Humans are intended to breathe through their nose. When one cannot, significant discomfort and a decreased quality of life are the result. Poor nasal breathing can contribute to the following conditions: inability to exercise, poor sleep, snoring, sleep apnea, decreased concentration, decreased ability to smell/taste, difficulty chewing with mouth open, poor performance in school/work, and many more.
There are many causes of poor nasal breathing. Medications treat some of these which are related to inflammation and thus swelling of the tissue lining the inside of the nose. The causes that don’t respond to medication are often addressed with surgery. The three most common surgically addressed causes of poor nasal breathing are: septal abnormalities, turbinate hypertrophy, and nasal vestibular stenosis.
The septum is the internal midline partition between the right and left side of the nose. Septal abnormalities are deviations, deflections, and spurs. The septum ideally should be straight or near straight and flat on either side. It rarely is. The abnormalities listed result in curves, convexities, and concavities, and bumps on the surface of the septum that alter airflow and make it less efficient.
The turbinates are structures on the inner surface of the sidewalls of the nose. Made of bone on the inside and nasal lining on the outside, their purpose is to condition and clean the air as it passed through the nose. The inferior turbinate (lowest in the nose) is the largest and is significant source of airway resistance upon breathing in. For a variety of reasons the turbinates can enlarge and narrow the airway to a critical point at which airflow decreases and nasal obstruction results.
Nasal vestibular stenosis is s complex entity that can be thought of in more simple terms as narrowing of a specific portion of the nasal airway. In essence it is closing down of and angle between the nasal side wall and the septum and can be static (meaning present all the time) or dynamic (triggered by breathing). A variety of factors can contribute to nasal vestibular stenosis. These include: Nasal length, nasal height, length of nasal bones, strength of nasal cartilage, shape of the nasal cartilage, and septal irregularities.
Breathing problems are often found concurrently with cosmetic deformities of the nose. That is form and function, shape and appearance are closely related and intricately intertwined. Nasal breathing problems can and should, in my opinion, be corrected together. Many nasal procedures thus have an insurance based component and a cosmetic self-pay based component.
Abnormalities of the septum are addressed with septoplasty is procedure that when done well results in straightening of the septum. Often it requires working with the cartilage and bone of the septum which does contain both tissue types. In most simple terms septoplasty involves removing some of the irregular tissue and leaving behind portions that are require for nasal support. Those portions are sometimes irregular and require maneuvers to improve their form. Thus, It some cases septoplasty can be a short and simple procedure but in other patients the septoplasty can be both very complex and quite delicate requiring a combination or scoring, suturing, and grafting procedures to achieve the desired result.
Large turbinates that impede nasal airflow can addressed surgical to reduce the resistance and obstruction they create. By reducing the size of the turbinates carefully, airflow can be improved. Reduction generally entails removal of some bone and some of the spongy tissue that that lies under the lining. Sometimes a small amount of lining is removed too. This is a powerful part of surgery to improve breathing in many patients and when done carefully can be done with minimal discomfort and reduced side effects.
Nasal vestibular stenosis correction is somewhat of an allusive entity. In my opinion nasal vestibular stenosis is an under-recognized problem and is often the result of dissatisfaction when present following septoplasty and trubinate reduction. Correction is a complex concept but can be thought of as adjusting the size of the critical angle inside the nose and/or strengthening the sidewall so as to prevent collapse upon inspiration. Nasal vestibular stenosis correction often entails the placement of spreader grafts to achieve the former. Other more custom grafts can be used to address the later.Key Points
- Keen eye for the interplay between the cosmetic look of a nose and the breathing a function of the nose.
- Utilizes patients own tissues to re-build the nose
- Additional advanced fellowship training in rhinoplasty
- Published scientific contributions regarding rhinoplasty technique improvement
- Speaking engagements on nasal surgery at major scientific meetings and a nationally ranked medical schools
The nasal airway procedures listed above are generally performed under general anesthesia in an outpatient setting. Swelling a bruise can be very mild but if an open septoplasty or when nasal vestibular stenosis is corrected it can be a little more significant, perhaps as much as a rhinoplasty. In some cases rib or ear cartilage is required and thus the recovery is as has been discussed above for rhinoplasty requiring rib or ear cartilage.