Dental

Communication

Biosci. Biotech. Res. Comm. 10(2): 93-96 (2017)

Impact of dome splitting on the nasal air ow ef cacy

of external airway

Sina Seyed Abbaszadeh

*, Behnam Bohlouli

, Mehdi Sezavar

, Hooman Houshangi

and Fatemeh Nasrollahi

Resident of Oral & Maxillofacial surgery, Tehran Dental Branch, Islamic Azad University, Tehran, Iran

Assistant Professor of Oral & Maxillofacial surgery, Tehran Dental Branch, Islamic Azad University,

Tehran, Iran

ABSTRACT

Dome splitting is effective technique in the nasal tip surgery indicated for the reduction of tip projection, increasing

tip rotation, domal arch narrowing and correction of the lobule asymmetry. However, there are concerns regarding

its negative effects on nasal air ow. The present study compared the effect of rhinoplasty with the dome splitting on

the ef cacy of external nasal air ow. In a prospective before and after clinical trial, 46 eligible patients (39 females,

6 males) were selected and standardized images of their nasal bases were obtained during normal and deep breathes

before and 3 months after the surgery. Patients were subjected to rhinoplasty with open technique and dome splitting

was done in the nasal lower cartilage between lateral and medial crura. The area of the nasal external airway was

measured during normal and deep breathes before and 3 months after the surgery. The percent of nasal air ow ef -

cacy was determined qualitatively and quantitatively in the patients’ left and right nostrils using McNemar and Wil-

coxon Signed Ranks tests. In the left and right nostrils, 67.4% (31) of the patients, the air ow ef cacy was decreased

and in 32.6% (15) patients, the air ow ef cacy increased. Dome splitting signi cantly decreased the air ow ef cacy

of the patients (P<0.05). Air ow ef cacy decreased (-7.19±23.7) in the left nostrils than right nostrils (-7.28±14.7).

Air ow ef cacy of the patients signi cantly decreased (P<0.05).These results suggested rhinoplasty surgery using

dome splitting decreased the nasal air ow ef cacy after the surgery, hence care must be exercised for alterations in

nasal air  ow resistance when manipulating the nasal framework is done.

KEY WORDS: RHINOPLASTY, DOME SPLITTING, NASAL AIRFLOW EFFICACY

ARTICLE INFORMATION:

*Corresponding Author: sina.seyedabbaszadeh.omfs@gmail.com

Received 31

March, 2017

Accepted after revision 29

June, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007 CODEN: USA BBRCBA

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Online Contents Available at: http//www.bbrc.in/

94 IMPACT OF DOME SPLITTING ON THE NASAL AIRFLOW EFFICACY OF EXTERNAL AIRWAY BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Sina Seyed Abbaszadeh et al.

INTRODUCTION

The surgery of the tip is the most dif cult and chal-

lenging part of any rhinoplastic surgery and dif culties

arise due to surgical problems and healing process. The

narrowing and reshaping of the tip is considered as an

integral part of the rhinoplastic operation rather than

ignoring it or considering it as a separate surgical pro-

cedure. In a routine rhinoplasty, whenever the nose is

narrowed, the tip will appear broad and rounded requir-

ing it’s remodeling in majority of the cases (Foda et al.

2013).

Nasal tip repositioning methods are used to adjust the

existing alar cartilages and to augment the nasal lobule

with grafts or implants (Kridel and Konior, 1990). Verti-

cal dome division of the alar cartilage is mostly used for

modi cation of the nasal tip projection in cosmetic and

reconstructive rhinoplasty. It is a valuable adjunctive

procedure for nasal tip re nement (Chang et al. 2008).

The Goldman  rst described Vertical dome which gives

rise to tip irregularities such as lower nasal third pinch-

ing and alar notching (Chang et al. 2008). Vertical dome

technique modi ed to create an approach with mini-

mal tissue excision that is focused on the incision and

mobilization of the lower lateral cartilages (Foda, 2001).

