When is a Rhinoplasty necessary to Fix Nasal Obstruction?

The most common surgical procedures for nasal obstruction are septoplasty and turbinate reduction. These procedures are often performed by ENT surgeons and are associated with a high success rate and quality of life improvement for patients. These are relatively simple procedures and can be performed through incision inside the nose with no change to the external nose. Essentially, the problem causing the obstruction is all within the nasal passages, so no alteration is necessary to the external nose.

In some cases, however, the cause of the nasal obstruction is more extensive and may require surgical procedures which changes the external nose. Taken together, these procedures are sometimes lumped together as “functional rhinoplasty”. There are three main procedures which comprise functional rhinoplasty

1. Reconstruction of the external (or structural) aspect of the septum. Most of the septum is inside the nasal passages within the head. However, the front of the septum projects out of the face and provides a foundation for the external nose. When this foundation is bent or deviated, functional rhinoplasty is necessary to reconstruct and straighten this support structure. Many times, this will also make the nose look straighter from the outside in addition to improving the airflow.
2. Repair of nasal valve pinching. The nasal valves refer to areas of the external nasal cartilages which are too narrow, preventing air from easily entering the nasal passages. This can be in the cartilages which form the bridge (upper lateral cartilages) or the tip cartilages (lower lateral cartilages). In either case, structural cartilage grafts can be place to open the nasal valves. This will lead to changes in the shape of the nose but in the hands of a skilled surgeon, the nose can be made to look normal or even better than the original nose.
3. Reduction of nasal fracture. When there has been a bad break in the nasal bones, the resulting deformity may cause narrowing of the nasal passage. In particular, when the bone has collapsed inward, the width of the nasal passage diminishes. Repositioning the bone back to a normal position through reduction of the fracture can help the airflow in such a situation.

When being evaluated for nasal obstruction, it is important to differentiate between which type of problem each individual has. If there are external nasal issues contributing to the obstruction, one or more of the above functional rhinoplasty procedures may be beneficial.