Is Paranasal Sinus Computed Tomography Required before Every Septorhinoplasty Surgery?

Year 2021, Volume: 4 Issue: 3, 77 - 80, 25.12.2021

Abdulhalim Aysel , Ali Murat Koc , Mehmet Ekrem Zorlu , Oben Yıldırım , Togay Muderris

Abstract

Background: Septorhinoplasty is one of the most common surgical intervention for patients with nasal obstruction and nasal deformities. We aimed to determine the pathologies detected in the preoperative Paranasal Sinus Computed Tomography (PNS CT) in patients who have undergone septorhinoplasty, to compare the planned surgery with the surgical method performed after the CT scan and to determine the patients who should be preoperatively evaluated with PNS CT.

Methods: In this retrospective study, a total of 100 patients who performed septorhinoplasty who had PNS CT scan due to nasal obstruction and nasal discharge symptoms were enrolled.

Results: According to PNS CT, nasal septal deviation was mild in 51 patients, moderate in 21 patients, and severe in 28 patients. Concha bullosa was detected in 36 patients, and paradox concha was detected in four patients. Inferior turbinate fracture, lateralization, and submucosal cauterization were performed in 23 of 51 patients with inferior turbinate hypertrophy. In nine of the patients (9%) (n¼ 3, functional endoscopic sinus surgery; n¼ 6, concha bullosa lateral
lamellar resection), the surgery plan was changed according to findings in PNS CT.

Conclusion: If a sinonasal vegetative mass lesion is detected in nasal endoscopy, or the nasal cavity and nasopharynx cannot be evaluated with the endoscope due to severe deviation, middle turbinate obstructing the nasal cavity, and a complication of chronic sinusitis, PNS CT can be applied.

Keywords

Rhinoplasty , tomography , rhinosinusitis

References

• Moon KM, Cho G, Min Sung H, et al. Nasal anthropometry on facial computed tomography scans for rhinoplasty in Koreans. Arch Plast Surg. 2013;40:610-615.
• Murrell GL. Components of the nasal examination. Aesthet Surg J. 2013;33:38-42.
• Daniel RK, Ethier R. Rhinoplasty: A CT-scan analysis. Plast Reconstr Surg. 1987;80:175-184.
• Bhattacharyya T, Piccirillo J, Wippold FJ. II. Relationship between patient based descriptions of sinusitis and paranasal sinus computed tomographic findings. Arch Otolaryngol Head Neck Surg. 1997;123:1189-1192.
• Graviero G, Guastini L, Mora R, Salzano G, Salzano FA. The role of three dimensional CT in the evaluation of nasal structures and anomalies. Eur Arch Otorhinolaryngol. 2011;268(8):1163-1167.
• Brenner DJ, Hall EJ. Computed tomography—An increasing source of radiation exposure. N Engl J Med. 2007;357:2277-2284.
• Gunbey E, Gunbey HP, Uygun S, Karabulut H, Cingi C. Is preoperative paranasal sinus computed tomography necessary for every patient undergoing septoplasty? Int Forum Allergy Rhinol. 2015;5:839-845.
• Rajeev CS, Friedman S, Randall AB, et al. Comparison of micro–computed tomography and clinical computed tomography protocols for visualization of nasal cartilage before surgical planning for rhinoplasty. JAMA Facial Plast Surg. 2019;21(3):237-243.
• Sedaghat AR, Kieff DA, Bergmark RW, Cunnane ME, Busaba NY. Radiographic evaluation of nasal septal deviation from computed tomography correlates poorly with physical exam findings. Int Forum Allergy Rhinol. 2015;5:258-262.
• Stewart MG, Sicard MW, Piccirillo JF, Diaz-Marchan PJ. Severity staging in chronic sinusitis: Are CT scan findings related to patient symptoms? Am J Rhinol. 1999;13:161-167.
• Wuister AM, Goto NA, Oostveen EJ, et al. Nasal endoscopy is recommended for diagnosing adults with chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2014;150:359-364.
• Hatipoglu HG, Cetin MA, Yu ¨ ksel E. Nasal septal deviation and concha bullosa coexistence: CT evaluation. B-ENT. 2008;4(4):227-232.
• Karatas D, Yuksel F, Senturk M, Dogan M. The contribution of computed tomography to nasal septoplasty. J Craniofac Surg. 2013;24:1549-1551.
• Bitterwolf L, Lunzner K, Heinrichs J, et al. Imaging quality and dosage in ENT-What do we really need? Laryngorhinootologie. 2013;92:332-337.
• Abul-Kasim K, Strombeck A, Sahlstrand-Johnson P. Low-dose computed tomography of the paranasal sinuses: Radiation doses and reliability analysis. Am J Otolaryngol. 2011;32:47-51.
• Hoang JK, Eastwood JD, Tebbit CL, Glastonbury CM. Multiplanar sinus CT: A systematic approach to imaging before functional endoscopic sinus surgery. AJR Am J Roentgenol. 2010;194:527-536.
• Michael W, Ashutosh K. What are the indications for the use of computed tomography before septoplasty? Laryngoscope. 2016;126(6):1268-1270.
• Moche JA, Cohen JC, Pearlman SJ. Axial computed tomography evaluation of the internal nasal valve correlates with clinical valve narrowing and patient complaint. Int Forum Allergy Rhinol. 2013;3:592-597.
• Schulz B, Potente S, Zangos S, et al. Ultra-low dose dual-source high-pitch computed tomography of the paranasal sinus: Diagnostic sensitivity and radiation dose. Acta Radiol. 2012;53:435-440.