Rhinology and Allergy for the Facial Plastic Surgeon, An Issue of Facial Plastic Surgery Clinics, 1e

129 Pages·2011·2.43 MB·English

by  Stephanie A. Joe MD

Rhinology and Allergy for
the Facial Plastic Surgeon
Guest Editor
STEPHANIE A. JOE, MD
FACIAL PLASTIC SURGERY
CLINICS OF NORTH AMERICA
www.facialplastic.theclinics.com
February 2012 • Volume 20 • Number 1
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RhinologyandAllergyfortheFacialPlasticSurgeon
Contributors
CONSULTING EDITOR
J.REGANTHOMAS,MD,FACS
ProfessorandChairman,Departmentof
Otolaryngology,UniversityofIllinoisat
Chicago,Chicago,Illinois
GUEST EDITOR
STEPHANIEA.JOE,MD
AssociateProfessor,Director,TheSinus&
NasalAllergyCenter;Co-Director,SkullBase
Surgery;ResidencyProgramDirector,
DepartmentofOtolaryngology–HeadandNeck
Surgery,UniversityofIllinoisatChicago,
Chicago,Illinois
AUTHORS
TERAHJ.ALLIS,MD MOHAMADCHAABAN,MD
DepartmentofOtolaryngology–HeadandNeck DepartmentofSurgery,Sectionof
Surgery,UniversityofNebraskaMedical Otolaryngology–HeadandNeckSurgery,
Center,Omaha,Nebraska UniversityofChicagoMedicalCenter,
Chicago,Illinois
PETES.BATRA,MD,FACS
AssociateProfessorandCo-Director,
JASONY.K.CHAN,MBBS
ComprehensiveSkullBaseProgram,
Resident,DepartmentofOtolaryngology–Head
DepartmentofOtolaryngology–HeadandNeck
andNeckSurgery,JohnsHopkinsMedical
Surgery,UniversityofTexasSouthwestern
Institutions,Baltimore,Maryland
MedicalCenter,Dallas,Texas
SETHM.BROWN,MD,MBA,FACS
JACQUELYNNEP.COREY,MD
AssistantClinicalProfessor,Departmentof
DepartmentofSurgery,Sectionof
Surgery,DivisionofOtolaryngology,University
Otolaryngology–HeadandNeckSurgery,
ofConnecticutSchoolofMedicine,
UniversityofChicagoMedicalCenter,
Farmington,Connecticut
Chicago,Illinois
PATRICKJ.BYRNE,MD,FACS
AssociateProfessor,DivisionofFacialPlastic STEVENMARCDAINES,MD
andReconstructiveSurgery,Departmentsof ResidentPhysician,Divisionof
Otolaryngology–HeadandNeckSurgeryand Otolaryngology–HeadandNeckSurgery,
Dermatology,JohnsHopkinsMedical UniversityofUtahSchoolofMedicine,
Institutions,Baltimore,Maryland SaltLakeCity,Utah
iv Contributors
ANDREWJ.HELLER,MD R.PETERMANES,MD
Chief,SectionofOtolaryngology–Headand AssistantProfessor,Sectionof
NeckSurgery,McGuireVeteransAffairs Otolaryngology–HeadandNeckSurgery,
MedicalCenter;ClinicalAssociateProfessor, DepartmentofSurgery,YaleUniversitySchool
DepartmentofOtolaryngology–HeadandNeck ofMedicine,NewHaven,Connecticut
Surgery,VirginiaCommonwealthUniversity,
JAMESW.MIMS,MD
Richmond,Virginia
AssistantProfessorofOtolaryngology,
DepartmentofOtolaryngology,WakeForest
STEPHANIEA.JOE,MD
SchoolofMedicine,Winston-Salem,
AssociateProfessor,Director,TheSinus&
NorthCarolina
NasalAllergyCenter;Co-Director,SkullBase
Surgery;ResidencyProgramDirector, RICHARDR.ORLANDI,MD
DepartmentofOtolaryngology–HeadandNeck AssociateProfessor,Divisionof
Surgery,UniversityofIllinoisatChicago, Otolaryngology–HeadandNeckSurgery,
Chicago,Illinois UniversityofUtahSchoolofMedicine,
SaltLakeCity,Utah
JOHNH.KROUSE,MD,PhD
ProfessorandChairman,Departmentof DOUGLASD.REH,MD
