Research Needs section from Improving Nasal Form and Function after Rhinoplasty CPG
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 grade 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 preoperative assessment to evaluate patients for preoperative comorbidities, including OSA (eg, STOP-BANG, Body Dysmorphic Disorder Questionnaire)?
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 data on revision rhinoplasty that include outcomes as they relate to patient expectation and preoperative counseling?
- 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 patients with a tool to measure their outcomes versus their 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 nonsteroidal anti-inflammatory drugs, to use after rhinoplasty?
- What is the optimal intraoperative 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 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 postoperatively, what antibiotic is the best, and what are the data showing optimal efficacy?
Steroids:
- What should be the specific steroid and dose given pre- and postoperatively?
- Are there increased wound complications or delays in wound healing when steroids are used postoperatively?
- Should steroids be given to immune-compromised patients after rhinoplasty?
- Do topical nasal steroids improve recovery after rhinoplasty?
Nasal Packing:
- What specific packing materials and time frames do rhinoplasty surgeons use?
- What are the long-term functional and cosmetic outcomes as they relate to the use of nasal packing in the postoperative 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?
