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

backgroundRecently, 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.

methodsWe 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).

resultsThe 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.

conclusionThe 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 .