When Is a Breathing Problem Severe Enough to Warrant Surgery?
There are risks with any surgery and nasal surgery is no exception. Similar risks occur whether nasal surgery is done for functional breathing problems or for cosmetic concerns. The benefits of nasal surgery should therefore outweigh the risks of harm or complications. The cause of the breathing problem also has to be considered because surgery is only effective for certain conditions. For instance, seasonal allergies or recurrent sinus infections normally improve with medical therapy without the need for surgical intervention while a deviated septum or crooked nose after nasal trauma will benefit from surgery to correct the deformity.
The nose plays an important role in the aesthetic appearance of the face since it is located in the middle of the face. The nose also is important to breathing and thus serves two purposes – beauty and function. Due to the dual roles of the nose, changing the form (or aesthetic appearance) can affect function (or breathing) while changing the structure to improve breathing can also affect the appearance of the nose. When improving breathing is the main goal, an honest discussion needs to be made about the potential of changing the patient’s appearance with nasal surgery. The benefits of surgery and the other risks of nasal surgery also have to be explained. Not all breathing problems are easily solved with surgery. Some problems with breathing can be improved with medical therapy and these options need to be exhausted before pursuing surgery.
The potential causes of nasal breathing that should be treated with medical therapy first include allergies and sinusitis. Occasionally, allergies can be severe enough to cause a significant blockage that is not improved with drugs and medications alone. In these cases, surgery to shave and shrink the spongy nasal tissue can be a great option. Chronic sinusitis with nasal swelling can also improve with surgery to open up the sinus passages when medical therapy has failed.
Structural causes of nasal breathing are more likely to permanently improve with nasal surgery and these causes include a deviated septum, crooked nose after nasal trauma, and narrowing of the entry to the nasal passageways also known as nasal valve collapse or stenosis.
Potential Surgical Treatment Options
The surgical treatment option that is most appropriate depends on the diagnosed cause of the nasal breathing problem.
The septum of the nose is the structure that runs in the middle of the inside of the nose, separating the two sides of the nose. It is made of both cartilage and bone and can become deviated or slant into one side of the nose resulting in a blocked nasal passageway. A deviated nasal septum can be corrected by septoplasty surgery, in which the deviated portion of the septum is either removed or moved back to the midline and secured with sutures or splints.
Allergies are another cause of nasal breathing problems. Allergies can cause recurrent and persistent swelling of the nasal tissues, which results in narrowing of the nasal airway. Often medical treatments with oral antihistamines or nasal sprays are enough to provide relief from the nasal symptoms of allergies. However, occasionally surgical treatment is warranted in refractory cases especially when the quality of life from constant breathing problems outweighs the risks of surgery. The inferior turbinates are often the site of the most swelling and can be treated by shaving and reducing the size of the inferior turbinates. This treatment is termed inferior turbinate reduction surgery.
Narrowed or collapsed nasal valves can be another contributing factor to nasal obstruction. The nasal valves are located between the sidewalls of the nose and the septum. This area is the narrowest portion of the nasal passageway and is prone to collapse from the forces of deep and forceful inhalation. Nasal valve collapse can occur from weak cartilages present since birth, cartilages that weaken with age, weak cartilages acquired from previous rhinoplasty surgery where the cartilages were over resected, or from trauma.
Blockage in the nose is rated with a number between one and four, one meaning 25% and four meaning 100% with 25% increments between each number.
A narrowed or collapsed internal nasal valve can be treated by surgically widening the nasal valve area. This can be done using a cartilage spacer between the lateral nasal wall and the septum or through the placement of sutures to flare out the lateral nasal walls.
There are other causes related to deformities of the nasal cartilages that can result in nasal breathing problems. This is usually addressed with a “functional” rhinoplasty in which the nose is opened to fix the underlying structural cause to the breathing dysfunction.
Benefits of Surgery
The goal of nasal surgery is to improve quality of life by improving breathing. Some patients who have trouble with nasal congestion at night and trouble falling asleep also have better sleep after nasal surgery.
Probability of Success
The likelihood of improvement in breathing after nasal surgery depends on the degree of nasal obstruction prior to surgery. If there is 25% blockage, there is less likely to be a dramatic improvement in breathing whereas a nasal airway with complete blockage on one side will witness a dramatic change in breathing. Nasal surgery has a good success rate and the benefits usually outweigh the risks of surgery.
There are risks with any surgery such as infection, bleeding, scarring, bruising, swelling, leg and lung clots, severe reactions to general anesthesia and even death. The risks specific for nasal surgery include:
– Worsened quality of breathing
– Unappealing cosmetic appearance
– Asymmetry of nostrils
– Irregularities of skin, bone, or cartilage
– Septal perforation (hole in the internal wall of the nose)
– Saddle nose deformity (collapse of the outside structure of the nose)
– Additional revision surgery required
Probability of Complications
There is a risk of complication with any surgery but the complication rate can be minimized by proper pre-operative planning. Use of perioperative antibiotics, cleansing of the skin, and use of sterile technique can decrease the risk of infection. Decongestant nasal sprays and saline nasal sprays will decrease nasal congestion during the postoperative period. Perioperative vitamins can also help speed recovery and minimize bruising and swelling. Other complications can be avoided by optimizing the patient’s health prior to surgery and complications with the cosmetic outcome of the nasal surgery can be diminished by choosing a surgeon with extensive experience in nasal surgery.