Endoscopic treatment of sinonasal disease in patients who have had orthognathic surgery

Certain skeletofacial patterns may be predisposed to aggravated sinonasal d isease postoperatively, These may include, but are not limited to, facial s keletal asymmetries with high septal deviations and those with obstructive nasal respiration and mouth breathing that leads to skeletal growth disturb ances such as vertical maxillary hyperplasia and apertognathism. These sino nasal diseases may partly be the result of osteomeatal blockage by pre-exis ting structures, or synechial shelves and webs blocking normal maxillary an tral mucosal flow. The use of nasal antral windows placed anteriorly in the lateral nasal wall at the time of downfracture LeFort (Hosaka window) do not seem to benefit the drainage of the maxillary antrum, This is because physiological flow of ten bypasses this region. If patients present postoperatively with new sino nasal disease or the aggravation of pre-existing symptoms, evaluation by bo th endoscopically assisted intranasal and axially and coronal computed tomo graphy (CT) is recommended, Functional endoscopic sinus surgery by the mini mally invasive Messerklinger technique, combined with intranasal use of las er-assisted turbinoplasty and soft tissue lysis, have been successfully use d for most of these patients. Because the anatomical positioning of the midfacial structure can potential ly affect patients with a predisposition to sinonasal physiological disturb ances, consideration should be given to preoperative evaluation and discuss ion of potential consequences.