title: Rhinoplasty from a rhinologist's perspective: need for recognition of associated sinonasal conditions.
abstract: BACKGROUND
  Facial plastic surgeons may primarily focus on esthetic improvement of the nasal shape in patients seeking rhinoplasty (RP). However, medical conditions inside the nasal cavity should not be neglected because they may lead to unresolved sinonasal problems and,  hence, dissatisfaction after esthetic RP. This observational study investigated the prevalence of sinonasal symptoms and endonasal pathology in patients requesting esthetic RP.
  
  
  METHODS
  Patients seeking RP (n = 269) were given a questionnaire evaluating nasal obstruction  and sinonasal symptoms using visual analog scales and the 22-item Sino-Nasal Outcome Test. In addition, patients underwent nasal endoscopy to evaluate anatomic and/or mucosal disease and skin-prick testing in case of clinical suspicion of allergy. Two control groups consisted of patients with  an otological or general ear/nose/throat problem (n = 65) and patients who planned for endoscopic sinus surgery (ESS; n = 90).
  
  
  RESULTS
  The general appraisal of nasal breathing on a scale from 0-10 in patients seeking RP was as low as 4.3 ± 3.1. Structural  pathology was found in 62% of RP patients, with septal deviation being the most frequent problem encountered (54%), followed by internal nasal valve dysfunction (14%). Mucosal disease was present in 28% of RP patients. The mean SNOT-22 score of RP patients (31.8 ± 23.3) was significantly  higher than the control group (11.6 ± 7.9; p < 0.001), but lower than the ESS patients (48.5 ± 22.0; p < 0.001).
  
  
  CONCLUSIONS
  The prevalence of endonasal structural or mucosal pathology in patients seeking RP is high and should not be overlooked at the  time of planning surgery.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Belgium.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Picavet
authors.forename: Jente
authors.initials: J
authors.lastname: Grietens
authors.forename: Mark
authors.initials: M
authors.lastname: Jorissen
authors.forename: Peter W
authors.initials: PW
authors.lastname: Hellings
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000473:pathology; D009666:Nose / Q000473:pathology*; D012225:Rhinoplasty