Triological thesis: concurrent endoscopic sinus surgery and cosmetic rhinoplasty: Rationale, risks, rewards, and reality

Abstract

While our data supports concurrent ESS and CR as safe, our findings suggest that the presence and treatment of concurrent sinonasal disease prolongs the patients' recovery from CR. This may be due to the effects of sinus pathology and manipulation of sinonasal venous and lymphatic drainage patterns or could be due to subclinical infectious soiling of rhinoplasty tissue planes. We recommend a two-team approach to promote excellent surgical technique, avoid surgeon fatigue, and enhance patient care. We recommend adequate medical management of chronic sinusitis prior to surgery, pre, intra and postoperative antibiotic coverage, appropriate postoperative sinus toilet beginning 1 week after surgery and careful and close patient follow-up to optimize results. Most importantly, we advocate close coordination of sinonasal and rhinoplastic care in a two-team approach to maximize care.

Analysis of the operative utilization of concurrent rhinoplasty and endoscopic sinus surgery

“…Compared to FESS alone and RP alone, RP + FESS increased OR time for RP and FESS by approximately 90 and 50 minutes, respectively. This is consistent with previous reports for concurrent surgery and may be due to the selection of less complicated pathology for combination cases . If performed alone, the cumulative time for both surgeries would eclipse 240 minutes over two separate OR days.…”

“…Likewise, NVR has been the option of choice during rhinoplasty for patients with known valve collapse to improve functional outcomes. Several retrospective case series and one nonrandomized retrospective comparative trial have reported that combination RP + FESS is safe and efficacious, with no increase in minor complications when compared to sinus surgery alone …”

“…However, with the advent of minimally invasive techniques for performing FESS, there is less disruption to nasal structures that support the external nose. Moreover, with present perioperative antibiotic therapy, contamination of the external nose from sinusitis is low . Several authors suggest that if surgery is indicated, a combined procedure seems to offer the benefit of reduced healing time, decreased cost, and increased operative efficiency .…”

Concurrent functional endoscopic sinus surgery and septorhinoplasty: using evidence to make clinical decisions

“…They noted that sinusitis in frontal or sphenoid sinuses, as well as pansinusitis, was a relative contraindication for them in moving forward with concurrent surgery. Sclafani and Schaefer 19 published a retrospective case-control study in 2009, looking at 13 patients who underwent concurrent FESS and SRP, compared to those patients who underwent SRP alone. They found no complications, but did find a significantly increased duration in nasal tip and dorsum swelling in those patients who had undergone concurrent procedures, and found that this correlated to the degree of sinusitis.…”

Use of Hyaluronidase for Pharmacokinetic Increase in Bioavailability of Intracutaneously Applied Substances

“…Here, the dependency of the effect on concentration [32,33], temperature [34], and pH value has been investigated [35], and sodium bicarbonate as adjuvant has been tested [36,37]. In addition, co-application of HAase in infiltration anaesthesia in dentistry [38,39,40], plastic surgery [22,41], proctologic surgery [42], nail reduction surgery [43], chronic pain syndromes [44], and traumatological procedures [45,46,47,48,49] has been described so far. Also useful in clinical practice is the acceleration of resorption in extravasation by HAase.…”