Otolaryngology–HeadandNeckSurgery, AssistantProfessor,Departmentof
TempleUniversitySchoolofMedicine, Otolaryngology–HeadandNeckSurgery,
Philadelphia,Pennsylvania JohnsHopkinsMedicalInstitutions,Baltimore,
Maryland
DONALDA.LEOPOLD,MD,FACS
CORRIEE.ROEHM,MD
DepartmentofOtolaryngology–HeadandNeck
ResidentPhysician,DepartmentofSurgery,
Surgery,UniversityofNebraskaMedical
DivisionofOtolaryngology,Universityof
Center,Omaha,Nebraska
ConnecticutSchoolofMedicine,Farmington,
Connecticut
TODDA.LOEHRL,MD
ProfessorandChiefofRhinology/Sinus BELACHEWTESSEMA,MD
Surgery,DepartmentofOtolaryngologyand AssistantClinicalProfessor,Departmentof
CommunicationSciences,ZablockiVA Surgery,DivisionofOtolaryngology,University
MedicalCenter,MedicalCollegeofWisconsin, ofConnecticutSchoolofMedicine,
Milwaukee,Wisconsin Farmington,Connecticut
RhinologyandAllergyfortheFacialPlasticSurgeon
Contents
RhinoplastyinLightofSinonasalIssues ix
StephanieA.Joe
ChronicRhinosinusitis 1
StevenMarcDainesandRichardR.Orlandi
Thisarticledefineschronicrhinosinusitis(CRS)andsharescontemporaryprinciples
for its diagnosis and management, focusing on practical considerations for rhino-
plasty surgeons. Nasal obstruction, the most common symptom of CRS, is fre-
quently the chief complaint of patients seeking functional rhinoplasty surgery.
Because correcting sites of anatomic obstruction to nasal airflow alone is unlikely
to adequately treat CRS, rhinoplasty surgeons must have a firm understanding of
theorigin,diagnosis,andmanagementofthisdiseaseprocess.Withnosinglecause
identified,CRSislikelyanumbrelladiagnosisorsyndromeencompassingnumerous
causativefactors,withthecommonendpointofchronicsinonasalinflammation.
AllergicRhinitis 11
JamesW.Mims
Familiarity with the diagnosis and management of allergic rhinitis is important for
physiciansconcernedwiththenasalairway.Allergicrhinitisisacommonandman-
ageableconditionthatmaycausepersistentorintermittentsymptomsthatvaryasto
duration and severity. Allergic rhinitis impairs quality of life, sleep, school perfor-
mance,andproductivityonascalethatcompareswithotherchronicdiseases.Di-
agnosisisprimarilyclinical,butsupportedbyallergytesting.Therapeuticoptionsfor
allergic rhinitis include pharmacotherapy, environmental control, and immunother-
apy. More recently, a role for sublingual immunotherapy and turbinate reduction
hasbeenreported.
NonallergicRhinitis 21
StephanieA.Joe
Thisarticlereviewsauniformwaytodescribenonallergicrhinitisinitsvariousforms.
Theinsightsintoitspathophysiologyarebrieflyreviewed.Aclassificationschemefor
the different forms is provided. This is followed by descriptions of the diagnosis,
evaluation,andmanagementofnonallergicrhinitis.
AllergicSkinDisease 31
AndrewJ.Heller
Thetwomostcommonallergicskindiseasesintheworldareoftentheleastfamiliarto
practicingsurgeons:atopicdermatitisandcontactdermatitis.Whenunrecognized,
these disorders can cause great discomfort and decreased quality of life. This is
onlymadeworsebyasurgicalprocedurewhichcanexacerbatethediseaseprocess.
