Rhinoplasty and Functional Endoscopic Sinus Surgery

An increasing number of patients are opting for combining sinus surgery and cosmetic rhinoplasty. The author has been performing rhinoplasty with FESS since April of 1990. The technique and equipment used in early cases is much different than that used in more recent surgeries. Specific advances include high definition monitor, intraoperative navigation system, and powered dissecting instruments. The benefits of these advances are illustrated by a review of the more recent cases performed by the author. Combined rhinoplasty and FESS can be performed with good results (functional and cosmetic) and minimal complications. Advances in sinus surgery technique and equipment have made the procedure safer, faster, more precise, and more comfortable. 1. Introduction Combining rhinoplasty and FESS was first reported in 1991 by Shemen and Matarasso [1]. Since then numerous authors have reported large studies illustrating the overall safety and efficacy of combining the two procedures [2–8]. The focus of this paper is to report the author’s recent specific experience with combining rhinoplasty and FESS and highlight the evolution that has occurred in sinus surgery during the authors’ 20 years of combining the procedures. 2. Methods A retrospective chart review was performed on all of the author’s patients who underwent combined rhinoplasty and FESS between July 2002 and October 2010. All patients underwent otolaryngologic work up which included history, head and neck exam, office rigid endoscopy, and fine cut (4？mm) CT scanning of the paranasal sinuses (axial and coronal views). All patients had been treated with oral antibiotics and nasal steroids prior to the CT scan. All patients had standard preoperative rhinoplasty photos taken. All cases were performed as outpatient procedures by the same surgeon under general endotracheal anesthesia. All patients received IV antibiotics (cefazolin 1 gram) and IV steroids (Dexamethasone 10？mg) at the time of induction. A throat pack was positioned, and cottonoid pledgets soaked in 4？cc of 4% cocaine were placed in the nose prior to nasal injection with 1% lidocaine with 1 to 100,000 epinephrine. If septoplasty was indicated, it was performed first and nasal splints secured. Next the FESS was performed using technique adapted from Messerklinger [9], Stammberger [10], and Kennedy [11]. Equipment for the FESS included high definition monitor, 4？mm endoscopes (0 degree, 30 degrees, and rarely 70 degrees) and powered instruments/Landmarx Navigation System by Medtronic (710 Medtronic Parkway, Minneapolis, MN, 55432-5604). Cottonoid