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Functional Septo-rhinoplasty

Rhinoplasty is a procedure that corrects or reconstructs the nose. 

The aims of surgery are:

  • to improve the nose cosmetically and to maintain or improve function

  • to produce a nose that is in harmony with the face

  • to produce a result that has a natural, non-operated appearance.

This is achieved through a careful assessment of the individual before the operation, to ensure that the surgical plan is tailored for each patient.

Nasal obstruction secondary to anatomic nasal deformities is a fairly routine problem seen by otolaryngologists in the office, usually after failed medical management.

While routine septoplasty and inferior turbinate reduction can improve the nasal obstruction symptoms for many patients, these procedures may not always be sufficient for all patients with symptoms of nasal obstruction.

 

When internal or external nasal valve collapse is present, formal functional septorhinoplasty can effectively address the problem. Functional septorhinoplasty, is a term often used to reference several different types of reconstructive nose surgery intended to improve the function of the nose. In essence, it is surgery being performed to help a patient breathe better through their nose. There is a wide variety of techniques that may need to be employed when trying to make the nose function better. Either an open approach or an endonasal approach can be used. If spreader grafts are planned, then an open approach will allow accurate placement of the grafts.

 

ASSESSMENT OF NASAL OBSTRUCTION
Examining his nose in more detail, there are a number of anatomical problems that need to be assessed and understood before proceeding with any type of reconstructive surgery. This is where experience in reconstructive nose surgery becomes so critical in terms of achieving a successful outcome.

 

INSURANCE COVERAGE FOR SEPTORHINOPLASTY
Because of the implications in terms of improving nasal function, this type of nose surgery (nasal valve repair) can often times be covered by the patient’s insurance plan. This is largely due to the fact the thrust of the surgery is to improve nasal function. Although there will be a change in the appearance of the nose, it is not being reshaped for purely cosmetic indications.

Breathing and Smell disorders

Breathing disorders

There are three major causes for nasal obstruction.

1. Mechanical causes are best treated by surgery and are due to decreased space inside the nose. Mechanical obstruction can be due to narrow nasal passages, nasal valve collapse, a deviated septum or big turbinates.

2. Mucosal swelling due to disease or allergy can also decrease nasal airflow.

3. Finally, altered perception of nasal airflow can be a cause of a sensation of nasal obstruction. These last two causes are best treated medically.

A septoplasty is a procedure that corrects a deviated nasal septum. The septum itself is an anatomic structure dividing the nose into left and right nasal cavities. When the septum is deviated it can interfere with nasal breathing. This causes a person to complain of nasal obstruction, congestion or the inability to breathe through one side of their nose.

A functional septorhinoplasty is a form of nasal surgery performed to improve both the external appearance of the nose, along with the internal breathing capabilities. We call it a ‘functional’ surgery, as the procedure is not carried out primarily for cosmetic purposes.

During surgery the structure of the nasal skeleton is addressed to improve nasal breathing. Problems with nasal breathing may occur due to anatomic obstruction of the nasal passages. A deviated septum is an example of this. In addition to the septum, the nasal skeleton is made up of nasal bones, upper lateral cartilages, and lower lateral cartilages. If any of these portions of the nasal skeleton are broken or weak, they may cause obstruction of the nasal passages and lead to complaints of nasal obstruction or difficulty breathing through the nose.

Turbinoplasty aims to correct nasal turbinate enlargement. Turbinate hypertrophy is often caused by nasal allergies and is a major cause of nasal congestion or blockage.

The nasal turbinates are vascular structures inside the nasal cavity which warm the air as it enters the nose. However, when the turbinates are enlarged, their ability to keep the nose moist and warm the air is hindered.

Usually, enlarged turbinates can be treated medically.

However, if medical management fails, the turbinates can be surgically reduced in size and repositioned to allow for a larger nasal airway. The procedure aims to remove as little tissue as possible in reshaping and repositioning the turbinate.

Nose and Sinus Surgery

Acute rhinosinusitis is an infection that can complicate a common cold and is one of the most common causes for taking antibiotics. Although most cases settle with supportive treatment only, antibiotics are considered if symptoms last for more than 10 days, or in severe cases.

Complications of acute sinusitis are rare, but in cases of swelling of the eye or very severe headaches, you should seek urgent medical advice.

Surgery for acute sinusitis is rarely required, except for those with complications, but is considered in patients who get more than five episodes a year.

The aims of surgery for acute sinusitis are:

  • to relieve nasal blockage or congestion, facial pain or pressure and nasal discharge

  • to improve the sense of smell and taste.

Medical treatments may include nasal sprays and washes, steroid tablets and antibiotics, often at a low dose but for a prolonged period.

Functional endoscopic sinus surgery may be an option for chronic rhinosinusitis or acute recurrent rhinosinusitis. It consists in surgically opening the natural sinus drainage pathways.   

Nasal polyps are found in some patients with chronic rhinosinusitis. Polyps are non-cancerous inflammatory swellings that grow from the lining of the nose. Patients with polyps most often report nasal blockage and may also report a loss of sense of smell.

The aims of polyp removal are:

  • to remove abnormal tissue growths that grow inside the nasal passages and sinuses

  • to clear the nasal passages for easier breathing

  • to restore the sense of smell, although this is not always possible.

Although polyp removal may not be a permanent cure, it is very effective in reducing symptoms of sinusitis, and helps medical treatment get to the sinuses where the problem arises, so that medical treatment can work better in the long term.

Surgery for reducing the size of turbinates (turbinoplasty) and septoplasty have been discussed under breathing disorders.

Snoring and Sleep Apnea

Snoring is a common problem and can be a problem, affecting your quality of sleep and life.

However, before snoring surgery is even considered, there are a variety of non-surgical options available to help cure your condition. Snoring can be caused by a range of factors such as age, body shape, nasal or sinus problems, alcohol, smoking, and certain medications. Ascertaining what is causing your snoring can help in finding a solution.

It is sometimes possible to remedy snoring by making lifestyle changes, such as:

  • Losing weight

  • Drinking less alcohol, especially before bed

  • Giving up smoking

  • Taking more exercise and being more active

If lifestyle changes are not effective, there are also other non-surgical methods which can help to address snoring problems. These include:

  • Nasal strips

  • Chin strips

  • Mandibular repositioning splint

  • Adjusting your sleep position

Snoring can also be a symptom of a more serious health condition, such as sleep apnoea.

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