Rhinoplasty from a rhinologist's perspective: need for recognition of associated sinonasal conditions

Abstract

Background: Facial plastic surgeons may primarily focus on esthetic improvement of the nasal shape in patients seeking rhinoplasty (RP). However, medical conditions inside the nasal cavity should not be neglected because they may lead to unresolved sinonasal problems and, hence, dissatisfaction after esthetic RP. This observational study investigated the prevalence of sinonasal symptoms and endonasal pathology in patients requesting esthetic RP.

Methods: Patients seeking RP (n = 269) were given a questionnaire evaluating nasal obstruction and sinonasal symptoms using visual analog scales and the 22-item Sino-Nasal Outcome Test. In addition, patients underwent nasal endoscopy to evaluate anatomic and/or mucosal disease and skin-prick testing in case of clinical suspicion of allergy. Two control groups consisted of patients with an otological or general ear/nose/throat problem (n = 65) and patients who planned for endoscopic sinus surgery (ESS; n = 90).

Results: The general appraisal of nasal breathing on a scale from 0-10 in patients seeking RP was as low as 4.3 ± 3.1. Structural pathology was found in 62% of RP patients, with septal deviation being the most frequent problem encountered (54%), followed by internal nasal valve dysfunction (14%). Mucosal disease was present in 28% of RP patients. The mean SNOT-22 score of RP patients (31.8 ± 23.3) was significantly higher than the control group (11.6 ± 7.9; p < 0.001), but lower than the ESS patients (48.5 ± 22.0; p < 0.001).

Conclusion: The prevalence of endonasal structural or mucosal pathology in patients seeking RP is high and should not be overlooked at the time of planning surgery.

Conflict of interest statement

The authors have no conflicts of interest to declare pertaining to this article

Figures

Figure 1.

General evaluation of nasal breathing on a visual analog scale from 0 (total blockage) to 10 (free nasal breathing) in patients requesting rhinoplasty (RP; n = 262), in patients who planned for endoscopic sinus surgery (ESS; n = 90), and in control subjects (n = 65). There is a significant difference in general evaluation of nasal breathing between RP patients and control subjects (*p

Figure 2.

Twenty-two-item Sino-Nasal Outcome Test (SNOT-22) score in patients requesting rhinoplasty (RP; n = 251), in patients who planned for endoscopic sinus surgery (ESS; n = 90), and in control subjects (n = 65). There is a significant difference in the mean SNOT-22 score between all three groups (*p