Nasal Obstruction and Rhinoplasty: A Focused Literature Review

Overview

Assessment, treatment and reported outcomes for nasal obstruction vary widely across the literature. This review set out to define the components of the nasal airway, identify the frequent causes of blockage, and survey the treatments in use.

Sections of note

• Systematic review including 135 studies; inclusion required English, human subjects, and a primary endpoint of nasal airway improvement.
• Excluded: abstract only, no airway data, pediatric patients, cleft rhinoplasty, sleep apnea, isolated traumatic reconstruction, and cadaver or animal studies.
• Obstructive sites identified: external nasal valve, septum, inferior turbinates, internal nasal valve, and nasal bones.
• Addressing the nostril rim alone may be insufficient; inspection of the lateral wall and the tip cartilage arms may be indicated.
• Correcting septal deviation requires attention to the bony base; mucosa-sparing turbinate treatment improves outcomes; the internal valve is a major source of obstruction, treated with spreader grafts.
• The bony vault can contribute, including because of surgical bone cuts.
• Pitfalls: failing to address the bony septum, over-resection of inferior turbinates, and narrowing of the nasal vault. Level of evidence V.

What it means for a patient

• Blockage has five possible anatomical sources, and treating the wrong one is why functional surgery fails.
• A crooked septum often involves the bone at its base, not just the cartilage, which is a common oversight.
• Removing too much turbinate causes crusting and dryness, so the lining is spared where possible.
• The bone cuts made to narrow a nose can themselves narrow the airway.

Why this paper matters

Breathing outcomes after rhinoplasty are inconsistent largely because the site of obstruction is misidentified or incompletely treated. Naming the five sites and the three recurring errors is directly actionable. As a level V review, it summarizes practice rather than establishing which treatments work best.

Terms

• External nasal valve: The nostril opening and its rim, which can collapse inward.
• Internal nasal valve: The narrowest part of the airway, between the septum and the upper lateral cartilage.
• Inferior turbinate: The lowest shelf of tissue on the inner nasal wall.
• Mucosal sparing: Removing inner bulk while leaving the surface lining intact.
• Spreader graft: A cartilage strip placed alongside the septum to widen and support the valve.
• Osteotomy: A controlled surgical cut through bone.