Obstructive sleep apnea (OSA) is a well known medical condition that is caused by obstruction of the upper airway. This obstruction can be anywhere from the nasal passages, the upper nasopharynx (soft palate), the oropharynx (tongue) down to the epiglottis. In many cases it is believed that the cause of OSA is at multiple levels of the upper airway and rarely is a result of one single level. Other than tiredness the patient may not even be aware that they have the problem but to others the snoring during sleep is a key giveaway.
There have been many treatments for OSA at every level of the upper airway, each with their own degrees of symptom improvement and morbidity. The nose is a frequent and historic source of blame for OSA symptoms due to nasal airway blockage by septal deviation and/or inferior turbinate enlargement. But despite being a known source of airway obstruction, the medical literature does not strongly support that septoplasty and turbinate reduction produces dramatic improvement in OSA symptoms.
In the June 2015 issue of the Plastic and Reconstructive Surgery journal the paper entitled ‘Can Functional Septorhinoplasty Independently Treat Obstructive Sleep Apnea?’ was published. Twenty-six (26) patients who had a different type of functional rhinoplasty had sleep studies before and after their procedure. This type of functional rhinoplasty used a closed approach, a caudal septoplasty, a dorsal releasing septoplasty and retensioning of the nasal sidewall by changing the overlap between the upper and lower alar cartilages. It should be pointed out that the authors used a special device, an Alar Nasal Valve Stent, for this portion of the procedure. It should also be noted that an inferior turbinate reduction as not done as part of the rhinoplasty. The results shows that the mean apnea-hypopnea index scores dropped over 1/3 of that before the surgery. If patients who were overweight were excluded (BMI greater than 30) the apnea-hypopnea scores improved over 50%.
This study shows that in the properly selected OSA patient, preferably those of good body weight, that functional rhinoplasty can offer good symptom improvement. It is interesting to note that this type of rhinoplasty is a faster and more minimally invasive procedure than the traditional open rhinoplasty approach using multiple cartilage grafts to open the internal nasal valve by build out the middle vault and adding structural support to the lower alar cartilages.
Dr. Barry Eppley
Indianapolis, Indiana