice Patterns of Dorsal Preservation Rhinoplasty.

Background: Dorsal preservation rhinoplasty (DPR) has recently received significant academic attention in part due to theoretical benefits over excisional surgical methods. The purpose of this study was to assess the global practice patterns regarding this technique. Materials and Methods: An 11-item questionnaire was electronically distributed to regional academies/societies representing rhinoplasty surgeons worldwide. Respondent exposure to and use of DPR were assessed based on geographic location. Results: Eight hundred thirty-six responses were received. Despite early publications on DPR originating largely from Western Europe and the United States, Turkey and Mexico have the greatest use of DPR techniques currently. The familiarity across many regions with preservation techniques appear to be secondary to courses and conferences rather than incorporation into training. Mexico demonstrates the greatest exposure to DPR during training. One hundred twenty-five respondents had previously used but abandoned dorsal preservation techniques. Poor results, less predictability, and complications (largely hump recurrence) are cited as common reasons for this. Conclusion: There is variability in the global practice of DPR across regions and this will likely continue to evolve.

Outcome of Free Diced Cartilage Grafts in Rhinoplasty: A Systematic Review.

Diced cartilage grafts are used to increase and refine the nasal contour, providing easy molding and versatility when compared with block grafts. However, all grafts present the possibility of visibility, distortion, and absorption. The aim of this study is to evaluate, through a systematic review, the outcome of the use of the free diced graft cartilage in rhinoplasty. A systematic search of the literature was performed in the databases (PubMed, Lilacs, Scielo, Cochrane) with the terms "diced cartilage" and "rhinoplasty." Studies were selected according to the inclusion and exclusion criteria and data extracted and grouped for analysis. Six eligible studies were included. In total, 4,044 patients underwent rhinoplasty with free diced cartilage graft, with 61 (1.51%) of them requiring reoperation. The main reasons were overcorrection and irregularities of the nasal dorsum. The infection rate was reported in three studies, with 2 (0.06%) of 3,252 patients presenting infection at the graft site. Two cases of displacement were treated with external molding, without reoperation. The graft resorption was reported in four articles, which described 22 (0.67%) cases of partial resorption in 3,288 patients. Therefore, the available evidence suggests that resorption of the graft and unfavorable outcomes are rare.

Tratamento com corticoide intratimpânico na doença de Ménière e seu impacto na qualidade de vida / Intratympanic corticosteroid treatment in meniere's disease and its impact on quality of life

A doença de Ménière foi descrita por Prosper Ménière, em 1861. A sua etiologia pode estar associada a processos infecciosos de natureza viral ou bacteriana, doenças imunomediadas, anormalidades no desenvolvimento do osso temporal, predisposição genética, trauma, otospongiose, entre outras. O diagnóstico é eminentemente clínico. Caracteriza-se por episódios recorrentes e espontâneos de vertigem, perda auditiva flutuante, do tipo neurossensorial, zumbido e plenitude aural. O tratamento pode ser clínico ou cirúrgico. O tratamento clínico consiste no alívio dos sintomas. Estudos evidenciam a prevalência do uso de alguns medicamentos em elucidação clínica, tais como: moduladores de fluxo sanguíneo, vasodilatadores, bloqueadores de canais de cálcio, diuréticos, anticonvulsivantes, antidepressivos, corticoides orais e sedativos. Quando o tratamento clínico não apresenta a resolução esperada, pode ser indicado o tratamento cirúrgico, sendo o principal: a cirurgia do saco endolinfático. O tratamento com corticoide intratimpânico (CI) vem sendo utilizado como terapia complementar ou adjuvante, em pacientes refratários ao tratamento com medicação via oral. Avalia-se a possibilidade de grande melhora da sintomatologia e da qualidade de vida dos pacientes com doença de Ménière, com remissão do quadro clínico e menor intervenção quando comparado ao tratamento cirúrgico. Este trabalho tem por objetivo avaliar as implicações do tratamento com corticoterapia intratimpânica em um grupo de pacientes acompanhados no serviço de Otorrinolaringologia do Hospital do Servidor Público Municipal de São Paulo. Foram utilizados os questionários desenvolvidos especificamente para tontura e zumbido ­ o Dizziness Handicap Inventory (DHI) e o Tinnitus Handicap Inventory (THI), respectivamente

Tratamento com corticoide intratimpânico na Doença de Ménière e seu impacto na qualidade de vida / Treatment with intratympanic corticosteroids in Ménière's Disease and its impact on quality of life

RESUMO A doença de Ménière foi descrita por Prosper Ménière, em 1861. A sua etiologia pode estar associada a processos infecciosos de natureza viral ou bacteriana, doenças imunomediadas, anormalidades no desenvolvimento do osso temporal, predisposição genética, trauma, otospongiose, entre outras. O diagnóstico é eminentemente clínico. Caracteriza-se por episódios recorrentes e espontâneos de vertigem, perda auditiva flutuante, do tipo neurossensorial, zumbido e plenitude aural. O tratamento pode ser clínico ou cirúrgico. O tratamento clínico consiste no alívio dos sintomas. Estudos evidenciam a prevalência do uso de alguns medicamentos em elucidação clínica, tais como: moduladores de fluxo sanguíneo, vasodilatadores, bloqueadores de canais de cálcio, diuréticos, anticonvulsivantes, antidepressivos, corticoides orais e sedativos. Quando o tratamento clínico não apresenta a resolução esperada, pode ser indicado o tratamento cirúrgico, sendo o principal: a cirurgia do saco endolinfático. O tratamento com corticoide intratimpânico (CI) vem sendo utilizado como terapia complementar ou adjuvante, em pacientes refratários ao tratamento com medicação via oral. Avalia-se a possibilidade de grande melhora da sintomatologia e da qualidade de vida dos pacientes com doença de Ménière, com remissão do quadro clínico e menor intervenção quando comparado ao tratamento cirúrgico. Este trabalho tem por objetivo avaliar as implicações do tratamento com corticoterapia intratimpânica em um grupo de pacientes acompanhados no serviço de Otorrinolaringologia do Hospital do Servidor Público Municipal de São Paulo. Foram utilizados os questionários desenvolvidos especificamente para tontura e zumbido ­ o Dizziness Handicap Inventory (DHI) e o Tinnitus Handicap Inventory (THI), respectivamente. Palavras-chave: Otorrinolaringologia, Doença de Mèniére, Betaistina, Corticoide Injetável.