Overresection of intranasal Soft Tissue

Overresection of intranasal soft tissue can result in atrophic rhinitis, such as that seen after resection of major intranasal tumors and after inferior turbinectomy. Despite having widely patent nasal cavities, these patients com­plain of nasal obstruction and nasal dryness (Figure 10).

In relatively mild cases of atrophic rhinitis, saline nasal spray may relieve symptoms.

Discussion

Levine33 reported that in 39% of patients who visited a rhinology practice with complaints of nasal obstruc-tion, endoscopy revealed findings that were not identified with traditional rhinoscopy. Many of Levine's patients had seen other physicians for treatment of nasal obstruc­tion and had not received adequate treatment. I have also found that several causes of nasal obstruction can only be diagnosed with nasal endoscopy or computed tomogra­phy (CT) (Figures 11-14).

For a patient with nasal obstruction without a clear diag­nosis, perform nasal endoscopy and also consider coronal­sinus CT. CT may demonstrate or better define the cause of nasal obstruction, which may be overlooked without careful endoscopic examination supplemented, at times, by CT.

Endoscopy is an office procedure that takes minutes and causes minimal discomfort. It provides potentially sig­nificant useful information that may alter the approach to surgical therapy in a way that improves functional out-come. In patients with a functional nasal problem, office endoscopy is reimbursed in the United States by most insurance companies. In light of all of this, I recommend that patients presenting for rhinoplasty who complain of nasal obstruction should undergo anterior rhinoscopy, and if complete visualization of the intranasal anatomy is not possible, anterior rhinoscopy should be followed by nasal endoscopy. In a significant number of patients, nasal endoscopy allows identification of clinically significant pathologic findings and thereby may cause an alteration in the approach to surgical therapy.

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