Rhinological procedures demand a high degree of technical expertise and anatomical knowledge. Because of limited surgical opportunities, ethical considerations and the complexity of these procedures, simulation-based training has become increasingly important. This review aimed to evaluate the effectiveness of simulation models used in rhinology training.

Searches were conducted on PubMed, Embase, Cochrane and Google Scholar for studies conducted between July 2012 and July 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (‘PRISMA’) protocol defined a final list of articles. Each validated study was assigned a level of evidence and a level of recommendation based on the Oxford Centre of Evidence-Based Medicine classification.

Following exclusions, 42 articles were identified which encompassed six types of simulation models and 26 studies evaluated validity. The rhinological skills assessed included endoscopic sinus surgery (n = 28), skull base/cerebrospinal fluid leak repair (n = 14), management of epistaxis and/or sphenopalatine artery ligation (n = 8), and septoplasty and septorhinoplasty (n = 6). All studies reported the beneficial impact of their simulation models on trainee development.

Simulation training in rhinology is a valuable adjunct to traditional surgical education. Although evidence is of moderate quality, the findings highlight the importance of simulation-based training in rhinology training.

This study aimed to propose a systematic approach for managing thick-skinned rhinoplasty patients.

A retrospective review of the treatment of 26 thick-skinned patients with aesthetic and/or functional problems over a period of three years from January 2018 to January 2021 with a follow up for one year. A presurgical evaluation of skin was carried out initially. Skin thickness due to sebaceous overactivity was treated with retinoic acid derivatives, and skin thickness due to increased adipose tissue or hypertrophic fibrofatty layers was treated surgically. Open rhinoplasty was performed in all patients and a strong osseocartilaginous framework was created with the skin stretched as much as the aesthetic tolerance allowed.

Post-operative outcomes were based on subjective assessment, photographic evaluation and the Rhinoplasty Outcome Evaluation questionnaire, which indicated significant patient satisfaction.

Using this systemic approach for treating thick-skinned rhinoplasty patients, predictable results with improved aesthetic satisfaction in patients were achieved.

This pilot study aimed to assess the feasibility of using a high-definition intra-operative exoscope in teaching septorhinoplasty.

The exoscope was used in septorhinoplasty cases with different trainers and trainees. A high-definition screen displayed real-time, magnified images. Post-procedure, a questionnaire was completed by trainer and trainees, assessing the feasibility, safety and content validity of the exoscope as a septorhinoplasty training tool.

Trainees and trainers assigned favourable ratings to all aspects of the exoscope as a training tool, particularly with regard to teaching anatomy and improving visualisation.

The exoscope is a potentially effective training tool in septorhinoplasty, and is especially useful in improving visualisation, without restricting the operator. Annotatable intra-operative photographs and videos allow trainees to study cases outside of the operating theatre environment. The use of an exoscope for septorhinoplasty in the UK may facilitate increased hands-on involvement earlier in training than is currently typical.

There are gaps within current meta-analyses looking at the effects of tranexamic acid on sino-nasal surgery. This study aimed to update and summarise all current available evidence on the use of tranexamic acid in sino-nasal surgery.

A literature search was performed using four medical databases, Cochrane Library, Embase, Medline and PubMed. Data analysis was performed using dedicated meta-analysis software Review Manager (Revman).

Thirteen studies were included in the meta-analysis. The amount of blood loss and duration of surgery in tranexamic acid groups was statistically lower than placebo for both sinus and nasal surgery. Tranexamic acid improves the surgical field quality in sinus surgery but worsens the field in nasal surgery. Topical or intravenous administration of tranexamic acid in sinus surgery reduces blood loss, duration of surgery and improves the quality of the surgical field.

This study suggests that the use of tranexamic acid in sinus surgery reduces blood loss, decreases surgical duration and improves surgical field quality.

This study was performed on fresh frozen cadavers to investigate the role of angular artery damage.

Lateral osteotomies (‘high-low-high’ method) were carried out bilaterally, with a 4 mm guarded lateral osteotome, after the creation of a subperiosteal tunnel. Following completion of the lateral osteotomy, a skin incision was made in the midline dorsum. The dermis and subcutaneous tissues were carefully dissected, taking care not to damage the angular artery. Overlying tissues were cut and retracted to show the course of the angular artery.

The angular artery was not damaged in any of the cadavers. The angular artery was always lateral to the lateral osteotomy line.

The high-low-high lateral osteotomy does not damage or traumatise the angular artery. The ecchymosis and oedema are related to other factors.

