Assessing the Nasal Midline in Rhinoplasty: How Good Are We?

Area of Science:

• Plastic Surgery
• Facial Analysis
• Surgical Outcomes

Background:

• Nasal asymmetry assessment is crucial for reducing rhinoplasty revision rates.
• Accurate evaluation of nasal midline deviation from the facial midline remains a challenge.
• Visual assessment accuracy by surgeons was compared against a computer algorithm.

Purpose of the Study:

• To quantify the accuracy of plastic surgeons' visual assessment of nasal midline deviation.
• To compare surgeon assessments with a validated computer algorithm.
• To investigate the influence of surgeon experience and fatigue on assessment accuracy.

Main Methods:

• Twenty 3D facial scans were used to evaluate nasal midline deviation in upper, middle, and lower thirds.
• Surgeons (residents and consultants) used a linear analog scale to assess deviation.
• Spearman correlations compared surgeon assessments to algorithm measurements.

Main Results:

• Surgeons' assessments showed poor correlation in the upper third (r=0.32) and moderate correlation in the middle (r=0.49) and lower thirds (r=0.41).
• No significant difference in accuracy was found between trainee and consultant surgeons.
• Surgeon fatigue significantly impaired assessment accuracy (P=0.0009).

Conclusions:

• Plastic surgeons exhibit difficulty in accurately assessing 3D nasal midline deviation.
• Surgeon experience does not significantly improve nasal midline assessment accuracy.
• Fatigue adversely affects the accuracy of nasal deviation assessments in rhinoplasty.