Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts.
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.
JAMA Facial Plast Surg. 2019 Jul 1;21(4):305-311. doi: 10.1001/jamafacial.2018.2118.
Spreader grafts have been shown to improve nasal airway obstruction in patients with nasal valve dysfunction; however, their use has been limited by concerns over their aesthetic penalty of widening the nasal dorsum.
To evaluate the association of functional septorhinoplasty (FSRP) using spreader graft placement with patient satisfaction with nasal appearance postoperatively.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study was conducted in a university-based tertiary care medical center. All participants were patients undergoing FSRP for the treatment of nasal obstruction who had spreader grafts placed between June 2016 and May 2018.
The Nasal Obstruction Symptom Evaluation (NOSE) scale and the FACE-Q Satisfaction With Nose, FACE-Q Satisfaction With Nostrils, and FACE-Q Social Functioning scales were administered to patients preoperatively and at 2, 4, 6, and 12 months postoperatively. Patient demographics, nasal history, and outcomes were analyzed.
Comparison of preoperative and postoperative NOSE and FACE-Q scores.
A total of 154 patients (72 male [46.8%]) with mean (SD) age of 36.8 (15.4) years underwent FSRP with spreader graft placement. Mean (SD) last follow-up was 5.8 (4.1) months postoperatively (range, 2-12 months). Fifty-seven patients had 6 months follow-up, and 42 patients had at least 12 months of follow-up. At time of last follow-up, mean (SD) NOSE and FACE-Q Satisfaction With Nose, Satisfaction With Nostrils, and Social Functioning scores significantly improved from 62.7 (20.7) to 22.8 (21.0) (P < .001), 54.7 (22.2) to 76.2 (25.1) (P < .001), 59.4 (27.9) to 83.6 (24.8) (P < .001), and 73.6 (21.8) to 81.7 (21.9) (P < .001), respectively. When separated into those with only spreader grafts (n = 89) and those with spreader grafts plus other graft types (n = 65), there was no significant difference between score improvements in the 2 groups. There were no significant differences in final nasal appearance scores between patients undergoing functional vs dual functional and cosmetic FSRP.
Despite concerns that placement of spreader grafts for the treatment of nasal obstruction due to nasal valve dysfunction during FSRP may have a negative impact on nasal aesthetics, this study shows that both nasal obstruction and patient satisfaction with their nasal appearance were significantly improved following surgery.
已经证明，在患有鼻阀功能障碍的患者中，使用扩鼻器移植物可以改善鼻气道阻塞;然而，由于担心扩大鼻背的美学损失，其使用受到限制。
评估功能性鼻中隔成形术（FSRP）联合使用扩鼻器移植物与术后患者对鼻外观满意度的关系。
设计、地点和参与者：这项前瞻性队列研究在一所大学的三级护理医疗中心进行。所有参与者均为因鼻阻塞而接受 FSRP 治疗的患者，并在 2016 年 6 月至 2018 年 5 月期间放置了扩鼻器移植物。
在术前和术后 2、4、6 和 12 个月时，使用鼻腔阻塞症状评估（NOSE）量表和面部-Q 鼻部满意度、面部-Q 鼻孔满意度和面部-Q 社会功能量表对患者进行评估。分析患者的人口统计学、鼻部病史和结果。
比较术前和术后的 NOSE 和 FACE-Q 评分。
共 154 例患者（72 例男性[46.8%]），平均年龄（标准差）为 36.8（15.4）岁，接受了 FSRP 联合扩鼻器移植物置入术。平均（标准差）最后一次随访时间为术后 5.8（4.1）个月（范围，2-12 个月）。57 例患者有 6 个月的随访，42 例患者有至少 12 个月的随访。最后一次随访时，NOSE 和 FACE-Q 鼻部满意度、鼻孔满意度和社会功能评分分别从 62.7（20.7）显著改善至 22.8（21.0）（P < .001）、54.7（22.2）改善至 76.2（25.1）（P < .001）、59.4（27.9）改善至 83.6（24.8）（P < .001）和 73.6（21.8）改善至 81.7（21.9）（P < .001）。当分为仅使用扩鼻器移植物（n = 89）和使用扩鼻器移植物加其他移植物类型（n = 65）的患者时，两组的评分改善没有显著差异。行功能性 FSRP 与双重功能性和美容性 FSRP 的患者之间，最终鼻部外观评分无显著差异。
尽管有担心在 FSRP 中因鼻阀功能障碍而放置扩鼻器移植物可能会对鼻美学产生负面影响，但本研究表明，术后鼻气道阻塞和患者对鼻外观的满意度均显著改善。
3。
