An objective and subjective evaluation of the effect on nasal obstruction of posterior-superior resection of the os vomer in primary septorhinoplasty patients undergoing bilateral osteotomy

Aim: The purpose of this study was to assess patient satisfaction with rhinomanometry performed in the pre- and postoperative periods in patients undergoing primary open septorhinoplasty (SRP) using the Nasal Obstruction Symptom Evaluation (NOSE), Rhinoplasty Outcomes Evaluation (ROE) and Visual Analogue Scale (VAS), to determine the relations between these parameters, and to evaluate the reliability and practicability of these forms in cosmetic nasal surgery. Materials-Methods: This study involved 100 cases of open SRP performed due to difficulty breathing through the nose and nasal deformity at the Atatürk University Medical Faculty Ear, Nose and Throat Clinic between January, 2017, and January, 2017. Patients' ages ranged between 18 and 44, with a mean age of 27.31±6.447 years. Sixty-two percent (n=62) were women and 38% (n=38) men. The study design involved retrospective evaluation of patient satisfaction in the preoperative period and prospective evaluation in the postoperative period. Patients with pre- and postoperative periods of at least 6 months underwent rhinomanometry, representing objective analysis, and were also asked to complete the Nasal Obstruction Symptom Evaluation (NOSE) and Rhinoplasty Outcomes Evaluation (ROE), representing subjective analyses, in order to evaluate satisfaction in terms of postsurgical cosmetic and functional outcomes, during the same visits. This was intended to provide a clearer assessment of the patient's pre- and postoperative status. Patients were also asked to provide an evaluation using the Visual Analogue Scale (VAS) and to provide separate scores in terms of nasal esthetic appearance and functionality before and after surgery. Results : No significant difference was determined between preoperative and postoperative 6th month total nasal air resistance (TNAR) values in the control group patients undergoing no procedure to the os vomer (p>0.05) However, a significant difference was observed between preoperative and postoperative 6th month TNAR values in patients undergoing posterior-superior os vomer resection (p<0.01). Examination of the NOSE results revealed a statistically significant decrease in postoperative values compared to preoperative values among the patient group (p<0.001), while postoperative values in the control group increased significantly compared to preoperative values (p<0.001). ROE measurements of patients undergoing posterior-superior vomer resection and control subjects receiving no surgical procedure to the vomer were performed preoperatively and at 6th months postoperatively. Significantly significant increases were observed in both groups (p<0.001). Mean cosmetic and functional VAS scores in the case group and mean cosmetic VAS score in the control group were statistically significant (p<0.01). However, while the mean function VAS score in the case group was statistically significant, no significance was observed in the mean functional VAS score in the control group (p>0.05). Analysis of preoperative and postoperative changes in all forms revealed that these were statistically correlated and significant. Discussion: Patient satisfaction in cosmetic and functional terms is the most significant indicator of operative success. Both objective and subjective methods can be used in the evaluation of cosmetic and functional patient satisfaction in nasal surgery. The use of disease- or area-specific quality of life evaluation forms developed for this purpose provides reliable results in assessing the effectiveness of the surgery performed. In conclusion, if performed under appropriate indications, septorhinoplasty is a surgical technique that increases patient quality of life in social, psychological and physical terms.