Open research questions in Nasal Surgery and Airway Studies
47 unresolved questions extracted from the limitations and future-work sections of 793 Nasal Surgery and Airway Studies papers in our library. Each links back to the study that raised it.
What the literature leaves open
Furthermore, the exact in vivo persistence and behavior of the collagen membrane used in this study remain unknown, and early resorption or displacement after placement cannot be excluded. Further studies involving larger case numbers and comparative designs are warranted to better define the indications and potential utility of this approach.
Adjunctive use of a collagen membrane for surgical closure of oronasal fistulae in dogs with challenging local conditions: a case series · 2026 · DOIThis study has several limitations. First, it is a retrospec- tive case series with a rather small sample size (n = 15) that restricts the generalisability of the results. Second, there is no control group, which does not allow for comparison of the results with other standard approaches to septal perfora- tion repair. Third, there might be a risk of selection bias due to the exclusion of patients with autoimmune disease, active cocaine use, or perforations larger than 3.5 cm. Fourth, the functional outcomes were measured on a clinical basis and not with a validated patient-reported outcome measure like the NOSE or SNOT-22 scales. Lastly, the mean follow-up was over 22 months, yet the longer-term results are still unknown. Multicentre prospective trials involving larger groups of patients are necessary in future to ascertain the reproducibility and long-term efficacy of this method.
Dynamic septal reconstruction using the Tsubasa flap: integration of depressor septi nasi muscle and temporoparietal fascia · 2026 · DOIThis study has several limitations that should be considered when interpreting the results. First, the inherent heterogeneity among the included studies—in terms of surgical techniques, patient demographics, follow-up durations, and outcome measures—limits direct comparability and introduces potential bias. The concept of "preservation rhinoplasty" itself lacks a universally accepted definition, with techniques and modifications often varying significantly between surgeons. As such, conducting a review on this evolving and ambiguous surgical category presents inherent challenges, and comparisons between studies must be interpreted with caution. The variation in outcome reporting, with some studies emphasizing aesthetic improvements while others focused on functional changes, further complicates synthesis. Another important limitation is the inconsistent reporting of anatomical complexity. Key parameters—such as the presence of severe septal deviations, deformities extending to the K-point, or cases requiring total septal reconstruction—were rarely defined in a standardized way. Because these factors strongly influence revision rates, surgical difficulty, and overall satisfaction, the lack of uniform severity descriptors limits the ability to compare preservation and structural techniques reliably across studies. Moreover, the majority of included studies relied on subjective patient-reported outcomes, such as ROE or NOSE scores, while only a few incorporated objective airflow or anatomical measurements. While PROMs provide important patient-centered perspectives on perceived functional and aesthetic benefit, they do not substitute for dedicated, standardized psychological outcome measures (e.g., validated assessments of body image, self-esteem, or broader quality-of-life constructs). The limited and inconsistent use of such psychological instruments in the available preservation rhinoplasty literature restricts conclusions regarding psychosocial impact beyond symptom and satisfaction reporting. This lack of standardized, validated outcome measures limits the ability to perform robust cross-study comparisons.
This study has several limitations that warrant considera- tion. First, the cross-sectional design limits causal infer- ences between anatomical variants and clinical outcomes, as no postoperative follow-up was included to assess long-term impacts on rhinoplasty success or revision rates. The sample size (n = 133) fell short of the calculated minimum (280) for optimal power, potentially reduc- ing the ability to detect subtle subgroup differences and introducing selection bias from consecutive enrollment at a single tertiary center. Retrospective CT review, while minimizing additional radiation, relied on existing scans not uniformly protocolized for research, which may have affected measurement consistency despite high inter- rater reliability (kappa > 0.80). The exclusion of patients with prior nasal surgery or acute sinusitis enhances focus on primary rhinoplasty candidates but limits gen- eralizability to revision cases or those with active infec- tions. Additionally, the Iranian cohort may not represent broader Middle Eastern or global populations, given eth- nic and environmental variations in sinonasal anatomy. Self-reported NOSE score data are subject to recall bias, and the absence of a control group precludes direct attri- bution of variants to rhinoplasty candidacy. Finally, while radiation concerns were mitigated by using routine scans, ethical debates on routine CT persist, and our study did not quantify exposure risks.
Computed tomography-detected sinonasal anatomical variations in rhinoplasty candidates: a cross-sectional study · 2026 · DOIObjective evaluation metrics for Empty Nose Syndrome treatment outcomes require development and validation to be consistently applied across different studies; solutions such as using natural disease progression as a control and independent assessor blinding need implementation but lack specific operational definitions.
