title: Radiofrequency thermotherapy vs bone-anchored suspension for treatment of lateral nasal wall insufficiency: a randomized clinical trial.
abstract: OBJECTIVE
  Lateral nasal wall insufficiency is a common problem with little consensus on optimal treatment.
  
  
  OBJECTIVE
  To assess the efficacy of radiofrequency (RF) thermotherapy for the treatment of lateral nasal wall collapse.
  
  
  METHODS
  A prospective randomized trial comparing RF thermotherapy with bone-anchored suspension technique (BAST) for lateral nasal wall collapse in 13 patients was conducted, with recruitment occurring between March 1, 2010, and February 28, 2012, and follow-up of 1 year. The setting was a tertiary care facial plastic and reconstructive surgery clinic at an academic hospital. Eligible patients had lateral nasal wall insufficiency and met study inclusion criteria.
  
  
  METHODS
  Participants were randomized to receive either BAST of the lateral nasal wall or RF thermotherapy to the lateral nasal wall.
  
  
  METHODS
  Outcomes were assessed 1, 3, 6, and 12 months after surgery using 2 subjective patient outcomes surveys (the Nasal Obstructive Symptom Evaluation and a visual analog scale) and a physician-derived assessment of lateral wall collapse.
  
  
  RESULTS
  Significant improvements in symptom scores were seen postoperatively for both treatment arms, though more consistently in the radiofrequency group. One month postoperatively, the mean (SD) drop in NOSE scores was 52.5 ± 22.2 and 51.7 ± 26 (P = .96) for the BAST and RF groups, respectively. Similar results were noted at 6 and 12 months postoperatively (56.7 ± 38.2 vs 50 ± 14.7 [P = .76] and 53.3 ± 20.2 vs 56.7 ± 18.9 [P = .84] at 6 and 12 months, respectively). No statistical difference in change in NOSE scores occurred between the 2 groups at 1, 6, or 12 months postoperatively. Likewise, the drop in VAS scores between the 2 treatment groups was similar at each time point. One month postoperatively, the mean (SD) drop in VAS scores was 5.1 ± 2.8 and 4.8 ± 2.6 (P = .90). Similar results were noted at 6 and 12 months postoperatively (5.8 ± 3.4 vs 4.9 ± 3.1 [P = .72] and 5.5 ± 3.1 vs 5.4 ± 1.3 [P = .96] at 6 and 12 months, respectively). Using a physician-derived score, significant improvement was seen in patients in the RF group at 1 month (P = .005), 6 months (P = .002), and 12 months (P = .03). For the BAST group, significant improvement was noted only at the 1-month postoperative visit (P = .007). Comparison of RF vs BAST revealed significant improvement in the RF group over the BAST group at 12 months (P = .04). The other periods revealed no significant differences between the two.
  
  
  CONCLUSIONS
  Radiofrequency thermotherapy is a viable alternative option for lateral nasal wall collapse, both in terms of improvements in symptoms and physical examination, with suggested evidence for efficacy at least as good as that for bone-anchored suspension.
  
  
  METHODS
  1.
  
  
  BACKGROUND
  isrctn.org Identifier: ISRCTN14219489.
authors: Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California.
authors: Joshua D
authors: JD
authors: Weissman
authors: Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, Stanford, California2associate editor, JAMA Facial Plastic Surgery.
authors: Sam P
authors: SP
authors: Most
mesh_terms: D019317:Evidence-Based Medicine; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies; D011846:Radio Waves; D019651:Plastic Surgery Procedures / Q000379:methods; D012225:Rhinoplasty / Q000379:methods*; D053441:Suture Anchors; D016896:Treatment Outcome