Although vertical dome division can be considered

a conservative, cartilagesparing approach to nasal tip

surgery, concerns about postoperative asymmetry and

cartilage visibility remain, especially in thin-skinned

patients (Lavinsky-Wolff et al. 2013).

It is suggest vertical dome technique is an effective

method for nasal tip deprojection and narrowing via an

open approach (Gandomi et al. 2011). Also, little effort

has been made to study patients’ satisfaction and qual-

ity-of-life outcomes after vertical dome surgery using

validated scales (Lavinsky-Wolff et al. 2013). Mainte-

nance of the structural integrity after nasal surgery is

important in preventing nasal airway stenosis (Yoo et

al. 2011). However, adverse effects reported for the verti-

cal dome surgery on air ow where in patients postop-

erativertical dome surgery failed to normalize air ow

(Conrad et al. 2000). Also, clinically asymptomatic were

reported in patients after surgery (Conrad et al. 2000).

So, the aim of the current study was to determine effect

of rhinoplasty with the dome splitting on the ef cacy of

external nasal air ow.

MATERIAL AND METHODS

SAMPLE SELECTION

The present study compared the effect of rhinoplasty

with the dome splitting on the ef cacy of external nasal

air ow in patients referred to a private clinic and Bu Ali

hospital at 2016-2017. In a prospective before and after

clinical trial, 46 eligible patients (39 females, 6 males

with the mean age of 36.4 years old) were selected and

standardized images of their nasal bases were obtained

during normal and deep breathes before and 3 months

after the surgery.

DOME SPLITTING SURGICAL PROCEDURE

The area of the nostril before and after the study deter-

mined before and after the study. In this regard, photog-

raphy obtained from each patient based on their gender

during the normal and deep breathes as S

0. The rhi-

noplasty was done in patients under general anesthesia.

The incisions were highlighted using methylene blue

(Hamilton and Grant, 2014; Pi et al. 2016). For dome

splitting, no other techniques such as alar contour graft

and alar base resection applied. If in patients other tech-

niques applied, they dropped from the study. Lateral

crura and medial crura cartilages were used for dome

splitting. Three months after rhinoplasty, the nostril area

was determined as S

1. All measurements were done

using caliper and photographs based on standard scale

(1:1). All photographs were done under the same condi-

tion by an expert operator using a digital camera (Can-

non D7, Tele 18-125) at a distance of the 120 cm. The

standard slides from the frontal, lateral and overhead

of the patients were done (Ettorre et al. 2006; Duron

et al. 2014). The area of the nasal external airway was

measured during normal and deep breathes before and 3

months after the surgery on the images by Adobe Pho-

toshop Ver. 12.0 software.

PERCENT OF NASAL AIRFLOW EFFICACY

The percent of nasal air ow ef cacy before the surgery

determined as

RE0 = S

0 ÷ S

0 × 100:

Where S

0 stands for normal and S

0 deep breaths.

Also, after 3 months air ow ef cacy determined as:

RE1 = S

1 ÷ S

1 × 100

Where S

0 stands for normal and S

0 deep breaths.

STATISTICAL ANALYSIS

Data were analyzed by repeated measure two-way anal-

ysis of variance (ANOVA) using SPSS 16.0 for Windows

(SPSS, Inc., Chicago, IL, USA). The percent of nasal air-

 ow ef cacy was determined qualitatively and quanti-

tatively in the patients’ left and right nostrils and sub-

jected to McNemar and Wilcoxon Signed Ranks tests

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS IMPACT OF DOME SPLITTING ON THE NASAL AIRFLOW EFFICACY OF EXTERNAL AIRWAY 95

Sina Seyed Abbaszadeh et al.

FIGURE 1. The dome splitting surgery

FIGURE 2. The photography of the of the dome

splitting in one patient

Table 1. nasal air ow ef cacy following dome splitting

Air  ow

Nostril Decrease (n, %) Increase (n, %) Total (n, %)

Left 31(67.4%) 15 (32.6%) 46 (100%)

Right 31(67.4%) 15 (32.6%) 46 (100%)

respectively. P<0.05 was considered as signi cant dif-

ference.

