title: Nasal airway function after maxillary surgery: a prospective cohort study using the nasal obstruction symptom evaluation scale.
abstract: OBJECTIVE
  To examine nasal airway function using a disease-specific quality-of-life survey instrument in subjects undergoing Le Fort I osteotomy without simultaneous rhinosurgical procedures.
  
  
  METHODS
  We conducted a prospective cohort study of nasal airway function in consecutive Le Fort I osteotomy patients, who had not received simultaneous rhinosurgical procedures, between 2007 and 2008 at Kaiser Permanente Oakland Medical Center. We administered the Nasal Obstruction Symptom Evaluation (NOSE) survey before and 3 months after surgery. Clinical and radiographic examinations were performed, and the relevant medical and demographic factors were analyzed.
  
  
  RESULTS
  The initial study sample comprised 55 patients, of whom 5 were excluded. Of the remaining 50 patients (median age 21 years, 60% women), the maxilla was advanced (median 4 mm, interquartile range 3 to 5) with minimal vertical change. During the follow-up period (median 5.5 months), significant improvement was seen in the NOSE scores for the cohort, with a median decrease of 10 units (P = .0005). Patients with moderate nasal obstruction (preoperative NOSE score >25) had the greatest improvement (P < .001). Those with severe nasal obstruction (preoperative NOSE score >50) improved, however, this did not reach statistical significance (P < .0625). The NOSE scores worsened in 10 patients; of these, 6 had minimal change. However, 4 had significant worsening, with 2 having symptomatic complaints. No predictor variables were identified in this small subgroup; however, individual case analyses revealed 1 subject with postoperative turbinate inflammation on the side of maxillary segmentalization and 1 had nasal septal buckling.
  
  
  CONCLUSIONS
  Our overall findings have suggested that nasal airway function improved after maxillary advancement and that subjects with greater preoperative NOSE scores (>25) were more likely to experience relief of nasal obstructive symptoms.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Highland General Hospital and Division of Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA 94611, USA.
authors.forename: Bryce J D
authors.initials: BJ
authors.lastname: Williams
authors.forename: Alex
authors.initials: A
authors.lastname: Isom
authors.forename: José R
authors.initials: JR
authors.lastname: Laureano Filho
authors.forename: Felice S
authors.initials: FS
authors.lastname: O'Ryan
mesh_terms: D000293:Adolescent; D000328:Adult; D059925:Anatomic Landmarks / Q000473:pathology; D002508:Cephalometry / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008437:Maxilla / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D015508:Nasal Obstruction / Q000145:classification*; D009300:Nasal Septum / Q000473:pathology; D009666:Nose / Q000502:physiology*; D056948:Orthognathic Surgical Procedures / Q000379:methods; D019340:Osteotomy, Le Fort / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D011788:Quality of Life; D012119:Respiration; D012220:Rhinitis / Q000209:etiology; D016896:Treatment Outcome; D014420:Turbinates / Q000473:pathology; D055815:Young Adult