Dr. Green recommended, and nine days later, performed two procedures, which do not require surgical incisions, and are usually done in tandem: a submucosal septal resection-also known as a septoplasty-in which portions of the septum are trimmed, reshaped and repositioned, and bilateral inferior turbinate resection, which reduces the size of the structure that fills the lower portion of the nasal airway. The procedures were performed at Nyack Hospital.

Mr. Carey began experiencing headaches after the first part of the procedure-the septoplasty. Mr. Carey subsequently was found to have a fracture of his cribriform plate, a portion of the horizontal plate of the ethmoid bone, a spongy hone that forms the roof of the nasal fossae and part of the floor of the skull's anterior fossa. On Oct. 9, he underwent repair surgery He continues to experience headaches.

Mr. Carey claimed that he had no nose-related problems, and thus, that the surgeries were unnecessary. Mr. Carey also alleged that Dr. Green departed from good and accepted standards of practice. Specifically, he contended that Dr. Green grabbed his cribriforn plate rather than snipping at his nasal cartilage, and thus, that Dr. Green caused the cribriform-plate fracture. He also contended that Dr. Green should have consulted with his primary-care physician. Mr. Carey's wife, Marina Carey, presented a loss-of-services claim.

They contended Mr. Carey's cribriform plate had been weakened by a sinus disease, and, as such, the damage was a risk of the surgery. They also contended the crib riform-plate damage occurred during the second half of the procedure. Thus, the defendants contended, Mr. Carey's headaches were unrelated to his cribriform-plate damage.

The defendants contended that Mr. Carey's injuries stemmed from a quiescent immune disease that became manifest months after the surgery. They contended the immune disease resulted in sinus infections, which damaged Mr. Carey's sinus tissue, and "empty nose syndrome," which contributed to his headaches.