Chronic nasal obstruction is defined by a sensation of nasal respiratory discomfort for more than three months. Many conditions can cause this feeling and is schematically subdivided into two groups : anomalies of the mucosa, and anomalies of nasal architecture .
The mucosal abnormalities include all cases that will lead to a thickening of the latter and are often associated with other symptoms such as loss of smell , runny nose and sneezing. The treatment is usually medical. Surgery will be discussed in case of failure of the various local treatments. Nasal obstruction can sometimes be related to the presence of nasal tumors, making it essential to consult in cases of obstruction of only one nostril.
Nasal obstruction due to an architectural origin is usually secondary to a deviated nasal septum, turbinate hypertrophy or impairment of the nasal valve. The treatment is usualy surgical.
Here are the procedures performed :
1. Lower turbinoplasty
The inferior turbinates function is to moisten and filter the air inhaled through the nose. In some cases, the turbinates may be too large and / or swell and cause respiratory gene . The radio frequency or electrocoagulation turbinoplasty involves sending an electrical current within the turbinate , causing retraction and improving breathing. The procedure can be carried out under local or general anesthesia. Local anesthesia is achieved by buffering with an anesthetic solution .
The probe is then placed in the inferior turbinate for 30 seconds on each side. This procedure is painless. The suites are frequently characterized by a swelling of the mucosa, wich may cause a worsening of nasal obstruction up to 3 weeks. It is common to have crusts that will be removed by nose washing.
2 . Septoplasty
This intervention is proposed to patients with a deviated nasal septum. The scar is located in the nasal cavity. The septum is tailored, replaced and maintened by two nasal splints. Post operative packing is painless removed 2 hours after intervention. It is common to have a temporary worsening of nasal obstruction for a week, especially when the splints are in place. The output can be considered the evening of surgery and there should be an appointment between 5 and 7 days later for removal of the splints. There are no postoperative mark on the face.
Case 1 :
Patient with a nasal obstruction due to a septal deviation. Pictures before and after surgery
3 . External nasal Valve
The external nasal valve is the area on the anterior part of the nasal cavity between the septum, the inferior turbinate and the cartilage of the ala “the alar cartilage .”
In some cases, the cartilage of the nose ala may be weakened , causing a narrowing of the valve in inspiration , what is called ” external nasal valve syndrome .”
This syndrome is diagnosed by the spreading the ala , which improves breathing . It is possible to use a silicone nasal dilator to simulate the intervention. Surgery of the external nasal valve consists in a strenghtening of the ala with a cartilage graft and / or spreading the weakened cartilage with tractor stiches. The procedure is performed under general anesthesia. The incision is in the concealed nostril or at the base of the nose whether rhinoplasty is associated .
A graft of nasal septum cartilage is often removed and placed on either side , against the weakened cartilage . In some cases , in particular in patients already operated , the septum cartilage is not sufficient to be able to be harvested . It is then necessary to take a graft of cartilage behind the ear. Splints and packings are frequently placed after the operation . The packs are removed in the evening or the next day, and splints on the 5th day.
This intervention, not painful , may cause swelling of the nose, wich may persist for several weeks.
4 . Internal nasal valve
The internal nasal valve is the angle between the nasal septum cartilage and the”triangular cartilage” , located below the nasal bone . The failure of the internal valve is a usualy associated with a previous rhinoplasty ablating a very large hump, without adequate reconstruction of nasal cartilage .
The nasal obstruction is often associated with a characteristic of the nose, in inverted V-shape. This disease is treated by placing cartilage grafts on each side of the septum , so as to reconstruct the deteriorated joint . These grafts can be taken from the septum or behind the ear.