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Original Investigation |

Outcomes of Open-Approach Extracorporeal Septoplasty Without Simultaneous Rhinoplasty Effects on Nasal Tip Projection and Rotation ONLINE FIRST

Ozlem Unsal, MD1; Gulpembe Bozkurt, MD1; Meltem Akpinar1; Pınar Akova, MD1; Bilge Turk, MD1; Berna Uslu Coskun1
[+] Author Affiliations
1Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Otorhinolaryngology & Head and Neck Surgery, Sisli, Istanbul, Turkey
JAMA Otolaryngol Head Neck Surg. Published online August 04, 2016. doi:10.1001/jamaoto.2016.1891
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Importance  Performing an open-approach extracorporeal septoplasty (OAES) without simultaneous rhinoplasty could have adverse effects. We sought to understand the effects of OAES without simultaneous rhinoplasty on nasal tip projection and rotation in patients with severe septal deviation.

Objectives  To evaluate the outcomes of OAES without simultaneous rhinoplasty in terms of nasal tip projection and rotation using objective measurements.

Design, Setting, and Participants  This retrospective study was conducted at a training and research hospital using medical records of 32 adult patients who underwent OAES without simultaneous rhinoplasty between April 10, 2012 and June 12, 2015. Patients who underwent endonasal septoplasty, revision septal surgery, septorhinoplasty, open-approach septoplasty with nasal tip plasty, or open-approach septoplasty without removal of the entire septal cartilage were excluded from the study. Postoperative photographs of the patients were taken at a mean (range) time of 16.4 (6-36) months after surgery. Nasolabial angle (NLA), nasofacial angle (NFA), and projection index (PI) were measured by the same surgeon on preoperative and postoperative lateral images.

Main Outcomes and Measures  Projection index was measured using the Goode method; NLA and NFA were measured drawing lines between specific facial points according to the literature. All measurements were compared statistically.

Results  Thirty-two adult patients (26 men and 6 women between ages 20 and 57 years) with severe septal deviation and underwent OAES without simultaneous rhinoplasty were included in the study. The postoperative values of NLA and NFA were observed to be decreased in all patients (100%). The PI was also determined to be decreased in 27 patients (84.6%) whereas it remained unchanged in 5 patients (15.4%). The overall postoperative mean values of NLA, NFA, and PI were found to be lower compared with preoperative mean values and the difference between them were determined to be statistically significant (NLA: 95% CI, 0.40-2.55, P = .005; NFA: 95% CI, 0.48-2.06, P = .003; and PI: 95% CI, 0.004-0.015, P = .002).

Conclusions and Relevance  This study reveals that the nasal tip lost height from facial plane and rotated caudally in most patients who underwent OAES without simultaneous rhinoplasty. Patients demanding only relief of nasal obstruction and scheduled for OAES have to be informed about the potential cosmetic alterations when a simultaneous rhinoplasty is not requested.

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Figure 1.
Open-Approach Extracorporeal Septoplasty Without Rhinoplasty

A, Preoperative lateral image of a patient who underwent open-approach extracorporeal septoplasty without rhinoplasty. B, Postoperative image of the same patient after open-approach extracorporeal septoplasty without rhinoplasty.

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Figure 2.
Examples of PI, NLA, and NFA Measurements

A, Measuring the PI using the Goode method, a line was drawn between nasion and alar crease that is perpendicular to the nasal tip-alar crease line. The length from nasal tip to the alar crease was devided by the length from nasal tip to the nasion. B, The NLA is the angle between the line from subnasale to nasal tip and the line from subnasale to upper lip vermilion border. C, The NFA is the angle between the line from glabella to pogonion and the line from nasion to the tip. C indicates alar crease; c, columella; G, glabella; N, nasion; NFA, nasofacial angle; NLA, nasolabial angle; P, pogonion; PI, projection index; s, subnasale; T, nasal tip; v, upper lip vermillion border.

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