Main Article Content
Abstract
enhance both the aesthetic and functional aspects of the nose. Preservation of the upper lateral
cartilages plays a crucial role in maintaining the structural integrity and function of the internal nasal
valve. This study aimed to evaluate the impact of preserving the upper lateral cartilages on internal
nasal valve function in open preservation rhinoplasty procedures, specifically focusing on the internal
nasal valve .
Methods: A non-randomized clinical trial between April 2022 and January 2023 was conducted in the
Sulaimani region of Kurdistan, Iraq, involving 36 adult patients undergoing OPR. Data collection
included preoperative and postoperative assessments using the NOSE questionnaire, along with
physical examinations at 9 days, 3 months, and 6 months post-surgery, and photographs 3 months post
operative.
Results: The results showed significant improvements in functional outcomes, including nasal
stuffiness or congestion, nasal obstruction, breathing problems through the nose, sleeping problems,
and breathing problems during exercise. These improvements were statistically significant (p=0.001).
Based on the Rhinoplasty Outcome Evaluation (ROE), significant differences were observed in nasal
shape, nasal breathing, friends' and acquaintances' approval of the surgery, unrestricted social activities,
the aesthetic and structural appearance of the nose, and the reasons for seeking nasal shape alteration
or rhinoplasty.
Conclusion: Preservation of ULCs in OPR procedures positively impacts internal nasal valve function,
as demonstrated by improved postoperative outcomes. This technique maintains nasal structure
integrity and INV function, leading to favorable functional and aesthetic results.
Keywords
Article Details
Copyright (c) 2024 University of Thi-Qar Journal Of Medicine

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
- Fichman M, Piedra Buena IT. Rhinoplasty. StatPearls. Treasure Island (FL) ineligible
- companies. Disclosure: Ignacio Piedra Buena declares no relevant financial relationships with
- ineligible companies.: StatPearls Publishing, Copyright © 2024, StatPearls Publishing LLC.; 2024.
- Kosins AM. Preservation Rhinoplasty: Open or Closed? Aesthetic Surgery Journal.
- ;42(9):990-1008. https://doi.org/10.1093/asj/sjac074
- Anco N, Caballero G, Adrianzen G. Preservation Rhinoplasty: A New Approach to Mestizo
- Noses. Plastic and reconstructive surgery Global open. 2023;11(5):e4972.
- https://doi.org/10.1097%2FGOX.0000000000004972
- Ng CL, D'Souza A. 120 Years of Dorsal Preservation in Rhinoplasty. Facial Plastic Surgery.
- ;37(4):1-20. http://dx.doi.org/10.1055/s-0041-1723826
- Haddad A, Dodin G, Hossu G, Perez M, Teixeira P, Rumeau C, et al. Anatomy of the nasal
- latero-lateral cartilage articulation: a micro-MRI study in human specimens. Surgical and
- radiologic anatomy : SRA. 2022;44(10):1367-74. https://doi.org/10.1007/s00276-022-03029-z
- Sakarya EU, Kar M, Bafaqeeh SA. Surgical Anatomy of the External and Internal Nose.
- In: Cingi C, Bayar Muluk N, editors. All Around the Nose: Basic Science, Diseases and Surgical
- Management. Cham: Springer International Publishing; 2020. p. 39-47.
- https://doi.org/10.1007/978-3-030-21217-9_4
- Shafik AG, Alkady HA, Tawfik GM, Mohamed AM, Rabie TM, Huy NT. Computed
- tomography evaluation of internal nasal valve angle and area and its correlation with NOSE scale
- for symptomatic improvement in rhinoplasty. Brazilian journal of otorhinolaryngology.
- ;86(3):343-50. https://doi.org/10.1016%2Fj.bjorl.2019.08.009
- Patel PN, Most SP. Open Preservation Rhinoplasty. Facial plastic surgery : FPS.
- ;39(5):537-46. https://doi.org/10.1055/s-0043-1770159
- Goksel A, Tran KN. Open Preservation Rhinoplasty Using the Piezo Electric Instrument.
- Facial plastic surgery clinics of North America. 2023;31(1):59-71.
- https://doi.org/10.1016/j.fsc.2022.08.007
- Bafaqeeh SA, Bayar Muluk N, Cingi C. Are preservation rhinoplasty techniques safer than
- structural ones? European review for medical and pharmacological sciences. 2023;27(5):11-8.
- https://doi.org/10.26355/eurrev_202310_34064
- Sozansky Lujan J, Goldfarb JM, Barrera JE. Functional and Aesthetic Outcomes of Let
- Down Dorsal Preservation Rhinoplasty. Facial plastic surgery & aesthetic medicine.
