Outcome of Septorhinoplasty in Deviated Nose Deformity: One Year Cross-Sectional Study

Abstract

To evaluate outcome of Septorhinoplasty in Deviated nose deformity using Nasal Obstruction Symptom Evaluation (NOSE) scale and Rhinoplasty outcome evaluation score (ROE). This observational study was conducted in the department of Otorhinolaryngology and Head and Neck Surgery of KLE University’s Jawaharlal Nehru Medical College and KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi from January 2015 to December 2015. Forty patients were evaluated and comparisons were made for NOSE score preoperatively and postoperatively. Comparison of decrease in NOSE score with age distribution, sex distribution, type of septorhinoplasty, ROE score of patients and ROE score of surgeons were also made. ROE score of patients and ROE score of surgeons were correlated. Their statistical significance (p value) and Cohen’s kappa (k) were calculated. Out of 40 patients, there were total of 16 Open Septorhinoplasty cases and 24 Close septorhinoplasty cases. NOSE score preoperatively and postoperatively showed statistically significant i.e., total score (p = 0.001). ROE score of patients and surgeons had poor correlation (k = 0.1; p = 0.2). Decrease in NOSE score postoperatively with ROE score of patients showed statistically significant (p = 0.01). There was no significance on comparison of decrease in NOSE score postoperatively with ROE score of surgeons (p = 0.09), age distribution (p = 0.1), sex distribution (p = 0.2) and septorhinoplasty (open/close) (p = 0.2). The outcome of septorhinoplasty has been validated with NOSE scale and ROE score and has been proven that there is improvement in nasal obstruction and quality of life after septorhinoplasty. The quality of life scoring is essential for patients subjected to septorhinoplasty for assessing success of the surgery.

Introduction

The nose is a central and prominent structure of the face. It is not only meant for breathing and perception of smell but also associated with facial aesthetics more than any other structure of the face. A deformity of the nose can significantly alter ones facial appearance or result in nasal complaints. External nasal deformity may have its anatomical basis in defect of bony pyramid, cartilaginous framework defect, septal deformity or combination of these vectors. Most common deformity is crooked/scoliotic nose (about 52%). It has been shown that 58% newborn babies have some sort of septal deviation and 4% of which have associated external nasal deformity [1–3].

Quality-of-life (QOL) being in relation to health of the nose. It’s proportionately important to perform septorhinoplasty for any symptoms associated with nasal deformity. The nasal obstructive symptoms evaluation (NOSE) scale is a disease specific quality of life instrument measuring the effectiveness of functional rhinoplastic techniques and the Rhinoplasty outcome evaluation (ROE) score used in assessing results of surgical treatment, quality of life (QOL), respiratory function and cosmetic result by patients subjected to septorhinoplasty [4, 5]. Hence, the present study is carried out to assess the outcome of the surgical intervention in deviated nose deformity i.e., septorhinoplasty.

Materials and Methods

This observational study was conducted in the department of Otorhinolaryngology and Head and Neck Surgery of KLE University’s Jawaharlal Nehru Medical College and KLES Dr. Prabhakar Kore Hospital and Medical Research Center, Belagavi from January 2015 to December 2015. All patients with deviated nose deformity undergoing septorhinoplasty were included in study except patients who were younger than 10 years and elder than 50 years, revision cases, patients suffering from systemic diseases such as sarcoidosis or wegener’s granulomatosis and psychological problems, pregnant patients, immunodeficient patients and patients with malignancy. But, patients of age 10–15 years were included in study provided the external deformity is severe enough and associated with septal deformity to an extent of interfering with their daily activities. A meticulous history was taken regarding patient symptoms, their duration and severity and any prior investigations or treatment the patient may have taken elsewhere. The patient’s symptoms were noted and scored according to NOSE scale prior to Septorhinoplasty.

40 patients were evaluated and comparisons were made for NOSE score preoperatively and postoperatively. Comparison of decrease in NOSE score with age distribution, sex distribution, type of septorhinoplasty, ROE score of patients and ROE score of surgeons were also made. ROE score was given by patients according to subjective relief in symptoms, aesthetic outcome after 6 weeks of surgery which is a visual analog scale and graded as given below. ROE score by operated surgeon was given after thorough clinical examination and aesthetic outcome after 6 weeks of surgery. The scoring was done accordingly as given below:

• score 1 = Poor

• score 2 = Average

• score 3 = Good

• score 4 = Excellent

The Total NOSE scores, ROE scores of patients and surgeons were noted and mean, median and standard deviation were calculated. Statistical analysis was done by Mc Nemer test, Paired t test, Chi square test and Independent t test. A preliminary comparison between preoperative and postoperative NOSE scores and ROE scores of patients’ and surgeons’ was made. The comparison was then made between decrease in NOSE score postoperatively and ROE score. Their statistical significance (p value) and Cohen’s kappa (k) were calculated.

Results

Of 40 patients, 26 (65.0%) were males and 14 (35.0%) were females. The mean age of females was 26.1 ± 11.0 years and that of males was 23.0 ± 6.7 years (Table 1). The mean age of entire sample was 24.1 ± 8.4 years. Of these, 16 (40.0%) were Open Septorhinoplasty and 24 (60.0%) were Close septorhinoplasty (Table 1). In our study, the total NOSE score preoperative septorhinoplasty with mean score of 11.43 ± 2.69 and postoperative septorhinoplasty with mean score of 3.28 ± 1.52 (Table 2, Fig. 1). We evaluated outcome of septorhinoplasty postoperatively by Rhinoplasty outcome evaluation (ROE) score for surgeons and patients and on correlation of both the scores, there was poor correlation and no significance (Table 3, Fig. 2). In our study, there was significance on comparison of decrease in NOSE score postoperatively with ROE score of patients’ (Fig. 3). There was no significance on comparison of decrease in NOSE score postoperatively with ROE score of surgeons’, age distribution, sex distribution and type of septorhinoplasty (Tables 4, 5, 6).

