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Blocked nose and nasal obstruction – SeptoRhinoplasty or Septoplasty?

Blocked nose and nasal obstruction – SeptoRhinoplasty or Septoplasty?

Nasal obstruction, or blocked nose, can compound pre-existing “sinus” problems or symptoms of allergic rhinitis (sneezing, runny nose, itchy nose), making nasal breathing. This obstruction can also lead to other issues like poor sense of smell (food tastes bland), pressure symptoms in the face (cheeks, forehead or between the eyes), or even snoring and obstructive sleep apnoea (which can potentially be harmful for your health). Many of us have seen our doctors for “sinus” related problems like blocked nose, and have been offered surgery. The surgery to correct this is usually septoplasty (to address deviated septums)  and/ or turbinate reduction. These procedures will widen the nasal passage to allow better air flow. So, how does rhinoplasty figure in the management of your blocked nose or compare with septoplasty and turbinate reduction?

SeptoRhinoplasty VS Septoplasty

Blocked nose may be due to problems with

i) central septum

ii) dorsal septum

iii) caudal septum

iv) internal nasal valve

v) external nasal valve

Traditionally, septoplasty performed only addresses problems in the central septum. Anatomical areas ii) to v) cannot be addressed with a simple septoplasty alone, but will require septorhinoplasty. Septoplasty, by definition, does not address problems of the Internal Nasal Valve, External Nasal Valve, Dorsal Septum and Caudal Septum. Septoplasty will only deal with deviations and problems of the central septum.

Simply put, septorhinoplasty addresses more problematic anatomical sites compared to just septoplasty alone.  If the problem is located only in that area and that area alone, a septoplasty will effectively improve your symptoms. However, if any of the Internal/ External Nasal valves, Dorsal/ Caudal septum is involved, you symptoms may not resolve with a simple septoplasty alone. This is one of the reasons why many patients continue to have persistent blocked nose even after surgery.

Dissatisfaction with nasal appearance?

Another very important point of consideration when deciding to go for just a septoplasty or septorhinoplasty is whether you intend to have any cosmetic changes to your nose now, or in future. In cosmetic rhinoplasty, the septal cartilage is the best material to use for reshaping the nose. It is from the nose, for reshaping the nose. The strength, texture, flexibility, stiffness are exactly how a nose should feel like. This precious material however, is damaged in a traditional septoplasty. Traditional septoplasty involves either total removal of the central septum, or scoring/ weakening, or stripping away part of the central septum. Whatever is removed is discarded. Whatever remains is weakened. This very precious material for cosmetic rhinoplasty is therefore rendered unuseable. As a result, your options for having a cosmetic rhinoplasty in future often means you need to consider having a rib harvest for sufficient cartilage material for your nose job.

 

Advantages of Septorhinoplasty over Septoplasty

In conclusion, advantages of a septorhinoplasty over just septoplasty are threefold:

1) ability to target and treat more areas causing nasal obstruction even if you do not desire cosmetic changes

2) precious cartilage is not destroyed or discarded and instead  reused or “banked” in the nose, enhancing the appearance at the same time

3) cost effectiveness of performing just 1 surgery vs multiple surgeries (potentially bigger surgeries involving rib harvest)

 

What are the disadvantages of septorhinoplasty over septoplasty?

As septorhinoplasty is a more involved surgery:

1) there is more swelling in the initial 2 weeks

2) surgical time is longer

3) Experience, Experience, Experience!  Experience in rhinoplasty is crucial and cannot be overemphasized. Rhinoplasty is considered the most demanding of all cosmetic surgeries. You need ample experience to have a good grasp and understanding of both function and aesthetics, as well as the technical ability to produce predictable results safely. This is perhaps the single most important factor in determining whether you get great results or end up with an unsatisfactory nose.

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