Septorhinoplasty, Easy Breathing

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Septorhinoplasty, Easy Breathing
July 18
11:55 2016

It’s the one feature that can’t be easily camouflaged by make-up or clothing. Situated right in the center of a person’s face, a nose of any kind is hard to miss. Now, not everyone is genetically blessed with the nose that we would like to have, but as we all know, there are ways to fix that. Sometimes, however, in addition to being an esthetic issue, a less than ideal nose can also pose a medical concern.

“If the nose is crooked on the outside, then most likely it is crooked on the inside,” said Dr. David Ellis, a facial plastic surgeon at the Art of Facial Surgery clinic in Toronto.

A conventional rhinoplasty can be performed to correct the external part of the nose, but more is required if the inside of the nose is not properly aligned.

Septorhinoplasty, Easy Breathing

Septorhinoplasty, Easy Breathing

“Anatomically, with the outside of the nose, you deal with a rhinoplasty,” continued Dr. Ellis. “The inside of the nose is the piece of cartilage and bone that goes down the midline and separates the left-hand from the right-hand side of the nose (the septum). And that could be crooked. If that’s crooked, you perform a septoplasty as well as a rhinoplasty.”

Dr. Ellis noted that when the septum is crooked or deviated, people will have difficulty breathing. When a nose is crooked, meaning that the nasal line is off-centered, then the septum has to be deviated, too, confirmed Dr. Ellis.

“If you have a crooked nose that is off-centered to the right and you’d break the nasal bones back into the midline without correcting the septum, in the healing period, the nasal bone might pull the septum off into the right, so the nose would still be crooked,” elaborated Dr. Ellis. “So you usually have to deal with them both at the same time.”

A deviated septum is usually formed either because of trauma to the nose, which makes the nose crooked, or it can be a result of growth in some young patients. In patients who have a fairly large nose, the septum grows more than the outside part of the nose, so it automatically bends to one side, causing the unilateral nasal obstruction, mentioned Dr. Ellis.

“Patients will come in and say, ‘I can’t breathe through the left side of my nose,’ and when you look inside the nose, there might be a curve of the septum into the left nasal airway, which narrows it,” expanded Dr. Ellis. “So what you have to do at the same time as you’re doing the cosmetic component, you may have to do something to improve the breathing, like to take the cartilage and move it more in the midline or remove the excessive cartilage bending into the nasal airway.”

With any septorhinoplasty procedure, the goal is to straighten the nose and septum, so that a patient’s breathing improves and the nose is as straight as it can be. However, there are many ways to perform a septoplasty surgery, affirmed Dr. Ellis.

Septorhinoplasty, Easy Breathing

Septorhinoplasty, Easy Breathing

He stated that in a case where a patient has a unilateral depressed nasal fracture, for instance, where the nose may look crooked but it really isn’t, as the midline is lined up in the center of the face, the treatment would be completely different than when the midline is actually off-centre.

According to Dr. Ellis, in a very complex case, most surgeons would perform the septoplasty surgery through an external approach. With this method, your doctor would make an incision across the columella, which is located between the nostril and under the nose. They would then raise the skin flap up over the dorsal, or bridge of the nose, in order to enter the nose through the top part of the septum and see where it is crooked. The bones of the nose will need to be fractured to get it as straight as possible.

“Sometimes,” added Dr. Ellis, “we would make an incision inside the nose, just behind the columella and elevate the lining through the cartilage and the septum and make the septum as straight as possible.”

When you are dealing with the septum and a crooked nose, remarked Dr. Ellis, turbinates on the outside sidewall of the nose sometimes become enlarged. When this happens, you usually would have to diminish or crush the turbinates to make them smaller, so that the airway remains as large as possible.

The septoplasty procedure typically takes approximately one, noted Dr. Ellis, and the operation will take longer on a nose that is crooked or off- centre than one that is straight.

“Usually, with a deviated or a crooked nose, it’s hard to get it exactly in the midline, but it’s usually improved in all the types of surgery,” maintained Dr. Ellis.

Post-procedure, Dr. Ellis recommends that patients don’t physically exert themselves for two weeks afterwards, or to do any strenuous physical activity. This will help to stop the post-op bleeding that can occur after any rhinoplasty.

A complication associated with this procedure is septum perforation, where a hole develops, but Dr. Ellis emphasized that this is rare. Another ongoing complication may be that the nose may not be perfectly straight, but it usually will be a lot straighter than it was before the surgery, Dr. Ellis reassured.

Although this operation is necessary for most patients, it is not for everyone. Dr. Ellis said that he would not operate on young patients that have not stopped growing or on athletes that are doing ongoing athletic activities, such as boxers, volleyball or soccer players, as they risk breaking or fracturing their nose on a regular basis.

When going in to get a septorhinoplasty, Dr. Ellis emphasized that is important that a patient has realistic expectations about what changes they want to their nose. Also, a patient who has difficulty breathing through their nose would notice a significant improvement, but their breathing still may not be perfect.

That being said, a septorhinoplasty is a sound surgical option for a patient who is both unhappy with the appearance of their nose and has trouble breathing.

“If you need it, you should have both done. They’re so geographically close to each other that there’s really no difference,” reiterated Dr. Ellis. “It adds a little bit of extra time to the surgery, but if you need it, you need it.”

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