Otolaryngology residents who underwent a brief intervention that included observing nasal photographs demonstrated significant improvement in nasal analysis.
The aim of the prospective observational study was to identify the common obstacles in performing photographic nasal analysis and to determine whether a systemic approach to teaching this analysis would be useful.
The study included 20 otolaryngology residents, including a control group and an intervention group that viewed a 10-minute, 11-slide presentation on systemic nasal analysis. Both groups underwent baseline assessment and postintervention testing 10 weeks later. The study was conducted during Oct. 1, 2015 to June 1, 2016.
An 18-point system served as the primary outcome measure.
Baseline findings show that participants could identify dorsal deviation and profile and describe tip angle and contour. They commonly failed to include “verification of the Frankfort plane, position of the lower lateral crura, radix position, and ratio of the ala to tip lobule,” according to the results.
Postintervention, scores for the intervention group significantly improved compared with their baseline performance, from 7.5 to 10.3 (P < .001). Results of the 10-week assessment showed that this was a 17% (95% CI, 10-23) mean comparative improvement in overall nasal analysis.
In an editorial accompanying the paper, Stephen S. Park, MD, of the division of facial plastic surgery and the department of otolaryngology at the University of Virginia Health System, noted that the study was well designed, with a simple intervention.
Although he acknowledged the small sample size, a lack of teaching session for controls, and the failure to include palpation in the photo analysis, he stressed that photographic analysis is a necessary tool for instructing residents.
“I am convinced that the key to teaching residents good rhinoplasty analysis is repetition under supervision,” he wrote. “Quarterly lectures or a weekend crash course will likely not suffice.”
Park suggested that standardization, consistency, and reproducibility in nasal analysis are critical. “The teaching program of Robitschek and colleagues serves as an excellent platform, but the resident must take it on himself or herself to practice nasal analysis repeatedly,” he wrote. “Although many residents may enjoy surgery and try to maximize time in the operating room, the value of a thorough and accurate rhinoplasty analysis cannot be overstated.”
The authors suggested that many residents easily identify the lateral view. Park agreed, and suggested that a more methodical and organized approach to all views is necessary.
“One size does not fit all, and we all develop an algorithm that best fits our style,” he wrote. “Teaching nasal analysis to residents is a worthwhile commitment. It is interesting to see what proves to work best with the present generation.” – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures. Park reports no relevant financial disclosures.