[About the functional aspect of septorhinoplasty]

Outcome of Concurrent Septorhinoplasty and Functional Endoscopic Sinus Surgery (FESS) in Patients with Sinusitis and Nasal Deformity: A Retrospective Study and Review of Literature

Patients with deformed external noses and deviated nasal septum also have lateral wall deformities compromising the osteomeatal complex leading on to sinusitis. These patients will need septorhinoplasty along with functional endoscopic sinus surgery (FESS) to facilitate proper drainage of sinuses. The two main risks of combined procedure are firstly the risk of infection if done in infected sinusitis and secondly, the fear of collapse of nasal bone and the frontal process of the maxilla if medial and lateral osteotomies are done after extensive ethmoidectomy for extensive sinus disease. Our objective was to study the outcomes of combined septorhinoplasty with functional endoscopic sinus surgery in patients having sinusitis along with nasal deformity. In this retrospective study we describe the outcomes of patients who have undergone combined FESS + Rhinoplasty. We controlled the sinus infection and avoided extensive polyposis for combined procedure. We found that nasal block, facial pain, anosmia, rhinorrhea improved in all the patients There was a complete resolution of symptoms in the group. Thus, in combined surgery, we could simultaneously get a good functional airway, solve the sinus complaints and improve the nasal aesthetics satisfactorily. The patients were subjected to SNOT scale in 2023 and average score of SNOT score was found as 11 at an average postop followup period of 14 Years post op. We found that combined Rhinoplasty and Functional Endoscopic Sinus Surgery for patients having nasal deformity with chronic Rhinosinusitis can be performed safely and effectively. Simultaneously harvested septal cartilage could be used judiciously for meticulous reconstruction. It, avoided the extra cost and patient's time of two staged partial surgery.

Outcome and Pitfalls of Open Rhinoplasty

The goal of rhinoplasty is to improve the nose aesthetically as well as functionally. Surgical access to the nose can be gained via close rhinoplasty, open rhinoplasty) or a combination of the two. To assess various types of nasal deformities, aesthetic results of open rhinoplasty and pitfalls of open rhinoplasty in patients planned for surgery. This prospective longitudinal study was done in the Department of ENT GMC Jammu between November 2015 and October 2016. This included patients with nasal deformities willing for corrective surgery, above 18 years of age. Postoperative aesthetic parameters were measured to evaluate the aesthetic outcomes on the 2 weeks, 6 weeks and 3 months. Post-operative complications were noted. 20 patients were admitted for open septorhinoplasty; crooked nose was the most common deformity found in 55% of the patients. Nasal trauma (50%) was most common cause of external nasal deformity. Autologous septal cartilage was used in 85% patients while autologous auricular cartilage was used in 15% patients. Eyelid edema was the most common complication seen. In this study according to the patient follow up self-evaluations, 65% patients were partially satisfied and 35% patients are satisfied with the aesthetic results. Additional procedures are required along with rhinoplasty for better results of surgery. Open rhinoplasty is better cosmetic surgery for the correction of nasal framework defects and post-operative complications are quite low with the open rhinoplasty.

Correlation between subjective and objective results in nasal surgery

BACKGROUND

There is a lack of medical literature demonstrating a positive correlation between subjective and objective results in functional nasal surgery.

OBJECTIVE

The author presents his experience measuring nasal function subjectively and objectively before and after functional nasal surgery.

METHODS

Between March 2011 and June 2012, a total of 119 consecutive patients with nasal obstruction underwent rhinoplasty with a variety of septorhinoplasty techniques. Results were evaluated with a scientifically validated patient questionnaire as well as pre- and postoperative rhinomanometry measurement comparisons. Preoperative and postoperative rhinomanometry measurements were standard protocol, and the rhinomanometry measurements were designed as a prospective study.

RESULTS

Ninety of the 119 patients had postoperative rhinomanometry measurements that could be compared with preoperative values, and these patients were included in the study. Statistically significant subjective and objective functional improvements were reported in 98.9% and 95.6% of patients, respectively, while 94.4% of patients had both subjective and objective statistically significant functional improvement. A statistically significant correlation between the subjective and objective improvements was noted.

CONCLUSIONS

The findings provide statistically significant evidence to support surgical treatment of nasal obstruction.

LEVEL OF EVIDENCE

3.

Does cosmetic rhinoplasty affect nose function?

Objective. To evaluate the changes in nasal dimensions of healthy Iranian volunteered for cosmetic rhinoplasty after surgery using acoustic rhinometry. Methods. Pre- and postoperative nasal dimension of 36 cases undergoing cosmetic rhinoplasty were compared using acoustic rhinometry (AR), and the measured variables were distance to first and second constriction (d1, d2), first and second minimal cross-sectional area (MCA1, 2), and volume. Results. Mean age (SD) of cases were 24.63 (4.4) years. Septoplasty was performed in 12 cases (33.3%). After surgery, bilateral d1 and both MCA2 decreased significantly, while significant increase was observed in MCA1 postoperatively using decongestant. Cases with septoplasty experienced more increase in MCA1 and less constriction in MCA2 postoperatively. In cases with rhinoplasty alone, they received benefit from double osteotomy in MCA1. In either group of rhinoplasty with and without septoplasty, placing a strut was beneficial for patients. Discussion. The cross-sectional area of the nose is a major factor in the determination of airflow. Cosmetic rhinoplasty may generate a mix effect on nose function. Performing osteotomy may better help patients to save nasal patency, septoplasty is beneficial even in mildly deviated septums, and placing a strut may be beneficial in most of the cases.