Assessment of nasal patency after rhinoplasty through the Glatzel mirror

Summary

Introduction: Objective evaluation of nasal function is a constant challenge for plastic surgeons, otolaryngologists, and allergists. The modified Glatzel mirror can evaluate nasal expiratory flow; however, there is little information on this method and its use in the measurement of nasal patency after surgical procedures.

Objective: To compare, in a prospective study, the functional results before and after cosmetic rhinoplasty and evaluate the use of the Glatzel mirror as an objective method to assess nasal patency.

Methods: To achieve this objective, we analyzed the functional results of surgery through a subjective questionnaire and objective evaluation through a modified Glatzel mirror, and evaluated the correlation between the 2 methods. Twenty patients (14 women and 6 men) underwent aesthetic rhinoplasty using spreader grafts. Pre- and postoperative evaluation (90–120 days) included a respiratory quality score (subjective) and modified Glatzel mirror test (objective). Subsequently, the Spearman test was used to compare the pre- and postoperative subjective and objective data.

Results: The subjective evaluation demonstrated a statistical difference between pre- and postoperative scores (8 ± 2 and 9.4 ± 0.7, P ≤ 0.001). There was no statistical difference in mean nasal patency by modified Glatzel mirror. No statistically significant correlation was observed when comparing the modified Glatzel mirror values with the subjective scores reported by patients pre- or postoperatively.

Conclusion: The Glatzel method lacks sensitivity in detecting patient-reported improvements in breathing following rhinoplasty. This suggests that the method is a poor assessment tool to detect small, post-surgical changes in the nasal airways.

Keywords

evaluation - rhinoplasty - respiration

• References

• 1 Passos AP, Alonso N, Utsunomia K, Ferreira MC. The accuracy of rhinometry in the evaluation of the nasal valve: study in 385 patients. Rev Bras Cir Plást 2009; 24: 262-4
• 2 Pochat V, Alonso N, Meneses J. Avaliação funcional e estética da rinoplastia com enxertos cartilaginosos. Rev Bras Cir Plást 2010; 25: 260-70
• 3 Zancanella E, Lima WTA. Acoustic rhinometry as a diagnostic method. Rev Bras Otorrinolaringol 2004; 70: 500-3
• 4 Degan VV, Puppin-Rontani RM. Aumento da aeração nasal após remoção de hábitos de sucção e terapia miofuncional. Revista CEFAC 2007; 9: 55-60
• 5 Altmann EBC. Espelho nasal milimetrado.
• 6 Bassi IB, Franco LP, Motta AR. Eficácia do emprego do espelho de Glatzel na avaliação da permeabilidade nasal. Revista da Sociedade Brasileira de Fonoaudiologia 2009; 14: 367-71
• 7 Sheen JH. Spreader graft: a method of reconstructing the roof of the middle nasal vault following rhinoplasty. Plast Reconstr Surg 1984; 73: 230-9
• 8 Howard BK, Rohrich RJ. Understanding the nasal airway: principles and practice. Plast Reconstr Surg 2002; 109: 1128-46 ; quiz 45–6
• 9 Wilcox D, Dove B, McDavid D, Greer D. UTHSCSA Image Toll for Windows. 3.00 ed. Texas: The University of Texas Health Science Center; 2002
• 10 Cole P, Roithmann R, Roth Y, Chapnik JS. Measurement of airway patency. A manual for users of the Toronto systems and others interested in nasal patency measurement. Ann Otol Rhinol Laryngol Suppl 1997; 171: 1-23
• 11 Melo FMGd, Cunha DAd, Silva HJd. Avaliação da aeração nasal pré e pós a realização de manobras de massagem e limpeza nasal. Rev CEFAC 2007; 9: 375-82
• 12 Watson WT, Roberts JR, Becker AB, Gendreau-Reid LF, Simons FE. Nasal patency in children with allergic rhinitis: correlation of objective and subjective assessments. Ann Allergy Asthma Immunol 1995; 74: 237-40
• 13 Hardcastle PF, White A, Prescott RJ. Clinical and rhinometric assessment of the nasal airway—do they measure the same entity?. Clin Otolaryngol Allied Sci 1988; 13: 185-91
• 14 Eccles RB. The nasal cycle in respiratory defence. Acta Otorhinolaryngol Belg 2000; 54: 281-6
• 15 Burrow A, Eccles R, Jones AS. The effects of camphor, eucalyptus and menthol vapour on nasal resistance to airflow and nasal sensation. Acta Otolaryngol 1983; 96: 157-61
• 16 Jones AS, Crosher R, Wight RG, Lancer JM, Beckingham E. The effect of local anaesthesia of the nasal vestibule on nasal sensation of airflow and nasal resistance. Clin Otolaryngol Allied Sci 1987; 12: 461-4
• 17 Brescovici S, Roithmann R. A reprodutibilidade do espelho de Glatzel modificado na aferição da permeabilidade nasal. Rev Bras Otorrinolaringol 2008; 74 (2) 215-222
• 18 Hasegawa M. Nasal cycle and postural variations in nasal resistance. Ann Otol Rhinol Laryngol 1982; 91: 112-4
• 19 Fisher EW, Palmer CR, Lund VJ. Monitoring fluctuations in nasal patency in children: acoustic rhinometry versus rhinohygrometry. J Laryngol Otol 1995; 109: 503-8
• 20 Fairley JW, Durham LH, Ell SR. Correlation of subjective sensation of nasal patency with nasal inspiratory peak flow rate. Clin Otolaryngol Allied Sci 1993; 18: 19-22
• 21 Sipila J, Suonpaa J, Laippala P. Sensation of nasal obstruction compared to rhinomanometric results in patients referred for septoplasty. Rhinology 1994; 32: 141-4
• 22 Simola M, Malmberg H. Sensation of nasal airflow compared with nasal airway resistance in patients with rhinitis. Clin Otolaryngol Allied Sci 1997; 22: 260-2