Daudia A, Alkhaddour U, Sithole J, Mortimore S
Department of Otolaryngology, Queen's Medical Centre, University Hospital NHS Trust, Nottingham NG7 2AU, UK.
Acta Otolaryngol. 2006 Dec;126(11):1201-5. doi: 10.1080/00016480600672675.
Following nasal septal surgery, minor aesthetic changes may occur in up to 39.5% of patients and major changes in up to 4.5%. As part of the informed consent procedure, the potential for cosmetic changes should be discussed with all patients undergoing nasal septal surgery.
To objectively measure aesthetic changes following nasal septal surgery using pre- and post-operative photographic documentation and to highlight issues surrounding informed consent for nasal septal surgery.
The study population comprised 75 patients undergoing nasal septal surgery (septoplasty, submucous resection or revision nasal septal surgery). The main outcome measures were measurement of aesthetic changes (tip projection, supra-tip depression and columella retraction) using standardized pre- and post-operative photographic documentation examined by two independent observers. Patients' subjective perception of a change in shape of their nose was assessed using a visual analogue scale. The presence of any septal perforations was recorded at the follow-up visit (mean 15 months, range 8-13 months, standard deviation 4.2 months).
The agreement between the two observers was very good when we considered a 1 mm difference as insignificant. Changes were arbitrarily defined as minor if < or =2 mm, and major, if > or =3 mm. With tip projection there was a minor change in 39.5% and major in 4.5% of patients. Supra-tip changes were minor in 6.7% and major in 1.3%. Minor columella changes occurred in 22% of patients, but there were no major changes. There was no statistically significant correlation between patients' subjective perception of changes in the shape of their nose with objectively measured changes. The septal perforation rate was 6.7%. Multivariate analyses (ANCOVA) showed no statistically significant influences of age, gender, grade of surgeon or type of nasal septal procedure.
鼻中隔手术后，高达39.5%的患者可能出现轻微美学变化，高达4.5%的患者可能出现重大变化。作为知情同意程序的一部分，应与所有接受鼻中隔手术的患者讨论美容变化的可能性。
使用术前和术后的照片记录客观测量鼻中隔手术后的美学变化，并强调鼻中隔手术知情同意相关问题。
研究人群包括75例接受鼻中隔手术（鼻中隔成形术、黏膜下切除术或鼻中隔修复手术）的患者。主要观察指标是使用标准化的术前和术后照片记录测量美学变化（鼻尖突出度、鼻尖上凹陷和鼻小柱退缩），由两名独立观察者进行检查。使用视觉模拟量表评估患者对鼻子形状变化的主观感受。在随访时（平均15个月，范围8 - 13个月，标准差4.2个月）记录是否存在鼻中隔穿孔。
当我们将1毫米的差异视为不显著时，两名观察者之间的一致性非常好。变化被任意定义为：如果≤2毫米则为轻微变化，如果≥3毫米则为重大变化。对于鼻尖突出度，39.5%的患者有轻微变化，4.5%的患者有重大变化。鼻尖上变化轻微的占6.7%，重大的占1.3%。22%的患者有轻微鼻小柱变化，但没有重大变化。患者对鼻子形状变化的主观感受与客观测量的变化之间没有统计学上的显著相关性。鼻中隔穿孔率为6.7%。多变量分析（协方差分析）显示年龄、性别、外科医生级别或鼻中隔手术类型没有统计学上的显著影响。
