Functional nasal airway surgery is intended to improve breathing though your nose by removing mechanical obstructions to airflow. Many patients confuse this type of nasal surgery with rhinoplasty which is the external reshaping of the nose. (particularly as it relates to insurance coverage!) This is understandable given that it is quite common to do both at the same time, simultaneously improving most of the major functions of the nose in a one surgery.

Nasal airway surgery almost always involves efforts to straighten the septum. While this central piece of cartilage (and bone in the back) separates the two sides of the nose, it is frequently not straight. As a result, septal straightening or septoplasty, is synonymous with better breathing as it may be deviated to one side which reduces airflow in at least half of the nose.

While septal deviation is common and usually needs realignment, there are other structures in the nose that can also cause obstruction. The turbinates bones are usually not even known to exist in most patient’s minds. These scrolled bones on the side of the nose (3 pairs) play a valuable role in helping to moisturize the air that we breathe which is often quite dry. The lower or inferior turbinate bone is the largest and may also be a culprit for airway resistance if enlarged.

Inferior turbinate reduction is done as commonly as septoplasty for airway improvement. There have been many methods to reduce the size of the turbinate. Most of these involve cutting or cauterizing it. While these are effective, they are also prone to cause bleeding during and after surgery and are a common source of postoperative bleeding. A recent article in the June 2009 Plastic and Reconstructive Surgery journal looked at another method that is less invasive for turbinate reduction…that of outfracturing.

Outfracturing of the inferior turbinate is the simple procedure of breaking the thin bone contained within it and moving it to the side. By so doing, the airway is opened as the turbinate is made ‘smaller’. The combination of septal straightening and turbinate relocation can really open up the nasal airway. The authors of this journal article looked at, with CT scans, whether inferior turbinate reduction by outfracturing resulted in a sustainable long-term improvement in the nasal airway. Their results shows that it provided a measureable improvement (around 25%) that was indeed maintained and did so without any complications such as bleeding.

Inferior turbinate reduction is an integral part of functional nasal airway surgery. In my Indianapolis plastic surgery practice, I have used outfracturing for some time and have been impressed that it appears to be effective despite its simplicity. This study reported in this June article provides scientific evidence to continue with this turbinate management method.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

One of the greatest fears of many patients who are considering rhinoplasty surgery is that their nose will be packed during surgery, subsequently requiring removal sometime after surgery. That thought is one of significant uncomfortability at best and outright pain at the worst. I have found that many potential rhinoplasty patients often ask….are you going to pack my nose?

 
The good news is that the need for packing a rhinoplasty surgery patient is very infrequent. If you are having a cosmetic rhinoplasty, where only the external nose is being operated on (hence the concept of a cosmetic rhinoplasty), then there is absolutely no reason to have to pack the nose after surgery. If you having a ‘rhinoplasty’ for breathing purposes only, other wise known as functional nasal airway surgery or septoplasty and/or turbinate surgery, then that possibility exists but it is still in my practice a very low likelihood.

 
The purpose of nasal packing is only two-fold, to stop bleeding and to help adapt the lining of the nose back in its place against the cartilage or bone so no bleeding occurs underneath it. Whe performing septal straightening, a very important component of airway surgery, you must first lift the lining off of both sides before strsightening it. Once straightened, the lining must be put back in its original place. Historically, packing the nose with gauze squeezed this lining back in place. The use of packing has been replaced by many surgeons with sewing it back into place through a sewing technique known as quilting. This has virtually replaced the need for packing, much to the applause of patients and plastic surgeons alike. Only in cases where there is too much bleeding at the end of surgery will packing be sued to control it, much like the way it is used to stop difficult nose bleeds.

 
So to those patients considering most forms of rhinoplasty surgery, this is one issue that you need not concern yourself with!

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis