Functional diagnostic tools in rhinoplasty: Italian experience

Rhinoplasty is one of the most common plastic surgery procedures, aimed to correct or reconstruct the nose. There are two types of rhinoplasty surgeries: functional rhinoplasty, used to improve the shape and the respiratory function of the nose, and the cosmetic rhinoplasty, the goal of which is to improve its external aesthetic. A good nasal breathing isn't always guaranteed postoperatively. Minimal septal deviations, concha bullosa, weak lateral cartilages or any other potential breathing problem not accurately assessed before rhinoplasty may cause residual nasal obstruction after surgery. This complex array of variables may vary as a consequence of the surgical procedure. Thus, it is important to evaluate nasal airflow both before and after the rhinoplasty. Narrowing or collapse of the internal valves with inspiration should be investigated, as well as inferior turbinate hypertrophy, which is typical in patients with septal deviation. Most measurements developed for nasal function have focused on evaluating nasal obstruction. They can be divided into two categories: patient-reported (subjective) and objective measurements. Traditionally, nasal ventilation is objectively measured by rhinomanometry or acoustic rhinometry. Rhinomanometry is a dynamic test of nasal function that calculates nasal airway resistance (NAR) by measuring transnasal pressure and airflow in the nasal passage during respiration. Acoustic rhinometry (AR) is a simple, reproducible technique for measuring the volume of the nasal cavity based on the analysis of sound waves reflected from the nasal walls. Another method for the measurement of nasal airflow is the peak nasal inspiratory flow (PNIF). This method assesses the highest airflow through both nostrils during the maximum forced nasal inspiration. Subjective analysis of nasal patency is generally based on patient-reported outcome measures (PROMs) with visual analogue scales and/or questionnaires. The most used questionnaires are the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) and the Nasal obstruction symptom evaluation test (NOSE), which aim to evaluate nasal symptoms including subjective obstruction.