The X-ray shown above belongs to a patient who had nasal obstruction on the left side only. A plastic surgeon performed bilateral inferior turbinectomies and did not do a septoplasty. Now, the patient has atrophic rhinitis and bitterly complains of nasal obstruction on both sides. (For those of you who are not familiar, atrophic rhinitis is a condition in which the nose does not have enough mucous lining. Taking out the inferior turbinates can lead to a situation where the nose is too dry and the patient loses sensation of airflow. In this situation, the patient physically has a very wide nasal airway but cannot feel the air passing through, so they complain bitterly of nasal blockage. This is an extremely debilitating problem for which there is no good treatment.) This patient illustrates clearly the reason that we condemn a "by-the-numbers" rhinoplasty. We advocate a thoughtful approach in which a careful examination allows proper diagnosis and is followed by proper treatment designed to address the specific cause ofnasal obstruction.

To provide some perspective on this, our team looked back on all patients that I operated on over a time period of approximately one year. We looked at patients who had two requests: treatment of nasal obstruction and improvement in nasal appearance (i.e., cosmetic rhinoplasty). Therefore, all patients whose nasal breathing was good - patients requesting only cosmetic rhinoplasty - were excluded.

We recorded our findings from looking inside the nose with a headlight (anterior rhinoscopy) and recorded additional findings on nasal endoscopy. In this study we looked at 95 patients, 83 of whom had primary rhinoplasties and 12 of whom had revision rhinoplasties. On an external exam and anterior rhinoscopy, we were able to identify a deviated septum, nasal valve compromise, and inferior turbinate hypertrophy. Additional findings that we discovered on nasal endoscopy included obstructing adenoids, large middle turbinates with concha bullosa, choanalstenosis, nasal polyps, and chronic sinusitis.

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