Facial Plast Surg 2010; 26(4): 320-327
DOI: 10.1055/s-0030-1262314
© Thieme Medical Publishers

Objective Measures in Aesthetic and Functional Nasal Surgery: Perspectives on Nasal Form and Function

Sachin S. Pawar1 , Guilherme J.M Garcia2 , Julia S. Kimbell3 , John S. Rhee1
  • 1Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin
  • 2Department of Pharmacology, University of North Carolina, Chapel Hill, North Carolina
  • 3Department of Otolaryngology, University of North Carolina, Chapel Hill, North Carolina
Further Information

Publication History

Publication Date:
27 July 2010 (online)

ABSTRACT

The outcomes of aesthetic and functional nasal surgery are difficult to assess objectively because of the intricate balance between nasal form and function. Despite historical emphasis on patient-reported subjective measures, objective measures are gaining importance in both research and the current outcomes-driven health care environment. Objective measures currently available have several shortcomings that limit their routine clinical use. In particular, the low correlation between objective and subjective measures poses a major challenge. However, advances in computer, imaging, and bioengineering technology are now setting the stage for the development of innovative objective assessment tools for nasal surgery that can potentially address some of the current limitations. Assessment of nasal form after aesthetic surgery is evolving from two-dimensional analysis to more sophisticated three-dimensional analysis. Similarly, assessment of nasal function is evolving with the introduction of computational fluid dynamics techniques, which allow for a detailed description of the biophysics of nasal airflow. In this article, we present an overview of objective measures in both aesthetic and functional nasal surgery and discuss future trends and applications that have the potential to change the way we assess nasal form and function.

