Postoperative Functional Sequelae of Rhinoplasty

ABSTRACT

Postoperative sequelae following rhinoplasty are particularly distressful to both the physician and the patient. As most patients appreciate function over form, even our most spectacular esthetic results through rhinoplasty can be marred by postoperative nasal obstruction. Nasal obstruction following rhinoplasty is not an unexpected sequela given that the majority of the procedures are carried out to narrow the nose and consequently reduce the nasal airway. Maneuvers performed during a rhinoplasty procedure that reduce the nasal airway include infracture of the frontal nasal process of the maxillary bone, reduction of the bony and cartilaginous hump, infracture of the nasal bones and upper lateral cartilage (ULC), resection of the upper border of the lower lateral cartilages (LLC), and alar base reduction. Postoperative nasal obstruction may result in part from the unmasking of previously unrecognized conditions that become clinically significant with further airway reduction. These conditions include: 1) nasal allergy, 2) turbinate dysfunction, and 3) nasal septal deformities. Airway problems following rhinoplasty may be caused by postoperative edema, inferior turbinate hypertrophy, narrowing or collapse of the internal nasal valve area, synechia or scarring, excessive alar base reduction, nasal septal perforation, or intrusion of the lower lateral cartilages.

It is the purpose of this article to review the pertinent anatomy and physiology of the nose with respect to rhinoplasty, outline and propose treatment for postoperative functional sequelae, and propose methods for preoperative identification and avoidance of complications.

Keywords

Rhinoplasty - airway obstruction - complication - nasal airway - septoplasty