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Comparison in Patient Satisfaction Between Structural Component and Hybrid T-bar Preservation Rhinoplasty: A Retrospective Propensity Score Matched Cohort Study

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  • Rhinoplasty
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Abstract

Background

Recently, a modified dorsal split preservation technique has been described. In this method, the integrity of the elastic keystone area is preserved by separation of the upper lateral cartilages from the septal T-bar. Our study aimed to evaluate the aesthetical and functional outcome in patients treated with the dorsal T-bar preservation versus the ‘gold’ standard dorsal split component reduction approach.

Methods

We performed a retrospective propensity score matched analysis in 234 patients enrolled for rhinoplasty. The severity of nasal obstruction was measured with the nasal obstruction symptom evaluation questionnaire (NOSE score). Aesthetic evaluation was performed with the FACE-Q nose and nostrils and Utrecht Questionnaire (UQ). Assessments were conducted prior to surgery, at 3 and at 6 months after surgery.

After propensity score matching, 172 patients in two cohorts were retained. The following covariates were taken into the statistical calculation: age, gender, ethnicity, previous nasal surgery, nasal trauma, respiratory allergy, and preoperative NOSE scores. The first cohort of 110 patients underwent rhinoplasty with T-bar preservation technique (TDP). The control cohort consisted of 62 patients who underwent dorsal split component reduction (SCR).

Results

The mean preoperative scores for FACE-Q nose, FACE-Q nostrils, UQ and VAS score improved significantly in all patients postoperatively. Both techniques had comparable aesthetic outcome measures that remained unchanged between 3 and 6 months postop. Functional outcome as measured by the NOSE score was in favor of SCR at 3 months postop but the difference between both techniques was not significant anymore at 6 months postop. In contrast to SCR, in TDP, only 31% of the patients needed spreader grafts or autospreader flaps at the internal valve area only for functional reasons.

Conclusion

The data in this study suggest similar patient satisfaction with SCR and TDP techniques for aesthetics as well as nasal function after 6 months postop. TDP is a very versatile cartilage-sparing method to aesthetically adapt the middle vault without interrupting the keystone area. It combines the popular component separation concept with the preservation of the delicate anatomy of the mid-vault.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Authors and Affiliations

  1. Department of Otorhinolaryngology, GZA-Hospitals, Campus Sint-Vincentius, Sint-Vincentiusstraat 20, Antwerp, Belgium

    Valérie Verkest & Frank Declau

  2. Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

    Valérie Verkest, Laura Pingnet, Galathea Van Hout & Frank Declau

  3. StatUa, Center of Statistics, University of Antwerp, Antwerp, Belgium

    Erik Fransen

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  1. Valérie Verkest
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Correspondence to Frank Declau.

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Ethical Approval

The study was conducted according to the declaration of Helsinki and approved by the Ethics committee of GZA Hospitals (Approval number: 190301ACADEM). After thorough information, all patients gave their written informed consent to participate in the study.

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Verkest, V., Pingnet, L., Van Hout, G. et al. Comparison in Patient Satisfaction Between Structural Component and Hybrid T-bar Preservation Rhinoplasty: A Retrospective Propensity Score Matched Cohort Study. Aesth Plast Surg 47, 2598–2608 (2023). https://doi.org/10.1007/s00266-023-03347-6

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