- ;25(2):159-64. https://doi.org/10.1089/fpsam.2022.0019
- Merino-Galvez E, Gómez-Hervás J. Evaluation of Nasal Obstruction Following
- Septoturbinoplasty Using the VAS and NOSE Scale. Iranian journal of otorhinolaryngology.
- ;36(1):335-42. https://doi.org/10.22038%2FIJORL.2023.75824.3541
- Merma-Linares C, Martinez MD, Gonzalez M, Alobid I, Figuerola E, Mullol J.
- Management of Mechanical Nasal Obstruction Isolated or Associated to Upper Airway
- Inflammatory Diseases in Real Life: Use of both Subjective and Objective Criteria. Current allergy
- and asthma reports. 2023;23(10):567-78. https://doi.org/10.1007%2Fs11882-023-01104-y
- Peterson AM, Kallogjeri D, Spitznagel E, Chakinala MM, Schneider JS, Piccirillo JF.
- Development and Validation of the Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic
- Telangiectasia (NOSE HHT). JAMA otolaryngology-- head & neck surgery. 2020;146(11):999-
- https://doi.org/10.1001/jamaoto.2020.3040
- Portillo-Vásquez AM, Jiménez-Chobillón MA, Santillán-Macías A, Cristerna-Sánchez L,
- Castorena-Maldonado AR. Validation of the Nasal Obstruction Symptom Evaluation Scale in
- Mexican Adults. Archives of Medical Research. 2022;53(3):329-35.
- https://doi.org/10.1016/j.arcmed.2022.02.002
- Carmel Neiderma NN, Halevy N, Kas T, Wengier A, Safadi A, Abergel A. Adaptation and
- Validation of the Hebrew Version of the Nasal Obstruction Symptom Evaluation (NOSE) Scale.
- The Israel Medical Association journal : IMAJ. 2023;25(8):564-7.
- Spiekermann C, Savvas E, Rudack C, Stenner M. Adaption and validation of the nasal
- obstruction symptom evaluation scale in German language (D-NOSE). Health and quality of life
- outcomes. 2018;16(1):172. https://doi.org/10.1186%2Fs12955-018-1004-x
- Karahatay S, Taşlı H, Karakoç Ö, Aydın Ü, Türker T. Reliability and validity of the Turkish
- Nose Obstruction Symptom Evaluation (NOSE) scale. Turkish journal of medical sciences.
- ;48(2):212-6. https://doi.org/10.3906/sag-1509-81
- Elwany S, Atef A, Ismail AS, Hussein WKA, Ibrahim AA, Abdelnaby M, et al. Arabic
- translation and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. The
- Egyptian Journal of Otolaryngology. 2021;37(1):92. https://doi.org/10.1186/s43163-021-00156-z
- Kim TK, Jeong JY. Surgical anatomy for Asian rhinoplasty: Part II. Arch Craniofac Surg.
- ;21(3):143-55. https://doi.org/10.7181/acfs.2020.00234
- Stergiou G, Tremp M, Finocchi V, Saban Y. Functional and Radiological Assessment After
- Preservation Rhinoplasty - A Clinical Study. In Vivo. 2020;34(5):2659-65.
- https://doi.org/10.21873/invivo.12085
- Brown WE, Lavernia L, Bielajew BJ, Hu JC, Athanasiou KA. Human nasal cartilage:
- Functional properties and structure-function relationships for the development of tissue
- engineering design criteria. Acta Biomaterialia. 2023;168:113-24.
- https://doi.org/10.1016/j.actbio.2023.07.011
- Yoon SH, Kim CS, Oh JW, Lee KC. Optimal harvest and efficient use of septal cartilage
- in rhinoplasty. Arch Craniofac Surg. 2021;22(1):11-6. https://doi.org/10.7181/acfs.2020.00486
- Park DH, Lee CA, Jeong CY, Yang HS. Nasotracheal intubation for airway management
- during anesthesia. Anesth Pain Med (Seoul). 2021;16(3):232-47.
- https://doi.org/10.17085/apm.21040
- Ashrafi AT. Management of Upper Lateral Cartilages (ULCs) in Rhinoplasty. World J Plast
- Surg. 2014;3(2):129-37.
- Paul MA, Kamali P, Chen AD, Ibrahim AMS, Wu W, Becherer BE, et al. Assessment of
- Functional Rhinoplasty with Spreader Grafting Using Acoustic Rhinomanometry and Validated
- Outcome Measurements. Plastic and Reconstructive Surgery – Global Open. 2018;6(3):e1615.
