Septoplasty and Turbinate Surgery

When a patient requesting rhinoplasty also complains of nasal obstruction, it is critical to accurately diagnose the cause. The author reviews diagnostic procedures, including anterior rhinoscopy, nasal endoscopy, and coronal-sinus computed tomography scan. He discusses technical aspects of septoplasty and turbinate surgery, which address common causes of nasal obstruction, emphasizing traditional and endoscopic septoplasty, septoplasty techniques
to address the caudal septum, and a graduated stepwise approach to the inferior turbinates. (Aesthetic Surg J 2003;23:393-403.)

It is not unusual to see patients with concerns about both nasal appearance and function. Therefore the surgeon must have intimate knowledge of both exter­nal and intranasal anatomy. The differential diagnosis of conditions causing nasal obstruction is extensive (Table 1). Although patients with these conditions are frequent­ly seen in practices that specialize in nasal function, some also present for treatment in rhinoplasty practices. It is critical that nasal obstruction be correctly diagnosed. Just as aesthetic analysis leads to an appropriate rhinoplasty plan, good functional nasal analysis dictates appropriate medical or surgical treatment.

In my practice, problems causing nasal obstruction in patients seeking rhinoplasty have included deviated sep­tum, chronic sinusitis, sinus polyps, antrochoanal polyp, rhinitis medicamentosa, turbinate hypertrophy, adenoid hypertrophy, tumor (rhinoplasty was deferred in this patient), concha bullosa, choanal stenosis, and internal and external valve collapse.

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