Nasal obstruction after rhinoplasty: Etiology, and techniques for correction

Abstract

Of 1,000 consecutive patients who underwent rhinoplasty, about 10 percent had some nasal obstruction postoperatively. The majority of patients in whom the author performed the primary rhinoplasty had an obstructive, vasomotor type of rhinitis that ensued, and which usually could be cured by the injection of corticosteroids into the turbinates. Fifty patients had undergone rhinoplasty by other surgeons, and most of those patients requested surgical correction to relieve the nasal appearance. In those patients the causes of nasal obstruction were; pre-existent, undetected, or diagnosed but uncorrected, septal deviation; or turbinate hypertrophy; intranasal adhesions; scar tissue web formation in the nasal vault; inadequate nasal tip support, and alar collapse. The author's technique of surgical repair for each of these conditions is outlined.

Vasomotor Rhinitis Is Not a Wastebasket Diagnosis

“…11 One is through direct stimulation of the parasympathetic nerve endings in the nasal mucosa, which is a result of the anatomic changes in the nasal tissues produced by the trauma. 11 Beekhuis, 16 who reports vasomotor rhinitis in 10% of postrhinoplasty patients, believes that it is a result of autonomic changes in the turbinate tissue as a result of the surgical trauma. Local reflexes are thought to be disturbed by trauma, resulting in neuropeptide release and adverse tissue response.…”

External Rhinoplasty: Analysis of 50 Consecutive Cases.

“…26 In the current study, this complication occurred in only one of the cases. This relatively low rate of post-operative nasal obstruction may be due to many factors; the first of which is that using the external approach eliminated the need for endonasal mucosal incisions that may have resulted in subsequent scarring and nasal obstruction especially if the nasal valve area was breached.…”

Rinite vasomotora pós-cirúrgica: diagnóstico diferencial de rinoliquorréia

“…Segal et al (1999) demonstraram uma diferença estatisticamente significativa na freqüência de rinite vasomotora entre pacientes que apresentaram traumas nasais e controles 12 . Beekhuis (1976) relatou a ocorrência de 10% de rinite vasomotora em pacientes submetidos a rinoplastia 14 . Os autores acreditam que o trauma nasal ocasionado pelo acesso cirúrgico nesta paciente tenha levado a alterações anatômicas nos tecidos nasais, que culminaram na estimulação direta do parassimpático ou na denervação simpática, ocasionando a rinite vasomotora.…”