Dr. Sania Arya (JR) Dr. Jagdeepak Singh (Professor) Dr. Dinesh Kumar Sharma(AP) Dr. Ravinder Singh(SR) Department of ENT, Government Medical College Amritsar MID-TERM EVALUATION OF RHINOPLASTY AND RHINO-SEPTOPLASTY

Introduction Derived from the Greek words for "nose" and "to shape", rhinoplasty is a plastic surgery procedure to improve the appearance and/or function of the nose. The major indications for rhinoplasty are cosmetic and cosmetic-functional.

At times the procedure may be considered a success by the surgeon, while the patient may not feel pleased with it, and the opposite is also true. In both cases, the operation can not be considered a successful one. In the scientific literature assessment of these interventions’ final result has not been very much studied from the patient's viewpoint.

A scientific method to estimate surgical results from the patient’s viewpoint is by means of quality-of-life (QOL) questionnaires. These QOL questionnaires: Standardize assessment & enable comparison of different techniques. Help measure the positive and negative effects. Identify possible patients who may not benefit from surgery. Rhinoplasty Outcomes Evaluation (ROE) questionnaire devised by Alsarraff is one such tool and is considered a gold standard to estimate rhinoplasty results.

ROE Questionnaire How much do you like the appearance of your nose? How much can you breathe through your nose? How much do you think your friends and those close to you like your nose? Do you think the appearance of your nose limits your social or professional activities? How safe are you that your nose has the best possible appearance? Would you like to surgically change the appearance or function of your nose?

Deviations of the nasal septum often accompany deviations of the nasal bridge. Another QOL tool Nasal Obstruction Symptom Evaluation (NOSE) score has been devised to measure the efficacy of functional rhinoplasty

Aims and Objectives To evaluate how satisfied are those patients who undergo rhinoplasty for correction of nasal deformities through ROE. To perform a prospective assessment of subjective treatment outcomes following septoplasty (along with rhinoplasty) through use of a validated outcome instrument named NOSE Scale. Evaluation of cosmetic improvement following rhinoplasty/septo-rhinoplasty using standardised pre- and post-operative photographs. To assess the cultural relevance of ROE Questionnaire and NOSE Scale vis-a-vis Indian patients.

Material and Methods The study comprised of thirty patients of either gender between 18 to 50 years of age. Patients were subjected to pre-operative photography as per Institute of Medical Illustrators National Guidelines All patients filled the pre-operative ROE and NOSE questionnaires. A complete ear nose and throat examination was performed. A Closed rhinoplasty or rhino-septoplasty was performed. Patients were asked to fill the ROE and NOSE questionnaires at end of 6 months and post-operative photographs were also taken.

Key Observations Majority of the patients were in between 18 to 20 years of age. 3/4 th of the patients were male and evenly drawn from urban & rural areas. While all the patients had some degree and type of external nasal deformity, most of them also complained of nasal obstruction thus they had both cosmetic as well as functional expectations from surgery. Almost one-fourth patients had a history of prior nasal surgery while one-third patients had history of nasal trauma of more than three months of duration. In rest of the patients no specific aetiological cause was identifiable.

Facial edema started subsiding by 3 to 7 days post- operatively in most of the patients and by 6 months there were no signs of facial edema in any patient. Post-operative photographs at 6 months were compared with pre-operative photographs by a non operating surgeon and were scored on 0-6 Surgeon Outcome Evaluation (SOE) scale. Values of post-op SOE and ROE correlated well.

Pre-Op ROE 33.3 Post-op ROE 88 Pre-op NOSE 50 Post-op NOSE 10

Pre-Op ROE 25 Post-op ROE 96 Pre-op NOSE 85 Post-op NOSE 0

Pre-op ROE 29.2 Post-op ROE 96 Pre-op NOSE 55 Post-OP NOSE 20

Pre-op ROE 16.7 Post-op ROE 67 Pre-op NOSE 60 Post-op NOSE 0

Conclusions-ROE ROE is a useful instrument to quantify and qualify the subjective outcomes of rhinoplasty. It also contributes towards identification of appropriate subjects for these procedures and effectively documents changes in quality-of-life indicators post- operatively. Gender and age of the patient as well as prior history of nasal trauma do not impact the outcomes after rhino- septoplasty as determined by ROE scores. The experience of the present study confirms the suitability of ROE questionnaire in Indian patients who come from diverse backgrounds.

Conclusions NOSE scale is a valid, reliable, brief and easy to complete instrument with its potential use for outcome studies in adults with nasal obstruction. The experience of present study confirms its appropriateness for use in Indian patients. Photographic documentation of patients undergoing rhinoplasty is essential for patient consultation, perioperative planning, and post-surgical evaluation. The experience of present study acknowledges that basic understanding and appreciation of photography is invaluable in surgical practice, especially in rhinoplasty.

Thank you!