**5. Conclusion**

*Rhinosinusitis*

**164**

signs of infection [17].

**Figure 10.**

*pseudo-nasal hump, and CRS post-trauma.*

A review of 268 rhinoplasties between 1997 and 2001 demonstrated 11 cases with concurrent surgery, and there were no complications noted in this study [17]. Furthermore, the authors mention a case report of a 22-year-old patient who underwent a septorhinoplasty and ESS on an outpatient basis at another institution and developed edema over the nose, cheek, glabella, and forehead regions with fever. A CT scan of paranasal sinuses showed evidence of opacification of the frontal sinuses with dehiscence of nasal bones which responded to intravenous medication and frontal trephination. Herzon in 1971 reported a 12% incidence of bacteremia in patients undergoing nasal septal surgery requiring nasal packing [23]. In 1978, Todd et al. reported the first case of toxic shock syndrome (TSS) [24].Four years later the

*Pre- (C1 and C2) and postoperative (C3 and C4) pictures of patient no. 26 who presented with twisted nose,* 

Most authors agree that performing the sinus surgery first allows the surgeon to determine if there is ongoing rhinosinusitis. Millman B who performs combination rhinoplasty with ESS recommends not proceeding with rhinoplasty if there are

There have been only 4 reported cases of MRSA associated postoperative complications following septorhinoplasty reported in the literature across all specialities [26]. Patients who are susceptible to MRSA infections may also be at higher risk for nasal colonization, and this includes elderly patients, patients recently hospitalized or treated in a rehabilitation center, and health-care workers. Few cases of MRSA infection following septorhinoplasty have been reported in the literature. Elimination

first case of TSS after septorhinoplasty was reported [25].

The author has reasonably good results combining rhinoplasty and ESS, and the benefits of these advances are illustrated by a review of the literature with good results (functional and cosmetic) and minimal complications. Extracorporeal approach was performed on all patients with gross high septal deviation. All the patients had some type of cartilage grafting with no evidence of infection, extrusion, malposition, or resorption since all the patients had autologous grafts inserted. Minor complications like erythematous columellar incisions were treated aggressively with a course of oral antibiotics. Advances in rhinoplasty and sinus surgery technique and equipment have made this one surgeon combined procedure safe and cost-effective with good results in selected patients.
