**1. Introduction**

There is an increasing demand for facial plastic surgery with more awareness of the procedure and its outcome. Many patients who seek surgery for their nasal aesthetics also have complaints of nasal obstruction and snoring [1, 2]. Severe gross septal deviations present big surgical challenges for the operating surgeon. The role of functional rhinoplasty in the management of internal nasal valve has been discussed by numerous authors (**Figure 1**).

A complete evaluation of these groups of patients with nasal endoscopy and CT scan of paranasal sinuses will often reveal concurrent chronic rhinosinusitis (CRS).

#### **Figure 1.**

*A close-up view showing the anatomical relationship of the left internal nasal valve to the septum anteromedially and the inferior turbinate laterally.*

Procedures of endoscopic sinus surgery (ESS), septoplasty (SP), and rhinoplasty (RP) were initially meant for functional improvement to which today an aesthetic aim is added. The functional aim of rhinoplasty is meant for recovery of normal sinonasal physiology and ventilatory function.

CRS is an inflammation of the nose and paranasal sinuses manifesting with two or more significant symptoms for 12 weeks with endoscopic and/or CT scan signs of disease. The symptoms include nasal obstruction, thick nasal discharge, and/ or facial pain/pressure and/or reduction or loss of sense of smell [3]. Diagnosis of CRS is primarily based on symptoms that are confirmed by nasal endoscopy and CT scans in coronal and axial views (**Figures 2** and **3**).

In functional rhinoplasty, the role of the spreader graft [4], columellar extension graft [5], shield graft [6, 7], onlay conchal graft [8], nasal valve suture suspension [9], and flaring sutures [10] has been advocated by numerous authors. Endoscopic sinus surgery (ESS) has also been accepted as a safe and efficient modality for the treatment of CRS. The combination of both these procedures would offer great benefit to the indicated patient group.

#### **Figure 2.**

*Coronal (A1) and axial (A2) CT scan serial cuts of paranasal sinuses showing a markedly deviated nasal septum with pneumatized diseased right middle turbinate and evidence of sinusitis.*

**155**

documented.

technique [14].

**Figure 3.**

**2.1 Patients**

outcomes of concurrent ESS and SP.

**2. Methods and materials**

outcomes of them undergoing concurrent surgery.

*post-trauma with evidence of paranasal sinus mucosal thickening.*

*Concurrent Rhinoplasty and Endoscopic Sinus Surgery DOI: http://dx.doi.org/10.5772/intechopen.89415*

Concurrent ESS, SP, and RP are affordable, reliable, and safe procedures when performed as a single surgical procedure to reduce operative time, general anesthetic, and recovery period [11]. The additional RP leads to an increase in postoperative complications but when analyzed separately is considered minor in the literature [12, 13]. Thus, the result of surgery and the patient's quality of life are not exceedingly compromised and therefore considered acceptable. Traditional surgeons have been concerned of combining rhinoplasty and ESS to avoid the possibility of increased postoperative complications. Recent publications have reported initial success with this combined

*Coronal (B1) and axial (B2) CT scan serial cuts of paranasal sinuses showing a grossly deviated nasal septum* 

Therefore, a larger sample study like this can better define how RP affects

We present a novel one surgeon combined endoscopic sinus surgery and rhinoplasty technique to evaluate patient satisfaction, efficacy, safety, and clinical

A retrospective clinical chart review was performed on all of the author's patients who had nasal surgery from January 2016 through December 2018 at the ENT unit of Pantai Hospital Kuala Lumpur (PHKL). All patients had severe nasal obstruction with chronic rhinosinusitis and were followed up for a minimum of 6 months post-surgery. The data revealed that 53 patients out of the 116 patients (45.6%) underwent concurrent open rhinoplasty and ESS by the same surgeon at PHKL. Patients who underwent rhinoplasty and ESS at different sittings (54.4%) were excluded from the study because the SNOT 22 subjective scoring system which was used only for the evaluation of patient symptoms in the concurrent group before and after surgery was sufficient, and therefore the need to compare with patients who underwent rhinoplasty and ESS at different sittings was not necessary. A history of nasal trauma and snoring was

Patients with primary nasal dysfunction and sinus complaints were seen by the same surgeon. All the patients underwent ENT workup which included history, head and neck examination, nasal endoscopy, and CT scans of paranasal sinuses

**Figure 3.**

*Rhinosinusitis*

**Figure 1.**

Procedures of endoscopic sinus surgery (ESS), septoplasty (SP), and rhinoplasty (RP) were initially meant for functional improvement to which today an aesthetic aim is added. The functional aim of rhinoplasty is meant for recovery of normal

*A close-up view showing the anatomical relationship of the left internal nasal valve to the septum* 

CRS is an inflammation of the nose and paranasal sinuses manifesting with two or more significant symptoms for 12 weeks with endoscopic and/or CT scan signs of disease. The symptoms include nasal obstruction, thick nasal discharge, and/ or facial pain/pressure and/or reduction or loss of sense of smell [3]. Diagnosis of CRS is primarily based on symptoms that are confirmed by nasal endoscopy and CT

In functional rhinoplasty, the role of the spreader graft [4], columellar extension graft [5], shield graft [6, 7], onlay conchal graft [8], nasal valve suture suspension [9], and flaring sutures [10] has been advocated by numerous authors. Endoscopic sinus surgery (ESS) has also been accepted as a safe and efficient modality for the treatment of CRS. The combination of both these procedures would offer great

*Coronal (A1) and axial (A2) CT scan serial cuts of paranasal sinuses showing a markedly deviated nasal* 

*septum with pneumatized diseased right middle turbinate and evidence of sinusitis.*

sinonasal physiology and ventilatory function.

*anteromedially and the inferior turbinate laterally.*

scans in coronal and axial views (**Figures 2** and **3**).

benefit to the indicated patient group.

**154**

**Figure 2.**

*Coronal (B1) and axial (B2) CT scan serial cuts of paranasal sinuses showing a grossly deviated nasal septum post-trauma with evidence of paranasal sinus mucosal thickening.*

Concurrent ESS, SP, and RP are affordable, reliable, and safe procedures when performed as a single surgical procedure to reduce operative time, general anesthetic, and recovery period [11]. The additional RP leads to an increase in postoperative complications but when analyzed separately is considered minor in the literature [12, 13]. Thus, the result of surgery and the patient's quality of life are not exceedingly compromised and therefore considered acceptable. Traditional surgeons have been concerned of combining rhinoplasty and ESS to avoid the possibility of increased postoperative complications. Recent publications have reported initial success with this combined technique [14].

Therefore, a larger sample study like this can better define how RP affects outcomes of concurrent ESS and SP.

We present a novel one surgeon combined endoscopic sinus surgery and rhinoplasty technique to evaluate patient satisfaction, efficacy, safety, and clinical outcomes of them undergoing concurrent surgery.
