Preoperative Evaluation of Paranasal Computed Tomography Reports of Patients Requesting Rhinoplasty for the Presence of Septal Deviation and Inferior Turbinate Hypertrophy: Retrospective Clinical Case Series Study

Special Article – Reconstructive and Aesthetic Surgery

Austin J Surg. 2019; 6(3): 1163.

Preoperative Evaluation of Paranasal Computed Tomography Reports of Patients Requesting Rhinoplasty for the Presence of Septal Deviation and Inferior Turbinate Hypertrophy: Retrospective Clinical Case Series Study

Aksoy MH*

Department of Plastic, Reconstructive and Aesthetic Surgery, Bahcesehir University, Turkey

*Corresponding author: Hasan Mete Aksoy, Department of Plastic, Reconstructive and Aesthetic Surgery, Bahcesehir University, Istanbul; VM Medical Park Kocaeli Hospital, Plastic, Reconstructive and Aesthetic Surgery Clinic, Kocaeli, Turkey

Received: December 06, 2018; Accepted: January 22, 2019; Published: January 29, 2019

Abstract

Background: A successful outcome in rhinoplasty should improve not only the aesthetic appearance of the nose but also the physiologic function of the nasal cavity. Nasal obstruction in many patients is caused by a deviated nasal septum and/or inferior turbinate hypertrophy. Preoperative proper diagnosis of these conditions is very important in planning cosmetic nasal surgery.

Methods: Paranasal computed tomography reports of 119 patients requesting cosmetic nasal surgery were evaluated for the presence of septal deviation and inferior turbinate hypertrophy.

Results: In 62 patients (52.10%) there was septal deviation with concave side facing the left nasal cavity and in 46 patients (38.65%) there was septal deviation with concave side facing the right nasal cavity. In only 11 patients (9.24%) there was no finding suggesting septal deviation. In 113 patients (94.96%) there was inferior turbinate hypertrophy. In only 6 patients (5.04%) there was no sign of inferior turbinate hypertrophy on paranasal computed tomography scan.

Conclusion: Despite the fact that radiologic imaging is usually not a standard part of the workup in patients who are candidates for rhinoplasty, preoperative paranasal computed tomography is essential to detect the presence of concomitant pathologies like septal deformities, inferior turbinate enlargement, bullous middle turbinate and chronic sinusitis. Preoperative paranasal computed tomography is a very valuable method to assess internal nasal structures especially for plastic surgeons who do not have endoscopic instruments to examine nasal cavities.

Keywords: Computed tomography; Paranasal; Septal deviation; Turbinate hypertrophy

Introduction

The role of nasal physiology should be well understood and respected by one who performs cosmetic nasal surgery. A successful outcome in rhinoplasty should improve not only the aesthetic appearance of the nose but also the physiologic function of the nasal cavity. Nasal obstruction in many patients is commonly due to a deviated nasal septum and/or inferior turbinate hypertrophy. Preoperative proper diagnosis of these conditions is very important in planning aesthetic nasal surgery. In this study paranasal computed tomography reports of patients who were candidates for cosmetic rhinoplasty operation were evaluated to detect the presence of septal deviation and inferior turbinate hypertrophy.

Materials and Methods

In this study paranasal computed tomography reports of 119 patients requesting cosmetic nasal surgery were evaluated for the presence of septal deviation and inferior turbinate hypertrophy retrospectively. Anterior rhinoscopy examination was performed in all patients prior to preoperative paranasal computed tomography. However, intranasal endoscopic examination was not performed since endoscopic instruments were not available at our plastic surgery clinic. So obtaining a paranasal computed tomography scan prior to rhinoplasty was a routine practice in our clinic. This study was performed in accordance with Declaration of Helsinki.

Results

There were 47 males (39.4%) and 72 females (60.5%) in this study. The age range of the patients was 15-52 years and the mean age was 27.85 years. In only 11 patients (9.24%) there was no finding suggesting septal deviation (Figure 1). In 62 patients (52.10%), there was varying degrees of septal deviation with concave side facing the left nasal cavity (Figures 2 & 3) and in 46 patients (38.65%), there was varying degrees of septal deviation with concave side facing the right nasal cavity (Figures 2 & 4). In 113 patients (94.96%), there was varying degrees of inferior turbinate hypertrophy (Figures 5 & 6). In only 6 patients (5.04%) there was no sign of inferior turbinate hypertrophy on paranasal computed tomography scan (Figure 5). None of our patients had paranasal computed tomographic findings of chronic sinusitis requiring ENT consultation and surgical treatment. Presence of bullous middle turbinate was not evaluated because bullous middle turbinates when detected were treated with the help of an ENT specialist during rhinoplasty procedure.