Kryukov A.I., Kunelskaya N.L., Turovsky A.B., Tsarapkin G. Yu., Kolbanova I.G., Aleksanyan T.A. One-step functional aesthetic rhinoplasty. Head and neck. Russian Journal. 2021;9(3):34–42 (In Russian).
The authors are responsible for the originality of the data presented and the possibility of publishing illustrative material – tables, figures, photographs of patients.
Purpose: to improve the aesthetic and functional results of surgical treatment of patients with congenital and acquired deformities of the external nose using the two-plane soft tissue dissection technique of the external nose. Material and methods: The study included 418 patients who underwent primary aesthetic nasal surgery (ANS). Patients were divided into the experimental and control groups. The patients of the experimental group underwent aesthetic surgery using the proposed method of the two-plane soft tissue dissection of the external nose in combination with functional nasal surgery (FNS). The FNS volume depended on the violations of the intranasal architectonics revealed. The control group patients underwent surgery according to the principles generally accepted for ANS. This group included patients who, for various reasons, did not undergo FNS.
Results: When analyzing the effectiveness of surgical treatment, functional results were assessed by the respiratory function testing of the nose in the operated patients according to the NOSE questionnaire and according to the data of anterior active rhinomanometry (AARM) before surgery and in the long-term postoperative period (after 1, 6, 12 months). The ANS results were assessed in the early post-operative period – 1 month, in the late post- operative period – 3 months, and in the long-term period – 12 months, using a 3-point system based on three objective components: aesthetic assessment (compliance with the preoperative model), functional assessment (comparison of pre- and postoperative results of AARM) and the presence of complications.
According to the results, in both groups, the initial data were comparable, the mean NOSE score in the experimental group was 3.5±0.71 at the preoperative stage, 2.9±1.05 after a month, 2.1±1.62 after 6 months, and 0.7±0.5 after 12 months. Concerning the symptoms: difficulty in nasal breathing – 2.75±0.48, nasal congestion – 2.5±0.31, sleep quality – 1.6±0.43, nasal breathing during exercise – 2.8±0.28. In the control group, the following values were obtained: total score before surgery – 3.5±0.37, after 1, 6 and 12 months – 3.05±0.65, 2.57±0.6, 1.67±0.35, respectively, and 2.9±0.55, 2.77±0.57, 1.9±0.37 and 2.95±0.47 for the symptoms.
According to the AARM data (total volume flow, total resistance) before surgery and 6 months after, the values were statistically significantly increased in patients who underwent simultaneous correction of the internal and external structures of the nose.When assessing ANS in the control group, over time, there were no significant differences in the number of the good, satisfactory and unsatisfactory results throughout the follow-up period. The changes of the results over time differed between the control and the experimental group, with the greater number of early (2.4% versus 5.9%, respectively) and long-term (1.8% versus 4.7%, respectively) unsatisfactory results in the control within the follow-up; over time, there was a decreasing number of satisfactory results and their conversion to good ones, which was statistically significant in the control group. In addition, in the same control group, the dynamics of results in the long-term period was characterized by declined increase in good results, which was less significant compared to the experimental group.
Conclusions: The use of an original method of aesthetic and functional nasal surgery with the two-plane soft tissue dissection of the external nose and various correction of intranasal structures has shown high efficiency, which made it possible to achieve full functional and aesthetic rehabilitation of the patients in most cases. The developed original method of aesthetic and functional nose surgery demonstrates a significant predominance of good results in the long-term period compared to the early one (80.1% versus 56.2%).
Key words: septoplasty, rhinoplasty, deviation of the nasal septum, external nose, external nose aesthetic surgery
Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study.