The nose is a filter, removing dust, allergens, and other particles from the air we breathe. At the same time, the nose helps to warm and humidify air. Together, these functions condition inspired air before it reaches our lungs. Air entering the nose is also deflected toward the roof of our nasal cavity where olfactory nerves provide our sense of smell. The internal structures (septum and turbinates), lining (mucosa), and mucous all help make these functions possible.
Nasal obstruction arises from a number of causes. More commonly, it may be transient when related to seasonal allergies or infections that lead to increased swelling of the nasal lining and increased mucous production. Obstruction may also be longstanding, though, if the anatomy of the nose is distorted and provides a fixed blockage of the air passages. And in many patients, multiple factors act in concert to block the nasal airway. When obstruction does occur, we must revert to far less efficient mouth breathing. Over time, the inability to efficiently breathe impacts our physical activities and culminates in any number of factors that can negatively impact our quality of life, including; decreased exercise tolerance, poor sleep, snoring, possible sleep apnea, daytime fatigue, altered concentration, decreased sense of smell and taste, dry mouth, and even nose bleeds.
If you suffer from nasal obstruction, schedule an appointment with Dr. Stallworth for an in-depth nasal analysis and exam. As a board certified facial plastic surgeon and otolaryngologist (ear, nose, & throat surgeon), he will identify the root causes of your obstruction and devise a treatment plan, surgical or non-surgical, to help restore your breathe of fresh air! Trust your nose to a board-certified nasal surgeon!
The nasal septum is the wall that divides the nose into two halves. It is made of cartilage anteriorly and comprised of bone further back into the nasal cavity. Not only does it provide a partition between the two nasal passages originating at the nostrils, it also provides support for the nose. The septum can be thought of as a load-bearing wall in a building. Superiorly, it provides support to the roof of the nose and nasal cavity. Anteriorly, it supports nasal length, nasal tip projection and tip rotation. In these ways, the septum is truly the foundation of the nose.
A septum that deflects to the right or left can dramatically reduce airflow on that side of the nose. This deflection may be inherited, may be the result of nasal trauma, or may arise over time due to extrinsic forces that influence the growth and shape of the septal cartilage. Irrespective of the cause, septal deviation is a common cause of nasal obstruction.
Septoplasty, or septal straightening surgery, is traditionally performed through an incision on the inside of the nasal cavity just inside the nostril. The lining of the septum is elevated and the deflected cartilage and/or bone is removed or reshaped to fall within the nasal midline. The incision is then closed with dissolving sutures. The procedure can be performed alone or in concert with additional nasal procedures.
Nasal Valve Surgery
A valve is a structure or device located at a transition point between two spaces. It functions to help facilitate and/or regulate flow between the spaces. The nose is built with both an external valve at the nostril opening and an internal valve just inside the nasal cavity. The external valve is formed primarily by skin and soft tissue found in the wing, or ala, of the nose. Together with the midline septum and tip cartilages, the alae make up the shape of the nostrils. The internal valve is comprised of cartilages that extend from the nasal bones and attach in the midline to the nasal septum. Much like an awning or the sides of a tent, these tissues drape off of the septum and tip cartilages and extend toward the cheek, making up the sidewalls of the nose. Just like the septum, these tissues can become distorted during facial growth or trauma, causing asymmetries in one or both sides of the nose. In addition, these tissues can become weak with increasing age or from previous nasal surgery. The result can be a valve that is too narrow for adequate air passage, or one that is too weak to remain open during inspiration.
Nasal valve compromise is a common finding in patients with nasal obstruction. This is particularly true in patients that have persisting nasal restriction after a previous surgery like septoplasty or rhinoplasty. Sometimes patients identify these problems on their own when they find their nasal breathing improves by pulling on their cheek or using products like Breathe Right Strips®. If the nasal valve is found to be compromised, augmentation techniques using your own cartilage may provide you with a more stable, patent valve at all times of the day.
Dr. Stallworth has a particular interest in nasal valve surgery, and is skilled in addressing each of the issues previously mentioned using a number of different techniques. These include, but are not limited to, batten grafting, spreader grafting, butterflying grafting, alar rim augmentation and flaring sutures. Each has specific indications and may be the answer in one patient, but inappropriate in another. Based on your history and nasal assessment, Dr. Stallworth will identify nasal valve issues if they exist, and if found, will help you to understand how these techniques can be tailored to address your unique nasal valve concern.
Turbinates are shelf-like structures that protrude from the nasal sidewalls and extend the length of the nasal cavity. They are made up a bony shelf covered in nasal lining, or mucosa. Turbinates work much like the grill in a radiator, exposing the air we breathe to the greatest surface area possible. In doing so, they humidify and warm our inspired air. They also secrete mucous to trap and filter allergens, infectious agents, and other particles from the air. When stimulated, the mucosa swells. This phenomenon is responsible for a stuffy nose when we suffer from a cold virus, a sinus infection, or are exposed to allergens and irritants.
Just like a callus on the skin, turbinates may enlarge and thicken over time from repeated exposure to irritants. Often times, this thickening and mucous production can be reduced with medications like oral antihistamines or nasal steroid sprays. However, there are instances where they enlarge, or hypertrophy, to a degree that is no longer amenable to medication. In these cases, reducing the size of the turbinates can make a profound impact on nasal breathing.
In the past, large portions of the turbinates were excised, permanently removing them from the nose. Unfortunately, this was found to rob patients of the valuable nasal lining needed to humidify and warm nasal air. Instead of remaining moist like the lining of the mouth, the nose would become dry. Also, the loss of all turbinate structure would remove the resistance needed to direct air to the back of the throat and on to the lungs, worsening nasal breathing. For these reasons, modern techniques are now employed to reduce turbinate size from the inside out, reducing their size to a more manageable volume while leaving the overlying lining intact. Today, this is achieved using small electric, radiofrequency, or shaving devices inserted into the turbinate through a small needle-sized incision. Turbinate surgery may be done alone or, more frequently, done in combination with other nasal surgeries.
Rhinoplasty, or nasal re-shaping surgery, is commonly performed to improve the outward appearance of the nose. However, it may also be necessary to improve the nasal airway. For patients with congenital nasal malformations, asymmetric nasal growth or traumatic injuries, and sometimes after previous rhinoplastic surgery, the nasal bones and septum can be deviated to one side or the other. There may also be deviations and malposition of misshapen nasal cartilages. Together, these can lead to external and internal nasal deviations that compromise the nasal valves and obstruct airflow. Traditional septoplasty may not be able to address the area of blockage without compromising the integrity of the critical support portions of the nasal septum. Similarly, there may be areas that require grafting or holes in the septum that cannot be fixed by these straightforward routes either. In cases where multiple levels of nasal repair are required, a formal rhinoplasty approach may be needed to gain access to all areas of the nasal framework and completely restructure or reinforce different elements of the nose.
Functional rhinoplasty is specifically indicated for improvements in nasal breathing. However, improving the nasal airway in certain patients may also translate into an improved outward appearance. Because nasal function is intimately associated with nasal form, a nose that does not breathe well often has structural problems that contribute to a less appealing appearance as well. For example, a collapsed nostril cannot breathe well and may be visually asymmetric or abnormal. Correction of the nostril geometry and support will not only improve breathing, but will also improve how it looks. Dr. Stallworth understands and continues to study the intimate association between nasal form and function. Together with thorough facial analysis and nasal analysis, he can provide classic, contemporary, and progressive surgical techniques required to meet both your aesthetic and functional nasal objectives.