Nasal Airway Function Following Maxillary Surgery: A Prospective Cohort Study using the Nasal Obstruction Symptom Evaluation (NOSE) Scale
Materials and Methods: We conducted a prospective cohort study of nasal airway function in consecutive LeFort I osteotomy patients , during 2007 to 2008 at Kaiser Permanente Oakland Medical Center. We administered the Nasal Obstruction Symptom Evaluation (NOSE) survey prior to and 3 months following surgery. Clinical and radiographic examinations were performed and relevant medical and demographic factors were analyzed.
Results: Fifty-five patients comprised the initial study sample and 5 were excluded. Among the remaining 50 (median age 21 years, 60% women) the maxilla was advanced (median 4 mm IQR 3 -5) with minimal vertical change. There was significant improvement in the median NOSE score for the cohort (P = 0.0005). Patients with moderate nasal obstruction (NOSE score > 25) had the greatest improvement (P < 0.001) while those with severe nasal obstruction (NOSE score > 50) improved but this did not reach statistical significance (P < 0.0625). NOSE scores worsened in 10 patients. Among these, half had minimal change while 5 had significant worsening. No predictor variables were identified in this small subgroup but individual case analyses revealed postoperative nasal septal deviation occurred in 3 subjects.
Conclusions: Our overall findings suggest that nasal airway function improved following maxillary advancement and subjects with higher preoperative NOSE scores (>25) were more likely to experience relief of nasal obstructive symptoms. Additionally, care should be taken to ensure passive septal positioning to avoid postoperative septal deviation
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