In the previous part of this Rhinoplasty Overview we discussed and described the various procedures that are used to produce cosmetic rhinoplasty results. In this chapter we will touch on the main cases of when surgical intervention into the nose is dictated by functional considerations and is meant to restore the proper operation of the nasal mechanism.
Keep in mind, that while insurance does not normally cover strictly cosmetic rhinoplasty, while some coverage may turn out to be available when it is dictated by a need to correct or improve one or more of the nasal functions, or a major injury or deformity. Some patients even take this as an opportunity to undergo a cosmetic rhinoplasty in the same session, saving considerable time and effort.
While rhinoplasty is typically a cosmetic surgery and is performed to improve the appearance of the nose, some functional problems may be addressed in rhinoplasty as well. Among the most common functions that need to be restored is the airway passage function of the nose. It is done by removing various nasal obstructions. Among the common functional rhinoplasty techniques we will find septoplasty, turbinate reduction and nasal polyp removal.
Septoplasty is meant to address and straighten a deviated septum, this way opening the blocked air duct and improve breathing in one of the or both nostrils. Enlarged turbinates may also cause nasal obstruction, and are addressed in turbinate reduction. Nasal polyps are benign small growths that can obstruct the nasal passage and are removed in the nasal polyp removal procedure. Among the other problems that functional rhinoplasty can address as well is the nasal valve collapse.
The nasal septum is the thin wall of bone and cartilage that runs the length of the nasal bridge, separating the nostrils. Ideally, the septum is supposed to be straight and positioned in the center of the nose, leaving equally sized airway paths to either nostril. In some cases the septum can become deformed or displaced to one side. This is known as a deviated septum condition.
It can be a born condition or caused by injury, but either way a deviated septum results in air passage obstruction and breathing difficulty. It can be mild or severe, sometimes leading to nosebleeds, snoring and sleep apnea. If these symptoms become so bad as to detract from a person’s quality of life and workplace functioning, surgical intervention will very likely be necessary.
Depending on the specific patient, septoplasty can be performed with either local or general anesthesia. In some cases where extra visibility is necessary, an endoscope may need to be used. During the septoplasty surgery the septum will likely need to be trimmed and/or repositioned, and some of the bone or cartilage may also have to be replaced. Incisions for septoplasty are usually made on the inside of the nose and will normally be closed with absorbable sutures. The surgery time will usually be between an hour and two hours depending on access, difficulty and visibility.
Upon completion of the septoplasty, silicone splints and nasal packing may be inserted into each nostril to provide support to the weakened septum and to minimize bleeding. The packing will usually be removed the next day, while the splints may need to remain in place for approximately one week. Very much like after other surgical procedures, you can expect some swelling, bruising and discomfort. It does, however, allow most patients to return to work within one to two weeks after the surgery.
Nasal Polyp Removal
Nasal polyps are benign growths that are commonly believed to be caused by allergy or asthma. They are not harmful in themselves, but they contribute to the collection of nasal mucosa in the region, causing an irritation and obstructed breathing. The removal of nasal polyps by surgical means can take between forty five minutes to one hour. The surgery can be performed under either general or local anaesthesia, and the polyps are removed using endoscopic surgery (Endoscopy typically refers to the means of looking inside a body for medical reasons using an endoscope). Recovery from this type of surgery can take between one and three weeks and normally causes very little discomfort
The turbinates are structures of soft tissue that are located on the side wall of the inside of the nose and protrude into the nasal passages. The turbinates’ main function is to warm and moisturize air passing through the nose, but they can also block the flow of air when they are hypertrophied.
There are several ways that are commonly employed to shrink the size of the turbinates. The surgical method can be called turbinate reduction or turbinate resection. This surgery can be performed in either the office ot the operating room, sometimes combining it with septoplasty.
No matter what your need is, always consult with your surgeon to decide on the optimal course of action for your specific circumstances. Read on about various other techniques and conditions in the next chapter of this blog, Rhinoplasty Overview – Part 3