REFERENCES

  • 1 Rhee J S. Measuring outcomes in nasal surgery: realities and possibilities.  Arch Facial Plast Surg. 2009;  11 416-419
  • 2 Most S P, Alsarraf R, Larrabee Jr W F. Outcomes of facial cosmetic procedures.  Facial Plast Surg. 2002;  18 119-124
  • 3 Lund V J. Objective assessment of nasal obstruction.  Otolaryngol Clin North Am. 1989;  22 279-290
  • 4 Rhee J S, McMullin B T. Outcome measures in facial plastic surgery: patient-reported and clinical efficacy measures.  Arch Facial Plast Surg. 2008;  10 194-207
  • 5 Allanson J E. Objective techniques for craniofacial assessment: what are the choices?.  Am J Med Genet. 1997;  70 1-5
  • 6 Werther J R, Freeman J P. Changes in nasal tip projection and rotation after septorhinoplasty: a cephalometric analysis.  J Oral Maxillofac Surg. 1998;  56 728-732; discussion 733
  • 7 Petroff M A, McCollough E G, Hom D, Anderson J R. Nasal tip projection. Quantitative changes following rhinoplasty.  Arch Otolaryngol Head Neck Surg. 1991;  117 783-788
  • 8 Byrd H S, Hobar P C. Rhinoplasty: a practical guide for surgical planning.  Plast Reconstr Surg. 1993;  91 642-654; discussion 655–656
  • 9 Ingels K, Orhan K S. Measurement of preoperative and postoperative nasal tip projection and rotation.  Arch Facial Plast Surg. 2006;  8 411-415
  • 10 Spörri S, Simmen D, Briner H R, Jones N. Objective assessment of tip projection and the nasolabial angle in rhinoplasty.  Arch Facial Plast Surg. 2004;  6 295-298; discussion 299–300
  • 11 Park H S, Rhee S C, Kang S R, Lee J H. Harmonized profiloplasty using balanced angular profile analysis.  Aesthetic Plast Surg. 2004;  28 89-97
  • 12 Chatrath P, De Cordova J, Nouraei S AR, Ahmed J, Saleh H A. Objective assessment of facial asymmetry in rhinoplasty patients.  Arch Facial Plast Surg. 2007;  9 184-187
  • 13 Daudia A, Alkhaddour U, Sithole J, Mortimore S. A prospective objective study of the cosmetic sequelae of nasal septal surgery.  Acta Otolaryngol. 2006;  126 1201-1205
  • 14 Kortbus M J, Ham J, Fechner F, Constantinides M. Quantitative analysis of lateral osteotomies in rhinoplasty.  Arch Facial Plast Surg. 2006;  8 369-373
  • 15 Da Silveira A C, Daw Jr J L, Kusnoto B, Evans C, Cohen M. Craniofacial applications of three-dimensional laser surface scanning.  J Craniofac Surg. 2003;  14 449-456
  • 16 Honrado C P, Larrabee Jr W F. Update in three-dimensional imaging in facial plastic surgery.  Curr Opin Otolaryngol Head Neck Surg. 2004;  12 327-331
  • 17 Beard L F, Burke P H. Evolution of a system of stereophotogrammetry for the study of facial morphology.  Med Biol Illus. 1967;  17 20-25
  • 18 Burke P H, Hughes-Lawson C A. Stereophotogrammetric study of growth and development of the nose.  Am J Orthod Dentofacial Orthop. 1989;  96 144-151
  • 19 van Heerbeek N, Ingels K J, van Loon B, Plooij J M, Bergé S J. Three dimensional measurement of rhinoplasty results.  Rhinology. 2009;  47 121-125
  • 20 Chau H, Dasgupta R, Sauret V, Kenyon G. Use of an optical surface scanner in assessment of outcome following rhinoplasty surgery.  J Laryngol Otol. 2008;  122 972-977
  • 21 Hilberg O, Jackson A C, Swift D L, Pedersen O F. Acoustic rhinometry: evaluation of nasal cavity geometry by acoustic reflection.  J Appl Physiol. 1989;  66 295-303
  • 22 Clement P AR, Gordts F. Standardisation Committee on Objective Assessment of the Nasal Airway, IRS, and ERS . Consensus report on acoustic rhinometry and rhinomanometry.  Rhinology. 2005;  43 169-179
  • 23 Cole P. Nasal airflow resistance: a survey of 2500 assessments.  Am J Rhinol. 1997;  11 415-420
  • 24 Ricci E, Palonta F, Preti G et al.. Role of nasal valve in the surgically corrected nasal respiratory obstruction: evaluation through rhinomanometry.  Am J Rhinol. 2001;  15 307-310
  • 25 Singh A, Patel N, Kenyon G, Donaldson G. Is there objective evidence that septal surgery improves nasal airflow?.  J Laryngol Otol. 2006;  120 916-920
  • 26 Chandra R K, Patadia M O, Raviv J. Diagnosis of nasal airway obstruction.  Otolaryngol Clin North Am. 2009;  42 207-225, vii
  • 27 Corey J P. Acoustic rhinometry: should we be using it?.  Curr Opin Otolaryngol Head Neck Surg. 2006;  14 29-34
  • 28 Corey J P, Gungor A, Nelson R, Liu X, Fredberg J. Normative standards for nasal cross-sectional areas by race as measured by acoustic rhinometry.  Otolaryngol Head Neck Surg. 1998;  119 389-393
  • 29 Grymer L F. Reduction rhinoplasty and nasal patency: change in the cross-sectional area of the nose evaluated by acoustic rhinometry.  Laryngoscope. 1995;  105(4 Pt 1) 429-431
  • 30 Vidyasagar R, Friedman M, Ibrahim H, Bliznikas D, Joseph N J. Inspiratory and fixed nasal valve collapse: clinical and rhinometric assessment.  Am J Rhinol. 2005;  19 370-374
  • 31 Lang C, Grützenmacher S, Mlynski B, Plontke S, Mlynski G. Investigating the nasal cycle using endoscopy, rhinoresistometry, and acoustic rhinometry.  Laryngoscope. 2003;  113 284-289
