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Research Needs - Improving Nasal Form and Function after Rhinoplasty

Research Needs - Improving Nasal Form and Function after Rhinoplasty

This guideline was based on the current body of evidence regarding the improvement of nasal form and function after rhinoplasty. While many of the key action statements were supported by Grade B and C level evidence, review of the evidence profile for other statements revealed knowledge gaps and the need for further research. As determined by the GDG’s review of the literature, assessment of current clinical practices, and determination of evidence gaps, research needs were determined as follows:

Communicating Expectations:

  • What are the short (<12 months) and long-term (>12 months) metrics showing patient satisfaction and functional outcome improvement following rhinoplasty?

Comorbid Conditions: 

  • What is the best pre-operative assessment to evaluate patients for pre-operative co-morbidities including OSA (i.e., STOP-BANG; BDDQ)?

Nasal Airway Obstruction: 

  • What is the best measure to evaluate and objectify airway obstruction in rhinoplasty patients?
  • What is the optimal time to evaluate nasal airway obstruction following rhinoplasty?

Preoperative Education:

  • What are the rates of litigation in rhinoplasty and revision rhinoplasty?
  • What are patients specifically told about surgical expectations?
  • What mechanism can be used to provide the patients with a tool to measure their outcomes versus patient satisfaction?
  • What is the sustained long-term benefit of using a tool to measure outcomes versus patient satisfaction?

Obstructive Sleep Apnea:

  • What are the best CPAP appliances to use following rhinoplasty as they relate to patient comfort, and optimal surgical healing while treating OSA?
  • When specifically, should CPAP be reinstated after rhinoplasty?

Managing Pain and Discomfort:

  • What is the optimal duration and dosage of pain medication including NSAIDS to use after rhinoplasty?
  • What is the optimal intra-operative pain medication?
  • Can the management of acute postoperative pain improve the overall outcomes and patient satisfaction following rhinoplasty?
  • What are the long-term outcomes of improved patient satisfaction of their rhinoplasty as it relates to the acute management of pain and discomfort?

Antibiotics:

  • What is the optimal prophylactic antibiotic to be given prior to rhinoplasty?
  • When used post-operatively, what is the best antibiotic and what is the data showing optimal efficacy?

Steroids:

  • What should be the specific steroid and dose given pre- and post-operatively?
  • Are there increased wound complications or delays in wound healing when steroids are used post-operatively?
  • Should steroids be given in immune-compromised patients after rhinoplasty?
  • Do topical nasal steroids improve recovery after rhinoplasty?

Nasal Packing:

  • What specific packing materials and duration of time are used by rhinoplasty surgeons?
  • What are the long-term functional and cosmetic outcomes as they are related to the use of nasal packing in the post-operative period?
  • What are the specific benefits of nasal packing?

Outcome Assessment:

  • What is the long-term data on validated metrics for patient satisfaction and functional outcome?