- https://doi.org/10.1097/gox.0000000000001615
- Kandathil CK, Saltychev M, Patel PN, Most SP. Natural History of the Standardized
- Cosmesis and Health Nasal Outcomes Survey After Rhinoplasty. The Laryngoscope.
- ;131(1):E116-E23. https://doi.org/10.1002/lary.28831
- de Souza OE, Lavinsky-Wolff M, Migliavacca RO, de Azeredo AM, Colognese Gabbardo
- AV, Velho JS. Analysis of Determinants of Postoperative Satisfaction After Rhinoplasty.
- Laryngoscope. 2022;132(8):1569-75. https://doi.org/10.1002/lary.29923
- Zojaji R, Ataei M, Zojaji SH, Meshkat M. The effect of nasal skin thickness on the outcome
- of rhinoplasty. European Journal of Plastic Surgery. 2024;47(1):6. https://doi.org/10.1007/s00238-
- -02156-
References
Fichman M, Piedra Buena IT. Rhinoplasty. StatPearls. Treasure Island (FL) ineligible
companies. Disclosure: Ignacio Piedra Buena declares no relevant financial relationships with
ineligible companies.: StatPearls Publishing, Copyright © 2024, StatPearls Publishing LLC.; 2024.
Kosins AM. Preservation Rhinoplasty: Open or Closed? Aesthetic Surgery Journal.
;42(9):990-1008. https://doi.org/10.1093/asj/sjac074
Anco N, Caballero G, Adrianzen G. Preservation Rhinoplasty: A New Approach to Mestizo
Noses. Plastic and reconstructive surgery Global open. 2023;11(5):e4972.
https://doi.org/10.1097%2FGOX.0000000000004972
Ng CL, D'Souza A. 120 Years of Dorsal Preservation in Rhinoplasty. Facial Plastic Surgery.
;37(4):1-20. http://dx.doi.org/10.1055/s-0041-1723826
Haddad A, Dodin G, Hossu G, Perez M, Teixeira P, Rumeau C, et al. Anatomy of the nasal
latero-lateral cartilage articulation: a micro-MRI study in human specimens. Surgical and
radiologic anatomy : SRA. 2022;44(10):1367-74. https://doi.org/10.1007/s00276-022-03029-z
Sakarya EU, Kar M, Bafaqeeh SA. Surgical Anatomy of the External and Internal Nose.
In: Cingi C, Bayar Muluk N, editors. All Around the Nose: Basic Science, Diseases and Surgical
Management. Cham: Springer International Publishing; 2020. p. 39-47.
https://doi.org/10.1007/978-3-030-21217-9_4
Shafik AG, Alkady HA, Tawfik GM, Mohamed AM, Rabie TM, Huy NT. Computed
tomography evaluation of internal nasal valve angle and area and its correlation with NOSE scale
for symptomatic improvement in rhinoplasty. Brazilian journal of otorhinolaryngology.
;86(3):343-50. https://doi.org/10.1016%2Fj.bjorl.2019.08.009
Patel PN, Most SP. Open Preservation Rhinoplasty. Facial plastic surgery : FPS.
;39(5):537-46. https://doi.org/10.1055/s-0043-1770159
Goksel A, Tran KN. Open Preservation Rhinoplasty Using the Piezo Electric Instrument.
Facial plastic surgery clinics of North America. 2023;31(1):59-71.
https://doi.org/10.1016/j.fsc.2022.08.007
Bafaqeeh SA, Bayar Muluk N, Cingi C. Are preservation rhinoplasty techniques safer than
structural ones? European review for medical and pharmacological sciences. 2023;27(5):11-8.
https://doi.org/10.26355/eurrev_202310_34064
Sozansky Lujan J, Goldfarb JM, Barrera JE. Functional and Aesthetic Outcomes of Let
Down Dorsal Preservation Rhinoplasty. Facial plastic surgery & aesthetic medicine.
;25(2):159-64. https://doi.org/10.1089/fpsam.2022.0019
Merino-Galvez E, Gómez-Hervás J. Evaluation of Nasal Obstruction Following
Septoturbinoplasty Using the VAS and NOSE Scale. Iranian journal of otorhinolaryngology.
;36(1):335-42. https://doi.org/10.22038%2FIJORL.2023.75824.3541
Merma-Linares C, Martinez MD, Gonzalez M, Alobid I, Figuerola E, Mullol J.
Management of Mechanical Nasal Obstruction Isolated or Associated to Upper Airway
Inflammatory Diseases in Real Life: Use of both Subjective and Objective Criteria. Current allergy
and asthma reports. 2023;23(10):567-78. https://doi.org/10.1007%2Fs11882-023-01104-y
Peterson AM, Kallogjeri D, Spitznagel E, Chakinala MM, Schneider JS, Piccirillo JF.