There has been increasing number of requests for cosmetic rhinoplastic surgery among Iranians in different age groups in recent years. One risk for those who undergo such plastic operations is the presence of body dysmorphic disorder (BDD) which might complicate the results and decrease the rate of satisfaction from surgery. This study was aimed to find the rate of BDD symptoms and mental problems in people demanding rhinoplastic surgery and a control group.

The scores of General Health Questionnaire (GHQ) and DCQ (Dysmorphic Concerns Questionnaire) were obtained for 50 people who were candidates for rhinoplastic surgery and the results were compared with normal control group.

The total GHQ score (p=0.0001) and scores in anxiety (p=0.009), depression (p=0.009), and social dysfunction (p<0.001) sub-scales were higher among the study group compared with the control. Similarly, the DCQ score in the study group (10.67±2.93) was obviously higher than the control group (2.54±2.34) (p=0.0001). However, the score of somatisation sub-scale of GHQ (p=0.06) was not significantly different between the two groups.

Psychiatric evaluation in candidates of rhinoplastic surgery seems necessary to prevent unnecessary and repetitive surgical operations.

Current study aimed to investigate self esteem and attitude toward Appearance schema in patients with rhinoplasty.

In this pretest-posttest semi-experimental design, sample population was consisted of total patients who refered to AmirAlam hospital and a private doctor office for rhinoplasty during the first six-month of 2010. Sampling method was convenient which based on 2 patients per week; the sample size was estimated as 40 persons. The study scales were a demographic questionnaire included variables like age, sex, education, job and the number of rhinoplasty operations. Also, Cooper smith inventory and Appearance schema inventory were used for data gathering.

The sample was 40 patients whom 27.5% were male and 72.5% were female. Also 77.5% of them were singles and others were marries. 5% had lower diploma education level, 25% diploma and others had university degrees. Results showed rhinoplasty could not change their self esteem but the scores of attitude toward Appearance befor and after sergury were different (0.05≥p? 39=df? 3.012=t)

Before rhinoplasty operation, patients should be assessed psychologically and in should be considered that before rhinoplasty, psychological factors play an important role on increasing self esteem and promoting attitude toward Appearance.

The primary goal of rhinoplasty is patient satisfaction and improved quality of life. The present study was conducted to assess patient satisfaction with face and nose appearance, and quality of life after rhinoplasty.

Patients presenting for rhinoplasty completed the FACE-Q survey. This is a new instrument that measures patient-reported outcomes in those undergoing aesthetic procedures. The FACE-Q scales include satisfaction with facial appearance overall, satisfaction with the nose, psychological well-being, psychosocial distress and social function.

Sixty-five patients completed the FACE-Q at pre-operative and at post-operative follow-up visits. Post-operative scores increased significantly in terms of: satisfaction with facial appearance (p < 0.0001, t = 15.639, degrees of freedom = 64); social function (p < 0.0001, t = 12.208, degrees of freedom = 64); psychosocial distress (p < 0.0001, t = 13.864, degrees of freedom = 64); psychological function (p < 0.0001, t = 12.681, degrees of freedom = 64); and satisfaction with nose (p < 0.0001, t = 16.421, degrees of freedom = 64). Most patients reported more than 79 per cent satisfaction with the post-operative outcome.

The FACE-Q is an adequate instrument for determining successful aesthetic surgery based on patient satisfaction.

This study aimed to investigate endoscopic revision septoplasty with semi-penetrating straight and circular incisions in patients for whom septoplasty was unsuccessful.

Patients in this study (n = 14) had a deviation of the nasal septum after septoplasty. Pre-operative and post-operative assessments were performed using a visual analogue scale and nasal endoscope. Semi-penetrating straight and circular incisions in front of the caudal septum and at the margin of the nasal septal cartilage–bone defect, respectively, were made. The mucoperichondrium and mucoperiosteum were bilaterally dissected until interlinkage with the cartilage–bone defect was achieved. Mucous membranes within the circular incision as well as the right mucoperichondrium and mucoperiosteal flaps were protected by pushing them to the right. This exposed the osteocartilaginous framework and allowed correction of the residual deviation. The patients were followed up for 30–71 months.

For nasal obstruction and headaches, a significant improvement was noted in post-operative compared to pre-operative visual analogue scale scores. No patients had septal deviations, saddle nose, false hump nose or contracture of the nasal columella.

