Taking off the Blinders: The Open Nose Approach Made Practical for Every Otolaryngologist

Many surgeons favor endonasal techniques for functional nasal surgery because of efficiency and familiarity. However, limited exposure can obscure critical anatomic pathology and restrict effective correction of complex functional problems. In this lecture, the authors draw on decades of experience with open rhinoplasty to illustrate how the external nasal approach can fundamentally improve both diagnosis and management of functional nasal disorders.
The presentation will walk through practical, reproducible techniques for executing the open approach, emphasizing steps that make the exposure safe, efficient, and approachable for surgeons new to the method. Using intraoperative examples, the speakers will demonstrate how enhanced visualization leads to more accurate identification of septal, valvular, and support-related abnormalities that may be underestimated or missed with closed approaches.
In addition, the authors will share favored techniques for addressing challenging functional problems—including dorsal strut and caudal strut management, valve collapse, and nostril asymmetry—that are particularly well suited to the exposure provided by the open approach. Authors will highlight favored techniques, including septal battening using ethmoid bone, clocking sutures to correct dorsal cartilage deviation, and lateral crura modifications. The aim of this lecture is to demystify the external nasal approach, reduce perceived barriers to adoption, and encourage surgeons to incorporate this powerful technique into their functional nasal surgery practice with confidence.