  • 32 Terheyden H, Maune S, Mertens J, Hilberg O. Acoustic rhinometry: validation by three-dimensionally reconstructed computer tomographic scans.  J Appl Physiol. 2000;  89 1013-1021
  • 33 Cakmak O, Celik H, Ergin T, Sennaroglu L. Accuracy of acoustic rhinometry measurements.  Laryngoscope. 2001;  111(4 Pt 1) 587-594
  • 34 Bermüller C, Kirsche H, Rettinger G, Riechelmann H. Diagnostic accuracy of peak nasal inspiratory flow and rhinomanometry in functional rhinosurgery.  Laryngoscope. 2008;  118 605-610
  • 35 Starling-Schwanz R, Peake H L, Salome C M et al.. Repeatability of peak nasal inspiratory flow measurements and utility for assessing the severity of rhinitis.  Allergy. 2005;  60 795-800
  • 36 Hanif J, Eccles R, Jawad S S. Use of a portable spirometer for studies on the nasal cycle.  Am J Rhinol. 2001;  15 303-306
  • 37 Hanif J, Jawad S SM, Eccles R. A study to assess the usefulness of a portable spirometer to quantify the severity of nasal septal deviation.  Rhinology. 2003;  41 11-15
  • 38 Seren E. Frequency spectra of normal expiratory nasal sound.  Am J Rhinol. 2005;  19 257-261
  • 39 Kjaergaard T, Cvancarova M, Steinsvåg S K. Relation of nasal air flow to nasal cavity dimensions.  Arch Otolaryngol Head Neck Surg. 2009;  135 565-570
  • 40 Batchelor G K. An Introduction to Fluid Dynamics. Cambridge, UK; Cambridge University Press 1967
  • 41 Keyhani K, Scherer P W, Mozell M M. Numerical simulation of airflow in the human nasal cavity.  J Biomech Eng. 1995;  117 429-441
  • 42 Subramaniam R P. Computational fluid dynamics simulations of inspiratory airflow in the human nose and nasopharynx.  Inhal Toxicol. 1998;  10 91-120
  • 43 Sung S J, Jeong S J, Yu Y S, Hwang C J, Pae E K. Customized three-dimensional computational fluid dynamics simulation of the upper airway of obstructive sleep apnea.  Angle Orthod. 2006;  76 791-799
  • 44 Garcia G J, Bailie N, Martins D A, Kimbell J S. Atrophic rhinitis: a CFD study of air conditioning in the nasal cavity.  J Appl Physiol. 2007;  103 1082-1092
  • 45 Hood C M, Schroter R C, Doorly D J, Blenke E JSM, Tolley N S. Computational modeling of flow and gas exchange in models of the human maxillary sinus.  J Appl Physiol. 2009;  107 1195-1203
  • 46 Xiong G X, Zhan J M, Jiang H Y et al.. Computational fluid dynamics simulation of airflow in the normal nasal cavity and paranasal sinuses.  Am J Rhinol. 2008;  22 477-482
  • 47 Chen X B, Lee H P, Chong V FH, Wang Y. Assessment of septal deviation effects on nasal air flow: a computational fluid dynamics model.  Laryngoscope. 2009;  119 1730-1736
  • 48 Lee H P, Poh H J, Chong F H, Wang Y. Changes of airflow pattern in inferior turbinate hypertrophy: a computational fluid dynamics model.  Am J Rhinol Allergy. 2009;  23 153-158
  • 49 Ozlugedik S, Nakiboglu G, Sert C et al.. Numerical study of the aerodynamic effects of septoplasty and partial lateral turbinectomy.  Laryngoscope. 2008;  118 330-334
  • 50 Lindemann J, Brambs H J, Keck T, Wiesmiller K M, Rettinger G, Pless D. Numerical simulation of intranasal airflow after radical sinus surgery.  Am J Otolaryngol. 2005;  26 175-180
  • 51 Xiong G, Zhan J, Zuo K, Li J, Rong L, Xu G. Numerical flow simulation in the post-endoscopic sinus surgery nasal cavity.  Med Biol Eng Comput. 2008;  46 1161-1167
  • 52 Zhao K, Pribitkin E A, Cowart B J, Rosen D, Scherer P W, Dalton P. Numerical modeling of nasal obstruction and endoscopic surgical intervention: outcome to airflow and olfaction.  Am J Rhinol. 2006;  20 308-316
  • 53 Segal R A, Kepler G M, Kimbell J S. Effects of differences in nasal anatomy on airflow distribution: a comparison of four individuals at rest.  Ann Biomed Eng. 2008;  36 1870-1882
  • 54 Liu Y, Johnson M R, Matida E A, Kherani S, Marsan J. Creation of a standardized geometry of the human nasal cavity.  J Appl Physiol. 2009;  106 784-795
  • 55 Elad D, Naftali S, Rosenfeld M, Wolf M. Physical stresses at the air-wall interface of the human nasal cavity during breathing.  J Appl Physiol. 2006;  100 1003-1010
  • 56 Bailie N, Hanna B, Watterson J, Gallagher G. A model of airflow in the nasal cavities: implications for nasal air conditioning and epistaxis.  Am J Rhinol Allergy. 2009;  23 244-249
  • 57 Garcia G J, Rhee J S, Senior B A, Kimbell J S. Septal deviation and nasal resistance: an investigation using virtual surgery and computational fluid dynamics.  Am J Rhinol Allergy. 2010;  24 e46-e53
  • 58 Cole P, Chaban R, Naito K, Oprysk D. The obstructive nasal septum. Effect of simulated deviations on nasal airflow resistance.  Arch Otolaryngol Head Neck Surg. 1988;  114 410-412
  • 59 Dinis P B, Haider H. Septoplasty: long-term evaluation of results.  Am J Otolaryngol. 2002;  23 85-90

John S RheeM.D. M.P.H. 

Department of Otolaryngology and Communication Sciences

Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226

Email: jrhee@mcw.edu

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