Utility of a systematic approach to teaching photographic nasal analysis to otolaryngology residents

Jon Robitschek, Harley Dresner, Peter Hilger

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


IMPORTANCE: Photographic nasal analysis constitutes a critical step along the path toward accurate diagnosis and precise surgical planning in rhinoplasty. The learned process by which one assesses photographs, analyzes relevant anatomical landmarks, and generates a global view of the nasal aesthetic is less widely described. OBJECTIVES: To discern the common pitfalls in performing photographic nasal analysis and to quantify the utility of a systematic approach model in teaching photographic nasal analysis to otolaryngology residents. DESIGN, SETTING, AND PARTICIPANTS: This prospective observational study included 20 participants from a university-based otolaryngology residency program. The control and intervention groups underwent baseline graded assessment of 3 patients. The intervention group received instruction on a systematic approach model for nasal analysis, and both groups underwent postintervention testing at 10 weeks. Data were collected from October 1, 2015, through June 1, 2016. INTERVENTION: A 10-minute, 11-slide presentation provided instruction on a systematic approach to nasal analysis to the intervention group. MAIN OUTCOMES AND MEASURES: Graded photographic nasal analysis using a binary 18-point system. RESULTS: The 20 otolaryngology residents (15 men and 5 women; age range, 24-34 years) were adept at mentioning dorsal deviation and dorsal profile with focused descriptions of tip angle and contour. Areas commonly omitted by residents included verification of the Frankfort plane, position of the lower lateral crura, radix position, and ratio of the ala to tip lobule. The intervention group demonstrated immediate improvement after instruction on the teaching model, with the mean (SD) postintervention test score doubling compared with their baseline performance (7.5 [2.7] vs 10.3 [2.5]; P < .001). At 10 weeks after the intervention, the mean comparative improvement in overall graded nasal analysis was 17% (95% CI, 10%-23%; P < .001). CONCLUSIONS AND RELEVANCE: Otolaryngology residents demonstrated proficiency at incorporating nasal deviation, tip angle, and dorsal profile contour into their nasal analysis. They often omitted verification of the Frankfort plane, position of lower lateral crura, radix depth, and ala-to-tip lobule ratio. Findings with this novel 10-minute teaching model should be validated at other teaching institutions, and the instruction model should be further enhanced to teach more sophisticated analysis to residents as they proceed through training. LEVEL OF EVIDENCE: NA.

Original languageEnglish (US)
Pages (from-to)459-462
Number of pages4
JournalJAMA Facial Plastic Surgery
Issue number6
StatePublished - Nov 1 2017

Bibliographical note

Funding Information:
We designed a prospective observational study. Twenty otolaryngology residents, ranging from postgraduate years (PGYs) 1 through 5, were enrolled from a single teaching institution. Participants were randomly selected into a study or a control cohort in an alternating fashion throughout the study period (Figure). This study was approved by the institutional review board of HealthPartners Institution for Education and Research, who waived the need for informed consent.

Publisher Copyright:
© 2017 American Medical Association. All rights reserved.


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