RESULTS

The dome splitting surgery is shown in  gure 1.

rowing. Scarce of consensus about the appropriate surgi-

cal approach utilized to gain access to the tip structures

continues to exist and is further underscored by surgeons

who practice an exclusively open approach to every rhi-

noplasty problem (Funk et al. 2009).

It is reported vertical dome division improves the

nasal airway by improve the nasal valve aperture

(Richard et al. 1998). In the current study, the left and

right nostrils, 67.4% (31) of the patients, the air ow

ef cacy was decreased and in 32.6% (15) patients, the

air ow ef cacy increased. Dome splitting signi cantly

decreased the air ow ef cacy of the patients. Air-

 ow ef cacy decreased (-7.19±23.7) in the left nostrils

than right nostrils (-7.28±14.7). Air ow ef cacy of the

patients signi cantly decreased. Vertical dome division

should replace horizontal trimming of the lower lateral

cartilage in rhinoplasty (Adamson et al. 1990). One must

consider involved in the nasal tip is decrease nasal air

 ow (Richard et al. 1998). The lower lateral cartilage is

The nasal air ow ef cacy following dome splitting is

shown in table 1. In the left and right nostrils, 67.4% (31)

of the patients, the air ow ef cacy was decreased and

in 32.6% (15) patients, the air ow ef cacy increased.

Dome splitting signi cantly decreased the air ow ef -

cacy of the patients (P<0.05). Air ow ef cacy decreased

(-7.19±23.7) in the left nostrils than right nostrils

(-7.28±14.7). Air ow ef cacy of the patients signi -

cantly decreased (P<0.05).

The result of the dome splitting in one patient is pre-

sented in  gure 2.

DISCUSSION

Since introduce of the dome division, numerous researches

was done on its accuracy. Surgical changes created in the

nasal tip represent an integral part of every aesthetic rhi-

noplasty; accomplished surgeons worldwide differ sig-

ni cantly in their personal preferences for tip re nement

approaches and techniques (Simons and Fine, 1977).

Most surgeons agree that preservation of the integrity of

the alar cartilage is desirable during tip sculpture, while

some surgeons imply numerous forms of vertical divi-

sion of the residual complete strip to accomplish tip nar-

96 IMPACT OF DOME SPLITTING ON THE NASAL AIRFLOW EFFICACY OF EXTERNAL AIRWAY BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Sina Seyed Abbaszadeh et al.

 xed medially at the collumella and at the lateral border

of the alar. Lower lateral cartilage holds up the soft tissue

of the nasal tip (Constantinides et al. 1996). If the carti-

lage get weaker, is was not able to maintain support of

the soft tissue which horizontal excision will contribute

to collapse and compromise at the nasal valve (Richard

et al. 1998). In a study on impact of vertical dome divi-

sion on nasal air ow, Conrad et al. (2000) reported the

air ow was negatively affected in 37.5% and improved

postoperatively in 25% of patients. The protocol which

they applied in their research was differ from ours.

Recently Gandomi et al. (2011) reported the modi ed

vertical dome technique is an effective method for nasal

tip de-projection and narrowing via an open approach.

Despite several research efforts, studies evaluating qual-

ity-of-life outcomes after nasal tip surgery with dome

division surgery remain scarce in the facial plastic sur-

gery literature. In the current study, we used dome divi-

sion technique to determine its effects on nasal air  ow.

We think obtained results of the current study can use

as base information for accuracy of this technique on

patients breathing. It is reported dome division tech-

nique improved the life quality of the patients during

a short period (Lavinsky-Wolff et al. 2013) which the

protocol applied in our study was different from incom-

ing research.

