THE LONG-TERM EFFECTS OF OPEN COSMETIC SEPTORHINOPLASTY ON NASAL AIR-FLOW

Objective: To determine if elective cosmetic septorhinoplasty impacts on nasal air flow resistance over the longterm. Design: Case series. M ean postoperative follow-up period was 41.5 months (range, 16 to 77 mo nths). Patients: A consecutive sample of 200 patients having undergone cosmetic open septorhinoplasty by one of us (P.A.A.) before July 1992 were contacted by telephone; 50 agreed to participate, and 27 actuall y participated in the study. Interventions: Open cosmetic septorhinopl asty performed by one of us (P.A.A.).Main Outcome Measures: Comparison of preoperative and postoperative nasal resistance values by head-out body displacement plethysmography; correlation of preoperative and po stoperative nasal valve anatomy with nasal resistance values; and corr elation of postoperative nasal resistance values with subjective evalu ation of nasal air flow as reported on a 10-point analogue scale. Resu lts: Of the 27 patients, 10 had normal preoperative nasal resistance v alues and 17 had elevated resistance values; Preoperative Normal Group : Four of the 10 patients' mean resistance values exceeded normal limi ts postoperatively. One of these four patients reported subjective nas al obstruction. Preoperative Abnormal Group: Of the 17 patients, surge ry resulted in normal resistance values postoperatively in six, decrea sed but still above normal resistance values in eight, and no decrease in postoperative resistance values in three. Conclusions: (1) Patient s with normal nasal resistance values may suffer long-term, asymptomat ic increase in nasal resistance values after cosmetic open septorhinop lasty, often with no quantifiable change at the nasal valve. (2) Patie nts with elevated nasal resistance measurements generally improve with open septorhinoplasty. Patients with isolated septal deformities impr ove with septoplasty. Patients with upper lateral cartilage collapse i mprove with spreader grafts. The lasting objective improvement on the nasal valve using spreader grafts is reported herein for the first tim e. (3) Subjective estimations of nasal patency do not correlate well w ith objective measures of patency, namely nasal resistance measurement s. (4) Cosmetic septorhinoplasty can alter nasal patency. Continued ca re must be exercised when manipulating the nasal framework for cosmeti c purposes, as slight changes to the nasal valve may result in signifi cant alterations in nasal air flow resistance.