Essentials of Septorhinoplasty by Hans Behrnohm Eugene Tardy

Author:Hans Behrnohm,Eugene Tardy
Language: eng
Format: epub
Publisher: Thieme Medical Publishing Inc.
Published: 2017-04-07T04:00:00+00:00

6.5 Preoperative Analysis

The basis of successful nasal surgery is, besides the detailed history, a thorough clinical examination. This includes anterior rhinoscopy and endoscopy before and after decongestion. Through that and a possibly complemented computed tomography, the surgeon is able to get a picture of the airway geometry, the membrane's condition, and can recognize evidence of chronic diseases of the paranasal sinuses.

Palpation of the entire nasal skeleton also adds essential information for preoperative planning. Especially important is to feel the anterior septum between two fingers. This can reveal a significant deviation in the isthmus area that is camouflaged from the eye.

Cottle's maneuver or one of its variants helps to diagnose an isthmus stenosis, which is frequently caused by the septum. But these tests have a tendency toward false-positive results. A more reliable clinical sign is the occurrence of a strict unilateral nostril collapse during forced inspiration. Fluid mechanics suggest that this indicates the existence of a relevant obstruction or isthmus stenosis on the contralateral side, provided the nasal sidewalls are relatively symmetrical. However, the physical effect can be camouflaged by facial muscle activity.

Today modern rhinomanometry methods, such as four-phase rhinomanometry, are routinely used to quantify the total resistance of the nose, which is, however, only one aspect of nasal breathing.1,2,8,16 In contrast, computational fluid dynamics (CFD), also called numerical flow simulation, is able to calculate arbitrary flow parameters in a high spatial and temporal resolution within the nasalcavity, including the total nasal resistance8,13 (Fig. 6.2). The only requirement is a computed tomography that provides data for the reconstruction of the three-dimensional geometry of the nose. CFD, maybe, will replace rhinomanometry in the near future.

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