Surgical Treatment of Nasal Obstruction in Rhinoplasty

Overview

The authors argue that a successful septorhinoplasty depends on understanding both nasal anatomy and how the nose functions, so that shape and breathing can be addressed in the same operation. The article covers taking a history and examining the patient to find where the blockage actually is, then reviews the surgical options for each site.

Sections of note

• The article is a review chapter, not a study of patients.
• History and physical examination are described as paramount in locating the obstruction.
• The common sites named are the internal nasal valve, the external nasal valve, the septum and the turbinates.
• Treatment of each site is described as nuanced, with multiple approaches discussed.
• The stated goal is a result that is both functional and cosmetic.
• No patient numbers, airflow measurements, complication rates or outcome data appear in the abstract.

What it means for a patient

• A blocked nose has several possible causes, and the fix depends on which one applies, so examination before surgery matters more than the label on the operation.
• A deviated septum is only one of four common causes. The valves, which are the narrow points where the nose flexes, are equally common and easier to miss.
• Breathing surgery and appearance surgery can be done together, but they involve different manoeuvres at different sites.
• A narrative review with no pooled data cannot say which technique works best for any given site.

Why this paper matters

Nasal obstruction is a frequent reason for revision rhinoplasty, often because the original operation narrowed the airway or missed the true site of blockage. Setting out the four common sites is the practical framework for avoiding that. Which technique performs best at each site remains unresolved in the literature this review draws on.

Terms

• Nasal obstruction: restricted airflow through the nose, felt as blockage.
• Septorhinoplasty: rhinoplasty combined with straightening of the nasal partition.
• Internal nasal valve: the narrowest part of the nasal airway, inside the middle of the nose.
• External nasal valve: the nostril opening and its supporting rim, which can collapse on breathing in.
• Septum: the central partition dividing the two sides of the nose.
• Turbinates: ridged structures on the side wall inside the nose that warm and humidify air.