Oblique view

Although it offers the least amount of objective data, the oblique view is an important esthetic view because the nose is most often seen at oblique angles.

Several aspects of nasal contour are highlighted on this view and should be assessed. The brow-tip esthetic lines and the soft tissue facets are especially prominent and should be assessed carefully because irregularities may be highlighted on this view. Abnormalities of the lateral aspect of the nasal bones, nasal length, dorsal height, and tip projection also may be highlighted on the oblique view.

Functional nasal examination

Anterior rhinoscopy is undertaken and may identify abnormalities, such as deviated septum, inferior turbinate hypertrophy, synechiae or scar bands, septal perforation, and other abnormalities. Examination also includes nasal endoscopy when there is a complaint of nasal obstruction [20,21]. If indicated, a sinus CT scan also may be obtained.

Pownell et al [20] described diagnostic nasal endoscopy in the plastic surgical literature. They trace the historical development of nasal endoscopy, explain its rationale, review anatomic and diagnostic issues including the differential diagnosis of nasal obstruction, and describe the selection of equipment and correct application of technique, emphasizing the potential for advanced diagnostic potential.

Levine [21] reported that 39% of patients with a complaint of nasal obstruction had findings on endoscopic examination that were not identified with traditional rhinoscopy. Many of Levine's patients had seen other physicians for this problem and had not received appropriate treatment.

In patients seeking cosmetic nasal surgery who also had nasal obstruction, Becker et al [22,23] described how nasal endoscopy allowed the diagnosis of additional pathology not seen on anterior rhinoscopy, including obstructing adenoids, enlarged middle turbinates with concha bullosa, choanal stenosis, nasal polyps, and chronic sinusitis. In their series, additional surgical therapy was undertaken in 28 of 96 rhinoplasty patients as a result of findings on endoscopic examination. Thirteen patients had endoscopic sinus surgery. Nine patients had a concha bullosa requiring partial middle turbinectomy. Three patientsdall revision surgeriesdhad persisting posterior septal deviation requiring endoscopic septoplasty. Two patients underwent adenoidectomy. One patient required repair of choanal stenosis. Static and dynamic nasal valve collapse occasionally is encountered in primary rhinoplasty patients [24]. In Becker et al's report [24] , only 2 of 21 patients with nasal valve collapse reported no past history of rhinoplasty.

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Ask Dr. Becker a question about revision rhinoplasty or make an appointment for a consultation, by calling 856-589-NOSE (6673) or emailing us at info@revisionrhinoplasty.com.