Through proper recognition, management, and peri-surgical prophylaxis flares of
thesediseasescanbeavoided,leadingtodecreasedmorbidityandimprovedpatient
satisfaction.Thisarticlesummarizesthepathophysiologyandmanagementofboth
atopicandcontactdermatitis,withattentiontoimplicationsforthesurgeon.
vi Contents
ConcurrentRhinoplastyandEndoscopicSinusSurgery:AReviewoftheProsandCons
andaTemplateforSuccess 43
DouglasD.Reh,JasonY.K.Chan,andPatrickJ.Byrne
HistoricallyconcurrentFESS/rhinoplastywasavoidedduetoconcernsofincreased
riskofcomplication.RecentstudieshaveshownthatFESS/rhinoplastycanbeper-
formedsimultaneouslywithgoodoutcomesandnosignificantincreaseincomplica-
tions. A thorough and effective approach to the patient with sinonasal obstruction
requires attention to aesthetic, functional, and inflammatory issues. Medical treat-
mentisanimportantadjuvanttosurgeryinordertooptimizeoutcomesbyimproving
patient symptoms long-term. Surgery for these patients should be performed in
acareful,stepwiseapproachtoaddressthenasalseptum,inferiorturbinates,para-
nasalsinuses,andexternalnasalstructures.
TheUnifiedAirway 55
JohnH.Krouse
The upper and lower respiratory tracts function as an interdependent physiologic
mechanism, and stimuli that trigger pathophysiologic changes in one portion of
the airway can provoke similar changes throughout the airway. The unified airway
model acknowledges these shared airway features, suggesting the importance of
comprehensive evaluation of patients with any respiratory symptoms. Two areas
areofspecificimportance totheseptoplasty/rhinoplastysurgeon:(1)preoperative
evaluationofthepatientwithrhinitisundergoingnasalsurgery,and(2)perioperative
andpostoperativemanagementofthenose.Managementofpotentialcardiopulmo-
naryrisksamongsusceptibleindividualsisvitalintheperioperativemanagementof
thesepatients.
PharmacotherapyofRhinitisandRhinosinusitis 61
MohamadChaabanandJacquelynneP.Corey
Concernsforthecosmeticsurgeonregardingallergicrhinoconjunctivitisandrhinosi-
nusitisincludediagnosis,treatment,andassessmentofthediseaseandwhetheror
notthetimingoroutcomeofcosmeticprocedureswillbeaffected.Inthisarticle,the
pharmacotherapyofallergicandnonallergicrhinoconjunctivitisandrhinosinusitisis
discussedwithemphasisonintranasalsteroids,antihistamines,andantibiotics.
TheRoleofAlternativeMedicineinRhinology 73
CorrieE.Roehm,BelachewTessema,andSethM.Brown
Complementaryandalternativemedicine(CAM)includestreatmentsfromtraditional
Chinesemedicine,homeopathy,naturopathy,herbalmedicine,Ayurvedicmedicine,
mind-body medicine, chiropractic or osteopathic manipulations, and massage.
Morethan40%ofpatientsintheUnitedStatesuseCAM,with17%ofCAMusere-
latedtootolaryngologydiagnoses,butnearlyhalfofCAMusersdonotcommunicate
their use ofthese medications to their physicians. Perioperative risk of bleeding is
a particular concern in surgical specialties, and knowledge of these therapies and
theirpotentialadverseeffectsiscritical.
SinonasalProblemsandReflux 83
ToddA.Loehrl
Extraesophageal reflux has been implicated inmany disorders affecting theupper
airway. This article reviews the recent literature regarding the relationship of
Contents vii
refractory chronic rhinosinusitis with extraesophageal reflux. Recent studies have
shownthatpatientswithrefractorychronicrhinosinusitishaveanincreasedpreva-
lence ofextraesophageal reflux. Anassociation may exist betweengastroesopha-
gealrefluxandrhinosinusitis,especiallyinindividualswithmedicallyandsurgically
refractorydisease.Thesestudieshaveapoorlevelofevidenceanddatasupporting
causationarelacking.However,evaluationandtreatmentshouldbeconsideredin
patientswithchronicrhinosinusitis,especiallyinthosewithrefractorydisease.
BacteriologyandAntibioticResistanceinChronicRhinosinusitis 87
R.PeterManesandPeteS.Batra
Chronic rhinosinusitis (CRS) is a prevalent health care problem that may be com-
monly encountered in patients desiring aesthetic or reconstructive rhinoplasty.
