The patient shown in these photographs presented to my office with nasal obstruction. As a secondary concern he was interested in rhinoplasty, specifically in improving the appearance of his twisted nasal tip.
He had been to other doctors who had told him that he had a deviated septum. However, when I examined him I couldn’t see all the way to the back of the nose with anendoscope, and so I obtained a CT scan, shown here. As you can see, this gentlemen had a benign but extremely large tumor. Fortunately, this bony tumor was benign, and we have been able to treat him successfully.
While this kind of problem is rare, it highlights the fact that there are a lot of different causes of nasal obstruction. This fact should not be ignored just because a patient wants a rhinoplasty.
As we go through this lecture we are showing you some of the uncommon things that we have seen from time to time over the years. Of course, we see the very common things – like a deviated septum – much more frequently. Still, it is important to realize that these rare problems can show up in any doctor’s office and that while they are uncommon, they definitely occur.
It is our job as doctors of the nose and as rhinoplasty surgeons to identify the common and the uncommon causes of nasal obstruction. To accomplish this, we must perform a thorough examination including endoscopy. If a patient comes in to see us for a rhinoplasty to improve their appearance and also to improve their nasal breathing, it is important to identify all the causes of nasal obstruction so that we give them the best possible result.
One of the problems that we see – more often that we would like – is that some surgeons seem to assume that if a patient complains of nasal obstruction they must have large inferior turbinates or a deviated septum. This leads to an “assembly-line” or “by-the-numbers” rhinoplasty approach that we strongly condemn.