Evidence-based approaches for Empty Nose Syndrome management: a systematic review highlighting current treatments and future directions · 2026 · DOIOnly one randomized controlled trial exists for Empty Nose Syndrome management despite multiple surgical, regenerative, and neurostimulation modalities being explored, with concerns noted regarding sample size justification and outcome assessment blinding; rigorous RCT designs are needed to establish evidence-based treatment standardization.
Evidence-based approaches for Empty Nose Syndrome management: a systematic review highlighting current treatments and future directions · 2026 · DOISex representation is uneven across Empty Nose Syndrome treatment studies, limiting the generalizability of findings regarding how biological sex influences surgical outcomes, implant integration, or response to pharmacological-cognitive interventions in this patient population.
Evidence-based approaches for Empty Nose Syndrome management: a systematic review highlighting current treatments and future directions · 2026 · DOICase-control studies on Empty Nose Syndrome surgical techniques lack true control groups and do not investigate placebo effects, as most compare two reconstructive techniques rather than comparing treatment against a control condition, preventing assessment of inherent placebo contribution to symptom improvement.
Evidence-based approaches for Empty Nose Syndrome management: a systematic review highlighting current treatments and future directions · 2026 · DOIThe timing of adverse events in Empty Nose Syndrome implant-related complications is documented inconsistently across studies: most events occur within one month, but documentation extends to four years with sparse intermediate reporting, leaving critical gaps in understanding late-stage graft resorption, extrusion, and material degradation trajectories.
Evidence-based approaches for Empty Nose Syndrome management: a systematic review highlighting current treatments and future directions · 2026 · DOIOutcome measures for Empty Nose Syndrome management are not consistently defined, validated, or reliably applied across studies, creating heterogeneity that hinders comparison of surgical, regenerative, and pharmacological-cognitive treatment efficacy across different patient populations.
Evidence-based approaches for Empty Nose Syndrome management: a systematic review highlighting current treatments and future directions · 2026 · DOICase series studies on Empty Nose Syndrome treatments lack standardized consecutive patient enrollment documentation and consistent follow-up duration (43.3% rated low risk, 20% high risk), preventing robust long-term outcome assessment beyond one year and limiting evaluation of treatment durability.
Evidence-based approaches for Empty Nose Syndrome management: a systematic review highlighting current treatments and future directions · 2026 · DOIThe study did not directly measure chronic changes in airflow patterns and their potential contribution to long-term functional adaptations affecting lung volumes and airway patency. Future research must employ time-series analysis of airflow dynamics over extended post-operative periods to characterize how nasal structural modifications influence sustained respiratory efficiency.
Sleep studies were not conducted to determine whether airflow changes resulting from alarplasty translate into sleep-related breathing disorders such as obstructive sleep apnea. Future research should include polysomnography and other sleep assessments to evaluate the functional implications of altered nasal valve structure on sleep-disordered breathing and oxygenation patterns.
The relatively small sample size (n=22) with multiple statistical comparisons across pulmonary and respiratory muscle strength variables increases risk of Type I error. Future studies must employ larger sample sizes with appropriate statistical corrections (e.g., Bonferroni adjustment) to increase generalizability of findings regarding alarplasty's effects on MIP, MEP, and spirometric parameters.
No control group of individuals without alarplasty was included; comparisons relied only on predicted values from the Global Lung Function Initiative rather than matched controls. Future research must incorporate appropriately matched control groups to account for individual variability in FEV1, respiratory muscle strength, and other pulmonary parameters independent of surgical intervention.
The study used a cross-sectional design with only single post-operative measurements, preventing determination of whether pulmonary function differences existed prior to alarplasty surgery. Future studies must employ longitudinal designs with pre-operative and post-operative pulmonary function measurements to establish causality between alarplasty and changes in spirometric values and respiratory muscle strength.
Nasal airflow resistance and nasal valve function were not directly measured using objective assessments such as rhinomanometry in this study. Future research must incorporate these direct measurement techniques to confirm theoretical explanations about how alarplasty affects nasal airflow dynamics and external nasal valve function.
This study shows that rhinoplasty may have a greater effect on nasal tip rotation as measured by NLA and that the effects of NLA and CPA are independent, signifying that a standardized measurement for nasal tip rotation is warranted.
It is often thought that the structure of NST and its function are poorly characterized and is rarely considered by rhinosurgeons during plan and make surgery.
Several limitations of this study should be acknowledged: Retrospective Design: The retrospective nature limits our ability to control for all variables and establish definitive causation.