Thepurposeofthisarticleistoreviewthecommonbacterialpathogensassociated
withCRS,aswellaspatternsofbacterialresistanceinthispatientsubset.Closeun-
derstandingofmicrobialpathogensinvolvedinCRSandtheirassociatedresistance
patternswillguidefacialplasticsurgeonsinoptimallymanagingthisimportantpo-
tentialcomorbidity,andinturnpositivelyinfluencetheoutcomeofrhinoplasty.
SmellandTasteDisorders 93
TerahJ.AllisandDonaldA.Leopold
Olfactionandtastepromotesatisfactionandprotectionindailylife.Theastutefacial
plasticsurgeonrecognizestheimportanceofabaselinesmelltesttodocumentthe
patients’olfactorystatusbeforesurgery.Aftersurgery,thesurgeonmustbealertto
the possible mechanisms of hyposmia and anosmia and the pertinent treatment
strategies.Thesurgeonmustalsounderstandtheimportanceofcounselingthepa-
tientandfamilyregardingthecauseofthedysfunctionandthepropertreatments.
Thisarticleupdatesthefacialplasticsurgeonontheimportanceofsmellandtaste
andassociateddisorderswithacurrentreviewoftheliterature.
Index 113
viii RhinologyandAllergyfortheFacialPlasticSurgeon
Facial Plastic Surgery Clinics
of North America
FORTHCOMING ISSUES RECENT ISSUES
FacialPlasticSurgery:MasterDiscussionand November2011
Debate-Part1
RobertKellmann,MD,andFredFedok,MD, 3DImagingTechnologiesforFacial
GuestEditors PlasticSurgery
JohnPallanch,MD,MS,GuestEditor
EmergingTrends in Facial Plastic Surgery
PaulCarniol,MD,GuestEditor
August2011
Scars:Prevention,Correction,andReduction
StevenRossMobley,MD,GuestEditor
May2011
AgingFacialSkin:LasersandRelated
SpectrumTechnologies
DavidA.F.Ellis,MD,FRCSC,
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THECLINICSARENOWAVAILABLEONLINE!
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RhinologyandAllergyfortheFacialPlasticSurgeon
Rhinoplasty in Light
of Sinonasal Issues
StephanieA.Joe,MD
GuestEditor
I am honored to have been chosen to guest edit evolvingtreatmentsforsinonasaldisorders.There
another issue of Facial Plastic Surgery Clinics of isonearticleonthecurrentthinkingoncontempo-
North America. This is a follow-up to the prior raneous sinus surgery and rhinoplasty. There are
issue, “Rhinology for the Rhinoplasty Surgeon,” articlesontheroleofconventionalpharmacology
publishedin2004.Onceagain,Ibelievethisissue and alternative medicine in rhinology. Lower
represents the ideal blend of my background in airway problems and reflux may be uncovered
bothrhinologyandfacialplasticsurgeryandhigh- during the evaluation for surgery and also may
lights the current topics facing the rhinoplasty affectthemanagementofsinonasalcomplaints.
surgeon. The authors of this issue practice otolaryn-
The rhinoplasty surgeon must be aware of gology in a variety of disciplines—facial plastic
the possible sinonasal problems that may be surgery, rhinology, and otolaryngic allergy. I wish
present when discussing potential reconstructive to thank them for their insightful contributions. I
orcosmeticnasalsurgerywithherorhispatients. hope that this issue serves as a reference for all
The presence of allergic rhinitis, nonallergic rhinoplasty surgeons and stimulates a continued
rhinitis, and/or chronic rhinosinusitis can affect dialoguebetweenallotolaryngologists.
the patients’ perception of their nasal symptoms.
Patients can suffer from skin-related sequelae to
varying degrees. Familiarity with the smell and
Stephanie A. Joe,MD
taste disorders provides rhinoplasty surgeons
Departmentof Otolaryngology–Head
withadditionalinformationfortheoverallmanage-
and NeckSurgery (MC648)
ment of their patients. Resistant infections are
Universityof Illinois atChicago
agrowingproblemforallphysicians.
1855West Taylor Street, Room 2.42
Furthermore,surgicaloutcomescanbeaffected
Chicago, IL60612, USA
bythechronicinflammationassociatedwithmany
of these conditions. With this in mind, I have E-mail address:
included articles addressing the constantly [email protected]
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1064-7406/12/$–seefrontmatter(cid:1)2012ElsevierInc.Allrightsreserved. a
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