Development and Validation of the Nasal Outcome Score for Epistaxis in Hereditary Hemorrhagic
Telangiectasia (NOSE HHT). JAMA otolaryngology-- head & neck surgery. 2020;146(11):999-
https://doi.org/10.1001/jamaoto.2020.3040
Portillo-Vásquez AM, Jiménez-Chobillón MA, Santillán-Macías A, Cristerna-Sánchez L,
Castorena-Maldonado AR. Validation of the Nasal Obstruction Symptom Evaluation Scale in
Mexican Adults. Archives of Medical Research. 2022;53(3):329-35.
https://doi.org/10.1016/j.arcmed.2022.02.002
Carmel Neiderma NN, Halevy N, Kas T, Wengier A, Safadi A, Abergel A. Adaptation and
Validation of the Hebrew Version of the Nasal Obstruction Symptom Evaluation (NOSE) Scale.
The Israel Medical Association journal : IMAJ. 2023;25(8):564-7.
Spiekermann C, Savvas E, Rudack C, Stenner M. Adaption and validation of the nasal
obstruction symptom evaluation scale in German language (D-NOSE). Health and quality of life
outcomes. 2018;16(1):172. https://doi.org/10.1186%2Fs12955-018-1004-x
Karahatay S, Taşlı H, Karakoç Ö, Aydın Ü, Türker T. Reliability and validity of the Turkish
Nose Obstruction Symptom Evaluation (NOSE) scale. Turkish journal of medical sciences.
;48(2):212-6. https://doi.org/10.3906/sag-1509-81
Elwany S, Atef A, Ismail AS, Hussein WKA, Ibrahim AA, Abdelnaby M, et al. Arabic
translation and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. The
Egyptian Journal of Otolaryngology. 2021;37(1):92. https://doi.org/10.1186/s43163-021-00156-z
Kim TK, Jeong JY. Surgical anatomy for Asian rhinoplasty: Part II. Arch Craniofac Surg.
;21(3):143-55. https://doi.org/10.7181/acfs.2020.00234
Stergiou G, Tremp M, Finocchi V, Saban Y. Functional and Radiological Assessment After
Preservation Rhinoplasty - A Clinical Study. In Vivo. 2020;34(5):2659-65.
https://doi.org/10.21873/invivo.12085
Brown WE, Lavernia L, Bielajew BJ, Hu JC, Athanasiou KA. Human nasal cartilage:
Functional properties and structure-function relationships for the development of tissue
engineering design criteria. Acta Biomaterialia. 2023;168:113-24.
https://doi.org/10.1016/j.actbio.2023.07.011
Yoon SH, Kim CS, Oh JW, Lee KC. Optimal harvest and efficient use of septal cartilage
in rhinoplasty. Arch Craniofac Surg. 2021;22(1):11-6. https://doi.org/10.7181/acfs.2020.00486
Park DH, Lee CA, Jeong CY, Yang HS. Nasotracheal intubation for airway management
during anesthesia. Anesth Pain Med (Seoul). 2021;16(3):232-47.
https://doi.org/10.17085/apm.21040
Ashrafi AT. Management of Upper Lateral Cartilages (ULCs) in Rhinoplasty. World J Plast
Surg. 2014;3(2):129-37.
Paul MA, Kamali P, Chen AD, Ibrahim AMS, Wu W, Becherer BE, et al. Assessment of
Functional Rhinoplasty with Spreader Grafting Using Acoustic Rhinomanometry and Validated
Outcome Measurements. Plastic and Reconstructive Surgery – Global Open. 2018;6(3):e1615.
https://doi.org/10.1097/gox.0000000000001615
Kandathil CK, Saltychev M, Patel PN, Most SP. Natural History of the Standardized
Cosmesis and Health Nasal Outcomes Survey After Rhinoplasty. The Laryngoscope.
;131(1):E116-E23. https://doi.org/10.1002/lary.28831
de Souza OE, Lavinsky-Wolff M, Migliavacca RO, de Azeredo AM, Colognese Gabbardo
AV, Velho JS. Analysis of Determinants of Postoperative Satisfaction After Rhinoplasty.
Laryngoscope. 2022;132(8):1569-75. https://doi.org/10.1002/lary.29923
Zojaji R, Ataei M, Zojaji SH, Meshkat M. The effect of nasal skin thickness on the outcome
of rhinoplasty. European Journal of Plastic Surgery. 2024;47(1):6. https://doi.org/10.1007/s00238-
-02156-
