Functional Rhinoplasty

The Rhinoplasty Clinic Pte Ltd.

Nasal obstruction

Nasal congestion or obstruction is a medical condition that may occur due to certain anatomic abnormalities in the normal nose structure of a person. It is also instigated by inflammatory processes, which may cause swelling in an individual’s nose.

The major cause of anatomic nasal obstruction in adults is associated with the size and shape of the nasal septum and/or turbinate. It may also be caused by the adenoids in children. Some of the common symptoms of nasal congestion are:

  • Running or stuffy nose
  • Mucus build-up
  • Sinus pain
  • Difficulty in breathing
  • Swollen nasal tissue

Causes of Nasal Obstruction

Some of the common factors that trigger nasal obstruction include:

  • Nasal Septum Deviation
  • Luminal (Nasal) Valve Obstruction
  • Adenoid
  • Tonsillitis
  • Nasal Polyps
  • Nasal Turbinate Hypertrophy

Nasal Obstruction: Treatment

Septoplasty: If a person’s deviated septum blocks the nasal passage and leads to nasal obstruction, septoplasty is recommended by the surgeon. In this case, incisions are made within the nose. Subsequently, the normal lining of the person’s nose covering the septum wall is elevated as well as preserved, so that the crooked sections of the septum are appropriately removed. Next, the lining is placed back and stitched in its place. In this type of nasal obstruction treatment, apposite care is taken by the rhinoplasty surgeon to leave certain significant supporting areas of the bone and cartilage intact to prevent any sagging of the tip or bridge of the nose.

Areas that cannot be addressed in a traditional septoplasty or SMR (Submucosal Resection) include obstructions in the Internal and External Nasal Valve area, Caudal Septum and Dorsal Septum. If these areas are not addressed during the surgery, a persistent sensation of obstruction can result after the surgery.

Turbinate Reduction: It is directed to patients with age-old nasal allergies. Turbinates are predominantly mucous membrane covered with bone shelves, extending the length of the entire internal nasal cavity. Positioned on the external wall of the nasal passage, turbinates are of three types – superior turbinate, middle turbinate, and inferior turbinate. As these turbinate tissues overgrow, they may lead to functional disturbances. In such cases, surgeons usually indicate a partial reduction of the turbinates. In this method, tiny incisions are made within the nose to remove the excess tissue improve the nasal airflow.

Adenoidectomy: It is the removal of adenoids through a surgical procedure. Being an outpatient surgery, no cuts are made on the face.

Polyp Removal: Polyps are mainly grape like structure that often obstructs the nasal passage. Removing a nasal polyp in a mild case is quite straightforward; however the risk of redevelopment in a person is often very high.

Nasal Valve Collapse: The nasal valve is lined with vertical membranes that swell and shrink to regulate the flow of air in the entire nose. In some cases, the nasal valve may collapse due to an accident, rigorous exercise, or deep respiration. Preventing and curing the nasal valve collapse is an integral element of the functional rhinoplasty.

Septal Deviation, Turbinate Hypertrophy, Allergic Rhinitis

Typically, patients with nasal obstruction also have problems of Allergic Rhinitis and Inferior Turbinates Hypertrophy. During the consultation, a comprehensive history and examination will attempt to ascertain the degree of contribution of each of these factors to tailor a surgical plan that will be most effective for you.

Internal Valve Problem

The Internal Valve Area is bounded by the dorsal septum, upper lateral cartilage and the inferior turbinate. Interestingly, this area if not adequately treated during surgery, can result in persistent obstruction despite a straight septum. It is thus important to find a surgeon who has the knowledge to assess and treat the internal valve area.

External Valve problems

Less common than Internal Valve obstruction, External Valve obstruction can also cause obstruction and is not relieved with a septoplasty or SMR alone. As the external valve is constituted by both the lower lateral cartilage and soft tissue, correction of external valve problems can also affect the appearance of the nose.

Deviated Nose / Crooked Noses

Overview

Deviated nose or crooked nose refers to the poor alignment of the nasal bridge. It is both a cosmetic and functional problem. Aesthetically, a crooked nose disrupts the balance of a person’s midface, distracting an observer from the other facial features. From the functional aspect, a crooked nose may cause partial nose blockage, which may further lead to difficulty in breathing and discomfort to a patient.

A crooked/deviated nose is mostly caused by:

  • congenital factor, i.e. the patient is born with this type of nose deformity
  • acquired due to injury, fracture, accident, rhinoplasty gone wrong, etc.

Often the problem starts at the foundation – the septum. Therefore, a careful endoscopic examination is important to assess the extent of surgery required. Often rib harvest may be considered necessary due to a severely deformed septum, especially those that are acquired from high impact injuries.

How to Treat A Twisted Nose or Crooked Nose?

Correction of a deviated nose is a challenging job and requires exceptional expertise to simultaneously straighten a twisted nose while managing the nasal airway. Some patients also opt for increasing the tip projection while fixing their crooked nose. For this reason, it is imperative to wisely choose the top rhinoplasty plastic surgeons as only the best surgeons are comfortable and familiar with numerous surgical approaches.

The key surgical procedures that are considered to correct a deviated or twisted nose are:

  • Camouflage Method: It is the simplest method, which is often used for correcting a slight deviation in the nose shape. This method involves grafting thick skin or cartilage to the affected part of the nose.
  • Nose Tip Cartilage: This method is used for fixing curved columella or nose tip by using the cartilage of the respective parts.
  • Nose Bone Fracture: In this method, nasal bone is fractured from both the sides in order to modify the affected area.
  • Fixing Inferior Nasal Concha: A patient with a curved or deviated nose may develop the problem of nasal obstruction. This is mainly caused by the inferior nasal (nose) concha. To correct this, a rhinoplasty surgeon may make incisions to increase the space within the nose.
  • Rhinoplasty Septal Cartilage Incisions: A nasal septum wall comprises of cartilage and bone. An overgrown septal cartilage or any deviation in the septum may result in the curved nose. In order to fix such a deformity, it is imperative to check for a curved or twisted nasal septum.

Implants For Correcting A Crooked Nose

Septal Cartilage:This is a popular implant material frequently used by most rhinoplasty surgeons. However, it may be substituted or replaced by auricular cartilage if the supplies are limited.

Rib (Autologous Costal) Cartilage: Rib graft is often used as an implant material to replace the major support structures of an individual’s nose.

Ear (Curved Concha) Cartilage:It is used for filling the dorsal concavities.

Acellular Dermis: It is used for camouflaging minor variabilities of the dorsum.

Alloplastic materials:such as Gore-Tex are although considered as a user-friendly and safe implant materials, but they are also associated with infection, extrusion, rejection, and subsequent scarring that may cause significant deformity post-surgery.

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