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Published on: June 20, 2018
Comparison of Dorsal Preservation Rhinoplasty and Dorsal Hump Reduction Rhinoplasty: A Systematic Review and
Mohammad Khatib1,2, Ron Skorochod3, Yoram Wolf3,4
1Plastic Surgery Unit, Hillel Yaffe Medical Center, Hadera, Israel. khatibmohammad6@gmail.com.
Background:
Rhinoplasty is one of the most popular facial cosmetic procedures. Compared to dorsal hump reduction (DHR), a dorsal "preservation" rhinoplasty (DPR) approach has been developed to reduce the risk of complications and achieve an appealing dorsum.
Methods:
An electronic search for articles comparing DHR to DPR was conducted on major databases. Results were screened through title/abstract and full-text stages. Included articles were extracted for information on demographics, surgical and patients reported outcomes, and for safety information. Newcastle-Ottawa scale and Cochrane's RoB 2.0 tool were utilized to assess the risk of bias in included article.
Results:
Our search yielded (257) articles, of which nine articles describing a total of 1364 patients were fit for inclusion. The mean age was 30.59 ± 7.27 years, and majority were females (75.22%). Open surgical approach 772 (56.6%) was utilized more than closed approach 592 (43.4%). A mean difference of 0.03 [95% C.I. - 0.06-0.11, p = 0.52] (I2=83.5%, p < 0.01) in postoperative MCA1 was recorded, which was not significant. However, a significant mean difference of 0.03 [95% C.I. 0.01-0.06, p=0.019] (I2=17.4%, p=0.3) in MCA2 was found. Both MCA1 and MCA2 estimates were in favor of DHR, although significance is questionable. SNOT-22 showed a change of -2.88 [95% C.I. - 4.89-0.87, p < 0.01] (I2=0%, p=0.53) between groups. The rate of complications was low. Forty-six incidents of early postoperative complications were reported, with nasal tip edema reported most (n=18, 39.13%) followed by nasal obstruction (n=10, 21.74%) and dorsal irregularity (n=6, 13.04%). Late complications were reported more, and a total of 128 incidents were reported. Contour irregularities occurred in 53 (41.41%) cases. Revisions were needed in 27 (21.09%) patients. Hump recurrence and nasal valve collapse occurred in 16 (12.5%) and 11 (8.59%) patients, respectively. For early complications, three studies were eligible for meta-analysis (OR=0.66 [95% C.I. 0.35-1.25, p=0.2], (I2=0%, p=0.38)). For late surgical complications there was a significant difference in late complication rate, favoring DPR compared to DHR (OR=0.21, [95% C.I. 0.13-0.33, p<0.01]) (I2=0%, p=0.5).
Conclusion:
DHR and DPR are comparable in effect, with each offering a promising outcome. DPR has a safety profile comparably beneficial to DHR, while DHR choice is appropriate in cases with substantial structure reshaping. Nevertheless, further research and clinical trials are necessary to establish the benefits of this alternative surgery.
No Level Assigned:
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
