**3. Additional diagnostic techniques**

that an ideal surgery with perfect results in an unsatisfied patient is a big failure and is best

The human nose bears a complex physiologic and functional role in breathing and smelling. For this reason it is logically expected that this delicate organ be preserved and even improved during aesthetic surgery. This evaluation usually starts with verbal interview with the patient. Any breathing problems may be easily detected. Exacerbating factors or problems are usually best described by the patient, and then the evaluation continues with direct inspection of the nose. Any deviation or deformity should be observed and documented. To assess the septum and turbinates sufficient light and a nasal speculum are necessary. A few drops of a vasocon‐ strictor such as phenylephrine in each nostril may be applied for better visualization [4-7].The final step is to check the valve. The Cottle test is a known method to assess the internal nasal valve. The patient is asked to take a deep breath through the nose, and then inhalation is repeated while the patient is retracting his/her nasal side wall. If a considerable improvement occurs (positive Cottle test), this means a serious weakness exists in the internal nasal valve (Figure1). [8].It is clear that a reinforcement or total reconstruction of the internal valve should be considered in treatment planning. This test should be done on both sides and documented

To assess the external valves the patient is asked to tilt the head backward and take a deep. The nose is closely observed by the surgeon. This test may be documented by simple standard photography. Excessive medial movements of the nostrils and/or collapse means that some kind of reinforcement technique needs to be considered in the rhinoplasty procedure [9-10].

prevented in this preoperative phase [2-3].

750 A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2

**2.2. Functional evaluation**

properly.

**Figure 1.** Cottle test.

**Water's view** radiograph is commonly used to evaluate the maxillary sinuses and nasal septum. In case a complex deformity or deviation is found, CT scan may help the surgeon better analyze the problem.

**Lateral nasal view** may help the surgeon measure the length and height of the bony vault though measurement, palpation and tactile sensation may easily provide the same data for the surgery.

CT scans are commonly used to assess internal compartments of the nose. Septal deformities and spicules are easily detected and documented. Nasal turbinates and paranasal sinuses are also clearly observed on CT scans. Nasal valve diameters are sometimes measured and documented as well.
