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Evaluating Severity and Trends of Nasal Obstruction Following Mohs Reconstruction of Nasal Subunits
Kaitlynne Y Pak1, Alberto Nunez1, Amanda Rosenthal2
1Division of Otolaryngology, Head and Neck Surgery, Cedars-Sinai Medical Center.
Background:
Although long-term complications are uncommon following Mohs micrographic surgery (MMS), some studies suggest postoperative nasal airway obstruction (NAO) is underreported. We aimed to evaluate severity and impacting factors for postoperative NAO.
Methods:
This is a survey study and retrospective review. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used for clinically significant changes in pre- and postoperative nasal breathing secondary to factors related to reconstruction after MMS. Subset analysis was performed.
Results:
The survey response rate was 51.4%. There were 54 cases (28 males, 26 females) with an average age of 71.9 years. The average time to follow up was 5.5 months. Overall, 18.5% (10) experienced postoperative NAO. The average ΔNOSE of the affected cohort was 14 ( P =0.0004), versus unaffected was 0. There was a significant difference between the affected and unaffected ΔNOSE ( P =0.0008). When stratified by NOSE severity, majority developed mild NAO, and one demonstrated moderate NAO. Significantly greater ΔNOSE scores were associated with the ala/alar groove or dorsum subsites, defect size above the median (80 mm), and reconstruction with regional flaps or primary closure. Other subsites (sidewall, tip/supratip, nasolabial fold) and skin grafts or secondary closure did not demonstrate a significant ΔNOSE.
Conclusion:
Our study demonstrates 18.5% developed NAO following MMS of nasal subsites with an average NOSE score of 14 (mild severity). This was a small study, and larger, prospective studies are needed for meaningful conclusions.
