Functional Factors

Abstract

As a plastic surgeon specializing in rhinoplasty, I deal with two patient populations: the cosmetic patient who wants a more attractive nose with the preservation of what they perceive to be normal respiration, and the secondary patient whose nasal function is often impaired. These problems are usually due to fixed anatomical defor mities, which require surg ical solutions rather than the more common form of nasal obstruction due to vasomotor rhinitis requiring medical management. This chapter provides a foundation for the younger surgeon to analyze, diagnose, and manage the rhinoplasty patient. The goal is to preserve normal respiratory function, recognize those who would be compromised by surgery, and treat those with fixed anatomical deformities. During the last decade, two radical changes have occurred in septo-rhinoplasty surgery as regards functional surgery. First, septal surgery has become far simpler and consists of four areas: body resection, caudal septal relocation, dorsal straightening, and total septoplasty. In contrast, a greater emphasis on valvular surgery requires attention to the external and internal valves. Second, the primary cause of post-rhinoplasty nasal obstruction has evolved from inadequate septal surgery (1980s)through untreated turbinate hypertrophy (1990s) to collapse of the nasal valves (2000). Currently, I am convinced that the major cause of post-rhinoplasty nasal obstruction is a failure to adequately diagnose and treat a preoperative problem. Careful preoperative history, examination, and planning for the functional portion of the internal nose are as important as the aesthetic improvement of the external nose. Compromise of nasal respiration severely downgrades even the most beautiful result.