Asymmetric Puzzle Spreader Graft: A Systematic Approach for Correction of Crooked Nose Deformity · 2026 · DOIBeyond the associated functional impairment, lateral nasal wall insufficiency may manifest as supra-alar pinching, parenthesis deformity, alar rim retraction, basal asymmetries, and a broad, poorly defined nasal tip [5].
The Modified Alar Batten Graft as a Tip-Alar Superstructure: A Technique to Restore Soft Triangle Stability and External Valve Support · 2026 · DOIEMR produced reproducible, charge-dependent reshaping at near-physiological temperatures, but human studies were lacking.
From Conventional Septoplasty to Patient-Specific Cartilage Reshaping: A Systematic Review of Laser-Mediated and Electromechanical Approaches · 2026 · DOIAll patients had similar aesthetic deformities with history of nasal trauma in childhood, limiting generalizability to other types of nasal deformations.
ORGAN-SAVING APPROACHES IN THE SURGICAL CORRECTION OF AESTHETIC DEFORMATIONS OF THE NOSE · 2026 · DOICONCLUSION: Based on our findings, although there is no consensus on the optimal time for splint removal, earlier removal of splints can be considered a favorable option after septoplasty operations.
Impact of Intranasal Splint Removal Time on Postoperative Complications after Septoplasty · 2024 · DOICONCLUSION: Despite the lack of consensus with postoperative nasal stents, this review suggests its safety and role in preserving shape and improving stenosis.
Most-cited papers in Nasal Surgery and Airway Studies
- Long-Term Effects of Nasoalveolar Molding on Three-Dimensional Nasal Shape in Unilateral Clefts · The Cleft Palate-Craniofacial Journal · 1999 · 67 citations
- Nasorespiratory characteristics and craniofacial morphology · European Journal of Orthodontics · 1995 · 49 citations
- Guidelines for Dorsum Preservation in Primary Rhinoplasty · Facial Plastic Surgery · 2021 · 47 citations
- An Artificial Intelligence Tool for Image Simulation in Rhinoplasty · Facial Plastic Surgery · 2021 · 37 citations
- Avoiding Aesthetic Drawbacks and Stigmata in Dorsal Line Preservation Rhinoplasty · Facial Plastic Surgery · 2021 · 32 citations
- Rhinoplasty Dissection Planes (Subcutaneous, Sub-SMAS, Supra-perichondral, and Sub-perichondral) and Soft Tissues Management · Facial Plastic Surgery · 2021 · 31 citations
- Biomechanical Nasal Anatomy Applied to Open Preservation Rhinoplasty · Facial Plastic Surgery · 2021 · 31 citations
- Nuances in the Management of Rhinophyma · Facial Plastic Surgery · 2012 · 28 citations
- Indications for Preservation Rhinoplasty: Avoiding Complications · Facial Plastic Surgery · 2021 · 25 citations
- The Use of the Nasometer and Interpretation of Nasalance Scores · Perspectives of the ASHA Special Interest Groups · 2020 · 23 citations
Most recent work
- Skin and Soft Tissue Management in Primary Rhinoplasty · Facial Plastic Surgery · 2026
- Contemporary Management of Caudal Septal Deformities: An Algorithmic Approach · Facial Plastic Surgery · 2026
- Application of 3D-Printed nasal models in lacrimal surgery training · Head & Face Medicine · 2026
- ORGAN-SAVING APPROACHES IN THE SURGICAL CORRECTION OF AESTHETIC DEFORMATIONS OF THE NOSE · Art of Medicine · 2026
- Alarplasty and its effects on respiratory function: a cross-sectional study · Frontiers in Medicine · 2026
- Evidence-based approaches for Empty Nose Syndrome management: a systematic review highlighting current treatments and future directions · Frontiers in Bioengineering and Biotechnology · 2026
- Computed tomography-detected sinonasal anatomical variations in rhinoplasty candidates: a cross-sectional study · Egyptian Journal of Radiology and Nuclear Medicine · 2026
- The Semi-columellar Strut Technique: Correction of Slight Sagittal Deviation of the Septum · Cureus · 2026
- Dynamic septal reconstruction using the Tsubasa flap: integration of depressor septi nasi muscle and temporoparietal fascia · European Journal of Plastic Surgery · 2026
- The Evolution of Nasal Stents in Eastern Rhinoplasty: From Adoption of Western Endogenous Extension Stents to Indigenous Development of Exogenous Extension Stents · Journal of Craniofacial Surgery · 2026
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