In a study on comparison of suture and vertical dome

division techniques of bulbous nose re nement, Ghaz-

ipour et al. (2011) was reported among the 35 patients

with transdomal and interdomal technique, 2 patients

(7.5%) had a previous bulbous nose deformity remained

stable of whom one patient resulted in revision sur-

gery. The overall satisfaction rate in these patients

was approximately 92%. Also, in 35 patients with who

underwent surgery using vertical dome division method,

in 3 patients (6.8%) complication as over narrowing

nasal tip was observed which in one case this led to

revision surgery and in one case (2.8%) collapse of lower

lateral cartilage occurred. Base on their report it seems

vertical dome division is effective for life quality of

the patients while in the current study obtained results

revealed vertical dome division leads to nasal obstruc-

tion. Despite these limitations, our results add relevant

quality-of-life data to the rhinoplasty literature, includ-

ing speci c information about the outcomes of vertical

dome division surgery in patients. In conclusion results

suggested rhinoplasty surgery using dome splitting

decreased the nasal air ow ef cacy after the surgery.

So care must be exercised for alterations in nasal air

 ow resistance when manipulating the nasal framework

is done.

REFERENCES

Adamson P, Smith O, Cole P: 1990. The effect of cosmetic rhi-

noplasty on nasal patency. Laryngoscope 100:357-359,

Chang CW, Simons RL. 2008. Hockey-Stick Vertical Dome

Division Technique for Overprojected and Broad Nasal Tips.

Arch Facial Plast Surg 10: 88-92.

Conrad K, Solomon P, Chapnik JS. 2000. Impact of vertical

dome division on nasal air ow. J Otolaryngol 29(3):162–165.

Constantinides MS, Adamson PA, Cole P: 1996. The long-term

effects of open cosmetic septorhinoplasty on nasal air  ow.

Arch Otolaryngol Head Neck Surg 122:41-45,

Duron JB,Bardot J,Aiach G, Nguyen PS, Nostrils. 2014 Surgery.

Ann Chirp last Esthet Des:596:52206

Ettorre G, Weber M, Schaaf H, Lowry JC, Mommaerts MY,

Howaldt HP.2006. Standard for digital photography in cranio-

maxillo-facial surgery- Part I: Basic view & guidelines. J

Canio-Maxillofac Surg 34(2):65-73.

Foda H.M.T. 2013 External rhinoplasty for the overprojected

nasal tip. J Ästhet Chir 6:26–32.

Foda HM.2001. Alar setback technique: a controlled method

of nasal tip deprojection. Arch Otolaryngol Head Neck Surg

127: 1341-6.

Funk E, Chauhan N, Adamson PA.2009. Re ning vertical lob-

ule division in open septorhinoplasty. Arch Facial Plast Surg

11(2):120–125

Gandomi B, Arzaghi MH, Rafatbakhsh M.2011 The Effective-

ness of modi ed vertical dome division technique in reducing

nasal tip projection in rhinoplasty. Iran J Med Sci 36(3): 196-

200.

Hamilton A, Grant S 2014. Y-V alar base reduction. Ear, Nose

& Throat Journal ;93,3,98.

Kridel RW, Konior RJ. 1990. Dome truncation for management

of the overprojected nasal tip. Ann Plast Surg 24: 385-96.

Lavinsky-Wolff M, Lutaif Dolci JE, Camargo HL, Manzini M,

Petersen S, Romanczuk S, , Pizzoni R, Polanczyk CA. 2013.

Vertical dome division: A quality-of-life outcome study. Oto-

laryngology– Head and Neck Surgery 148(5) 758–763.

Pi H, Kurlander DE, Guyuron B.2016 Effects of the rhinoplasty

maneuvers on upper lip position and incisor show. Aesth Plast

Surg :1-5.

Richard E. Goulding, MD, Laura L. Scott, RN.1998. Vertical dome

division for nasal valve incompetence operative techniques in

otolaryngology--head and neck surgery, 9(2): 107-116

Simons RL, Fine IJ. 1977. Evaluation of the Goldman tip in

rhinoplasty. In: Plastic and Reconstructive Surgery of the Face

and Neck: Proceedings of the Second International Sympo-

sium. New York, NY: Grune & Stratton; 39–46

Yoo S., Most SP. 2011. Nasal airway preservation using the auto-

spreader technique. Arch Facial Plast Surg. 13(4):231-233.