Evaluating Severity and Trends of Nasal Obstruction Following Mohs Reconstruction of Nasal Subunits

Kaitlynne Y Pak; Alberto Nunez; Amanda Rosenthal; Geena Conde; Nima M Gharavi; Matthew K Lee

doi:10.1097/SCS.0000000000012177

Evaluating Severity and Trends of Nasal Obstruction Following Mohs Reconstruction of Nasal Subunits

J Craniofac Surg. 2025 Nov 18. doi: 10.1097/SCS.0000000000012177. Online ahead of print.

Authors

Kaitlynne Y Pak¹, Alberto Nunez¹, Amanda Rosenthal², Geena Conde³, Nima M Gharavi², Matthew K Lee¹

Affiliations

¹ Division of Otolaryngology, Head and Neck Surgery, Cedars-Sinai Medical Center.
² Department of Dermatology, Dermatologic Surgery,Cedars-Sinai Medical Center.
³ David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.

PMID: 41251754
DOI: 10.1097/SCS.0000000000012177

Abstract

Background: Although long-term complications are uncommon following Mohs micrographic surgery (MMS), some studies suggest postoperative nasal airway obstruction (NAO) is underreported. We aimed to evaluate severity and impacting factors for postoperative NAO.

Methods: This is a survey study and retrospective review. The Nasal Obstruction Symptom Evaluation (NOSE) scale was used for clinically significant changes in pre- and postoperative nasal breathing secondary to factors related to reconstruction after MMS. Subset analysis was performed.

Results: The survey response rate was 51.4%. There were 54 cases (28 males, 26 females) with an average age of 71.9 years. The average time to follow up was 5.5 months. Overall, 18.5% (10) experienced postoperative NAO. The average ΔNOSE of the affected cohort was 14 (P=0.0004), versus unaffected was 0. There was a significant difference between the affected and unaffected ΔNOSE (P=0.0008). When stratified by NOSE severity, majority developed mild NAO, and one demonstrated moderate NAO. Significantly greater ΔNOSE scores were associated with the ala/alar groove or dorsum subsites, defect size above the median (80 mm), and reconstruction with regional flaps or primary closure. Other subsites (sidewall, tip/supratip, nasolabial fold) and skin grafts or secondary closure did not demonstrate a significant ΔNOSE.

Conclusion: Our study demonstrates 18.5% developed NAO following MMS of nasal subsites with an average NOSE score of 14 (mild severity). This was a small study, and larger, prospective studies are needed for meaningful conclusions.

Keywords: Mohs micrographic surgery; nasal obstruction; nasal valve insufficiency.