The technique allowed exposure of the septal osteocartilaginous framework and a broad operational vision, which enabled successful correction of various deformities of the nasal septum.

This study aimed to determine the distance between the most anterior part of the anterior nasal spine and the posterior septal angle.

Sinus computed tomography images from February to April 2016 were retrospectively analysed. Scans from adult Caucasians were included. Those with evidence of previous surgery, large slices or poor quality were excluded. The distance between the posterior septal angle and the most anterior part of the anterior nasal spine was measured digitally by two independent raters.

Of 122 scans, 100 met the inclusion criteria (49 males and 51 females; mean age of 52.5 years). The mean distance measured was 5.13 mm (standard deviation = 1.24 mm, range = 1.85–8.00 mm). Measurements between male and female patients were not significantly different (t=0.450, p=0.654, 95 per cent confidence interval = -0.382 to 0.606).

There is variability in the distance between the anterior nasal spine and the posterior septal angle. Surgeons should observe this relationship intra-operatively to avoid instability and unintended aesthetic changes.

Procedures of limited clinical value require pre-authorisation in the National Health Service, of which rhinoplasty and septorhinoplasty are two such operations. This study surveyed clinical commissioning groups within England to document the variable eligibility criteria for rhinoplasty and septorhinoplasty.

In February 2016, a letter was sent to 209 clinical commissioning groups requesting their rhinoplasty and septorhinoplasty commissioning criteria.

A total of 200 clinical commissioning groups responded. Although 89.5 per cent allow septorhinoplasty in the presence of nasal obstruction, further criteria, such as documented health problems resulting from nasal blockage, severe functional impairment or a specific percentage of blockage, must be shown for septorhinoplasty to be authorised by most of the clinical commissioning groups.

There is great variation within individual clinical commissioning groups in England regarding the criteria for septorhinoplasty and rhinoplasty. Some criteria seem not to be clinically relevant and difficult to demonstrate. It is recommended that the guidelines are reviewed and harmonised nationally in future revisions.

Nasal obstruction is a common ENT complaint; however, decisions on its management are challenging, with high rates of dissatisfaction following surgery. This study investigated the practice of UK clinicians in the evaluation of nasal patency.

Seventy-eight UK-based rhinologists were surveyed at the 2015 British Academic Conference in Otolaryngology.

Clinical history and examination are almost universally used to evaluate nasal blockage. The most commonly used test was the nasal misting pattern (73 per cent), followed by peak nasal inspiratory flow (19 per cent). The Sino-Nasal Outcome Test 22 or 23 was utilised by 29 per cent of respondents. Sixty-three per cent of respondents reported that a lack of equipment was the principle reason for not using objective measures, followed by time constraints and a lack of correlation with symptom scores.

British clinicians rely on clinical skills to evaluate nasal blockage. There is a desire for a simple, non-invasive device that objectively measures airflow for nasal breathing during physiological resting and correlates with subjective symptom scores.

Piezoelectric technology has existed for many years as a surgical tool for precise removal of soft tissue and bone. The existing literature regarding its use specifically for otolaryngology, and head and neck surgery was reviewed.

The databases Medline, the Cochrane Central Register of Controlled Trials, PubMed, Embase and Cambridge Scientific Abstracts were searched. Studies were selected and reviewed based on relevance.

Sixty studies were identified and examined for evidence of benefits and disadvantages of piezoelectric surgery and its application in otolaryngology. The technique was compared with traditional surgical methods, in terms of intra-operative bleeding, histology, learning curve, operative time and post-operative pain.

Piezoelectric technology has been successfully employed, particularly in otology and skull base surgery, where its specific advantages versus traditional drills include a lack of ‘blunting’ and tissue selectivity. Technical advantages include ease of use, a short learning curve and improved visibility. Its higher cost warrants consideration given that clinically significant improvements in operative time and morbidity have not yet been proven. Further studies may define the evolving role of piezoelectric surgery in otolaryngology, and head and neck surgery.

Conchal cartilage is frequently used in rhinoplasty, but donor site morbidity data are seldom reported. This study aimed to investigate the complications of conchal cartilage harvesting in rhinoplasty.

A retrospective chart review of 372 patients who underwent conchal cartilage harvesting for rhinoplasty was conducted. Data regarding patient demographics, types of nasal deformities, graft usage and complications were analysed.