Table 1.

Age/sex/septorhinoplasty distribution

Variables	No. of patients (n = 40)
Sex
Male	26
Female	14
Age
10–19	11
20–29	21
30–39	5
> 40	3
Type of septorhinoplasty
Open	16
Close	24

Table 2.

Total NOSE score

NOSE score	Mean score	Standard deviation
Preoperative	11.43	2.69
Postoperative	3.28	1.52

p = 0.001

Fig. 1.

Total NOSE score

Table 3.

ROE score

ROE score—patients	ROE score—surgeons			Total
	Average	Good	Excellent
Good	11	17	1	29
Excellent	0	10	1	11
Total	11	27	2	40

K = 0.1, p = 0.2

Fig. 2.

ROE score

Fig. 3.

ROE score of patients and decrease in NOSE score postoperatively. p = 0.001

Table 4.

Age distribution and decrease in NOSE score postoperatively

Age distribution	Decrease in NOSE score postoperatively
	No. of patients	Mean	Median	Standard deviation
10–19	11	9.55	10.00	3.62
20–29	21	7.38	7.00	2.42
30–39	5	7.20	8.00	1.10
> 40	3	10.00	11.00	1.73

p = 0.1

Table 5.

Sex distribution and septorhinoplasty (open/close)—decrease in NOSE score postoperatively

Variables	Decrease in NOSE score postoperatively
	No. of patients	Mean	Median	Standard deviation
Sex
Male	26	7.73	7.00	2.82
Female	14	8.93	8.00	2.70
Type of septorhinoplasty
Open	16	8.94	9.00	2.57
Closed	24	7.63	7.00	2.89

p = 0.2

Table 6.

ROE score of surgeons and decrease in NOSE score postoperatively

ROE score of surgeons	Decrease in NOSE score postoperatively
	No. of patients	Mean	Median	Standard deviation
Poor	0	–	–	–
Average	11	6.73	7.00	1.85
Good	27	8.56	8.00	2.41
Excellent	2	10.50	10.50	9.19

p = 0.09

Discussion

Deviated nose deformity is a challenging problem to correct and is considered as a common nasal deformity. Although there are different approaches to correct the nasal deformity given by various authors [6–8] but it is the surgeon’s perception to consider on table regarding the best method of surgery for the patient. However, Nasal obstruction having multifactorial etiology should not be neglected issue in the treatment by the rhinoplasty surgeon. All the cases were analyzed with NOSE scale preoperatively and postoperatively and ROE score postoperatively. When demographic data was analyzed it showed that 65% were Males (most common) and 35% were females who underwent the surgery with maximum group of cases were of second decade (Table 1).

In study by Arima et al. [9], showed males (89.5%) and females (10.5%); in study by Hosseini et al. [11] showed males (80%) and females (20%) which were similar to our study. When total NOSE score postoperatively having mean score of 3.28 ± 1.52 were compared with preoperative mean score of 11.43 ± 2.69, it showed statistically significant with p value (p = 0001). In study done by Sam P Most [10], mean NOSE scores were decreased in all patients who underwent functional rhinoplasty. On comparison of mean NOSE scores preoperatively and postoperatively which showed statistically significant (58.4 vs. 15.7; p < 0.01). The results of this study showed similarity with the results of the study done by us. We also used rhinoplasty outcome evaluation (ROE) score for patients and surgeons which is a visual analogue scale based upon satisfactorty outcomes of patients and surgeons were evaluated after septorhinoplasty surgery. Twenty-nine patients out of forty gave the score-3 = good and eleven patients scored as score-4 = excellent. Surgeons have given score-2 = average for eleven patients, score = 3=good for twenty-seven patients, score-4 = excellent for two patients (Table 3, 6).

In study done by Won et al. [12], where septorhinoplasty outcome was evaluated in 31 patients using NOSE scale. When scores were compared preoperatively and postoperatively, the mean scores were decreased in postoperative NOSE scale which showed statistically significant with p value (p < 0.001) and the results were similar to our study. A study done by Arima et al. [9], where outcome evaluation in rhinoplasty was done with ROE scale. The mean satisfactory scores of ROE was statistically significant (p < 0.0001) and it showed that postoperatively there was 100% satisfaction score where postoperative score was better than from preoperative score. The results of this study were similar to the present study.

There are various factors which influence the outcome of septorhinoplasty and it’s difficult to measure a patient’s psychosocial and subjective satisfaction precisely. Although there are various instruments introduced to assess QOL quantitatively such as Glasgow Benefit inventory, the medical Outcomes Study’s 36-item short-form health survey, world health organisation’s QOL assessment and Derriford Appearance scale 59 (DAS-59) but there are only few studies evaluated subjective improvement in QOL after septorhinoplasty.

Conclusion

Septorhinoplasty should be considered for correction of both functional and aesthetic aspects of nose which improves disease specific quality of life without getting inclination only towards aesthetic aspects. The quality of life (QOL) scoring is essential for patients subjected to septorhinoplasty for assessing success of the surgery.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

“Informed consent was obtained from all individual participants included in the study.” “Additional informed consent was obtained from all individual participants for whom identifying information is included in this article”.