The inside of the nose is an elegantly arranged channel of multiple bones and cartilages, all covered and lined by tissue called mucosa. The nasal septum stands vertically in the center of the nose, separating the right from the left nasal passage. While the septum ought to be fairly straight, it may develop curvatures or spurs that block the passage of air. This is frequently called a “deviated septum.”
In contrast, the turbinate bones are curled or comma-shaped bones which originate from the sidewalls of the nose and project inward into the nasal passage. Their presence actually helps create a smooth flow of air through the nose. In certain diseases, such as allergic rhinitis, the turbinates may enlarge or become poorly oriented within the nose, obstructing airflow.
Obstruction to breathing through the nose can be a real detriment to your daily life. Mouth breathing is uncomfortable and unsightly, interferes with eating and leads to a dry mouth, chapped lips and a sore throat upon waking in the morning.
Secretions may become stuck in obstructed areas of the nasal airway. Outflow from the paranasal sinuses may become blocked, leading to recurrent sinusitis. Orthodontists, oral surgeons and ENT surgeons alike recognize that nasal obstruction and chronic mouth breathing in your formative years can even result in abnormal facial growth.
Nasal obstruction and mucosal inflammation may be evident upon simply looking into the front of the nose. However, a deeper view into the nasal passages may be required to better diagnose nasal pathology or to more carefully understand the exact point of obstruction. In these cases, an endoscope, or fiberoptic camera, may be useful for examining the internal nasal anatomy. The exam is brief and, with the use of topical anesthetic/decongestant spray, well tolerated in the office. A computed tomography (CT) scan may also assist in further understanding diseases that result in nasal obstruction.
Often, diseases of the nasal mucosa, such as allergy or infection, result in swelling of the surface soft tissues that may conspire with otherwise minor deviations of the septum to cause obstruction. In these cases, medical management is often effective at reducing just enough swelling in the nose, that despite minor septal deviation, obstruction is relieved.
In other cases, however, swelling of the surface tissues is not the key issue. The obstruction is simply a matter of anatomic structures. In these cases, surgery is indicated. Straightening the septum and reducing the size of the turbinate bones relieves the obstruction in most patients.
Septoplasty is an outpatient procedure performed under general anesthesia. It involves an incision inside the nose and the correction of the deviated portions of the nasal septum. The external appearance of the nose remains unchanged from a septoplasty, but breathing can be greatly improved. Inferior turbinate reduction can be accomplished through a variety of means, the choice of which is based on individual variables.
Septoplasty and inferior turbinate reduction procedures may be performed together. If more extensive reconstruction of the nasal framework is necessary, such as to correct functional collapse of the nasal “valves,” a septorhinoplasty may be required.