A total of 372 patients who underwent conchal cartilage harvesting for rhinoplasty were enrolled. The harvested conchal cartilage tissues were used in a variety of applications: tip graft, dorsal graft, septal reinforcement and correction of nostril asymmetry. Nine cases (2.4 per cent) with donor site morbidities were identified, including four cases (1.1 per cent) with keloids and five cases (1.3 per cent) with haematomas.

Conchal cartilage harvesting is a safe and useful technique for rhinoplasty, with a low complication rate. However, patients should be informed about the possibility of donor site morbidities such as keloids and haematomas.

This study aimed to develop a multidisciplinary coded dataset standard for nasal surgery and to assess its impact on data accuracy.

An audit of 528 patients undergoing septal and/or inferior turbinate surgery, rhinoplasty and/or septorhinoplasty, and nasal fracture surgery was undertaken.

A total of 200 septoplasties, 109 septorhinoplasties, 57 complex septorhinoplasties and 116 nasal fractures were analysed. There were 76 (14.4 per cent) changes to the primary diagnosis. Septorhinoplasties were the most commonly amended procedures. The overall audit-related income change for nasal surgery was £8.78 per patient. Use of a multidisciplinary coded dataset standard revealed that nasal diagnoses were under-coded; a significant proportion of patients received more precise diagnoses following the audit. There was also significant under-coding of both morbidities and revision surgery.

The multidisciplinary coded dataset standard approach can improve the accuracy of both data capture and information flow, and, thus, ultimately create a more reliable dataset for use outcomes and health planning.

When performing septoplasty or septorhinoplasty, we have observed that patients blink on injection of local anaesthetic (lidocaine 1 per cent with adrenaline 1:80 000) into the nasal mucosa of the anterior septum or vestibular skin, despite appropriate general anaesthesia. This study sought to quantify this phenomenon by conducting a prospective audit of all patients undergoing septoplasty or septorhinoplasty.

Patients were observed for a blink reflex at the time of local anaesthetic infiltration into the nasal vestibule. Also measured at this point were propofol target-controlled infusion levels, remifentanil rate, bispectral index, blood pressure, heart rate, pupil size and position, and patient movement.

There were 15 blink reflexes in the 30 patients observed. The average bispectral index value was 32.75 (range, 22–50) in the blink group and 26.77 (range, 18–49) in the non-blink group. No patients moved on local anaesthetic injection.

The blink reflex appears to occur in 50 per cent of patients, despite a deep level of anaesthesia. Without an understanding and appreciation of the blink reflex, this event may result in a request to deepen anaesthesia, but this is not necessary and surgery can proceed safely.

This paper presents a novel method for spreader graft placement without dorsum resection in patients who have a deviated septum with a narrow internal nasal valve angle.

A Killian incision was used for the endonasal septoplasty, and all spreader grafts were harvested from excised deviated septal cartilages. Procedures were conducted under general anaesthesia at the same centre by the same surgical team that performed the endonasal procedure. Successful placement of spreader grafts was achieved endonasally.

Although the endonasal placement of spreader grafts seems to be more difficult than placement conducted by an open approach technique, an endonasal procedure has many advantages. Our technique provides surgeons with the opportunity to shorten operation time, obtain autologous septal graft material and secure the columellar architecture. Surgeons familiar with the classical (endonasal) septoplasty procedure can easily apply this technique to widen a narrow internal nasal valve angle, without corrupting nasal integrity.

Sir Harold Gillies, born in New Zealand, is widely considered a British icon and the father of modern plastic surgery.

This article provides an overview of his life and the circumstances which led to him laying the foundations of plastic surgery in Britain in the early twentieth century.

A hand search and review of case notes from the Gillies Archives at Queen Mary's Hospital in Sidcup, UK, where he made history, was conducted.

Gillies' ongoing legacy was found to also include his influence on the development of his cousin Sir Archibald McIndoe's work. Gillies was a talented sportsman who engaged in charitable activities. Additionally, he was a gifted teacher, with his hospital attracting many young surgeons from around the world. He was found to have expressed genius in both the design and execution of the art and science of surgery. He incepted reconstructive techniques ranging from the world's first gender reassignment operation to facial reanimation procedures for the treatment of facial paralysis. His operative work on ex-servicemen in need of complex rhinoplasty and in particular the inception of the tubed pedicle flap are depicted.

The successful execution of lateral osteotomies in rhinoplasty is an important step that can influence the functional and aesthetic outcome of the procedure.

This paper describes an alternative method for achieving mobilisation of the nasal bones by careful application of Walsham forceps during primary rhinoplasty.