Concurrent rhinoplasty and endoscopic sinus surgery: a review of the pros and cons and a template for success

Overview

Patients with a blocked nose may have three problems at once: a deviated septum, swollen turbinates and inflamed sinuses, plus an external shape they want changed. The authors review whether functional endoscopic sinus surgery and rhinoplasty can safely be done together and lay out an approach for such patients.

Sections of note

• Review article; the abstract cites recent studies but gives no numbers from them.
• Concurrent FESS and rhinoplasty was historically avoided because of concern about increased complications.
• Recent studies are reported as showing simultaneous surgery with good outcomes and no significant increase in complications.
• A complete approach addresses aesthetic, functional and inflammatory issues.
• Medical treatment is described as an important adjunct to surgery for long-term symptom control.
• Recommended stepwise surgical order: nasal septum, inferior turbinates, paranasal sinuses, then the external nasal structures.

What it means for a patient

• Sinus disease and a rhinoplasty may be treated under one anesthetic rather than two separate operations.
• Medication for sinus inflammation remains part of the plan before and after surgery.
• The abstract gives no complication rates, so the safety claim rests on studies not detailed here.

Why this paper matters

Combined procedures save a second anesthetic and recovery but raise infection and swelling concerns. This review sets out an order of operations for surgeons who do both. Which patients benefit most, and infection rates with grafts in the presence of sinus disease, are not quantified in the abstract.

Terms

• Functional endoscopic sinus surgery (FESS): opening blocked sinus drainage pathways with a camera through the nostrils.
• Sinonasal obstruction: blocked nasal breathing from the nose or sinuses.
• Nasal septum: the wall of cartilage and bone dividing the nose.
• Inferior turbinates: the largest of the scroll-shaped structures on the side walls of the nasal passage that warm and humidify air.
• Paranasal sinuses: air-filled cavities in the facial bones that drain into the nose.
• Adjuvant: a treatment added to the main treatment to improve results.