It is important to note that additional surgical therapy was undertaken in 28 of 93 patients due to findings on endoscopy (and at times CT scan):
Partial middle turbinectomy with resection of a concha bullosa was undertaken in 9 patients. Endoscopic sinus surgery was undertaken at the same time as rhinoplasty in 13 patients. 2 patients required adenoidectomy. Choanal stenosis occurred in 1 patient. 3 patients had persisting posterior septal deviation after having had septoplasty elsewhere.
In the remaining 20 minutes or so I would like to go through some patient examples that highlight some of these things that we discovered on endoscopy. I think that these cases will be illuminating.
The patient shown below told us that she had been to approximately 10 prior surgeons seeking treatment of her nasal obstruction and improvement in her nasal appearance. I asked if she had undergone a nasal endoscopy and she told me that no doctor had looked in her nose with an endoscope. In her case, endoscopy revealed extremely large adenoids. I was able to make the diagnosis of adenoid hypertrophy.
In the worst case scenario – if she had had rhinoplasty surgery and had not had her adenoidectomy at the same time (in other words if a surgeon had overlooked this problem) – then she would have had persisting nasal obstruction. Eventually one might imagine that a doctor would have finally found this problem and she would have gone back to surgery (for a second operation) for an adenoidectomy. In the case of obstructing adenoids, this unnecessary second trip to the operating room can be avoided by a careful examination with endoscopy.