Posted by Dr. Hardesty
AIRWAY OBSTRUCTION BECAUSE OF A DEVIATED SEPTUM, LARGE TURBINATES OR NASAL POLYPS: SOLUTIONS AND TREATMENT OPTIONS
There are several common causes of nasal obstruction:
- Deviated septum (the portion separating the left and right nasal passages). This can be congenital (born with it) or acquired (injury or traumatic)
- Large turbinates which are a set of 3 paired out pouches that function to humidify the air we breath). These can be congenitally large, become large to compensate for a deviated septum or because of chronic allergies.
- Nasal polyps are usually non cancerous growths that grow and by their size obstruct the airway.
- Combination of the above
Deviated Septum: If the septum is crooked and is causing airway obstruction a septoplasty can be performed to improve the nasal passage(s) opening and thus airflow resulting in better airflow.
Hypertrophic (large) Turbinates: If the turbinates are large and causing decreased air flow they can be surgical reduced while still slowing them to function.
Nasal Polyps: If there polyps that are obstructing air flow through the nasal passages likewise they can be removed.
Anyone has airway obstruction, is a moderately good health and desires and improvement.
A septoplasty is performed using only internal nasal incisions on the nasal mucosa (the lining tissue of the septum) gently and precisely lifting the nasal mucosal off of the septum and either removing the obstructing portion of the septum or straightening the septum.
Turbinate reduction is usually performed by:
- Making an incision over the mucosal of the turbinates removing the underlying protruding and obstructing turbinate bone.
- Reducing the turbinate by amputating it at his base -or using a technique of “out fractioning” the turbinate bone which collapses the turbinate bone and then shrinking the mucosal with a electrocautery.
Nasal polyps are removed using only internal incisions and the polyps are usually removed at their base using electric cautery or a snare with electrocautery.
Once the deviated septum and is repaired and healed the septoplasty should last a lifetime unless additional trauma occurs.
Turbinate reduction is a permanent surgery. It is only very rare cases that either the turbinate boney grows back or there can be hypertrophy of the turbinates nasal mucosa. This is unusual and may be needto be addressed if it again causes nasal airway obstruction.
Nasal polyps usually do not grow back. However, once you’ve developed a nasa polyp, you may grow new polyps which may cause additional symptoms of obstruction. Thus you may need to have these additional polyps removed.
The usual septal recovery is 7 to 10 days. The reason is that often internal splints (Doyle splints) are placed and sutured to prevent movement. Occasionally and rarely nasal packing is used. Often the patient returns to work in 2 to 3 days depending on how they feel. The splints are removed usually at around the 10th day.
Turbinate and polypectomy recovery is usually straight forward and those with non physical or non strenuous work the recovery is only a few days.
Unfortunately when there is a mechanical obstruction there are very few non-surgical options. Most patients have tried using antihistamines, nasal mucosal shrinkage sprays such as Afrin nasal decongestants. However, patients can develop resistance to such medications. when the symptoms are not relieved patients often then consult a Plastic Surgeon for remedies.
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If the septum is not crooked, the turbinates are not enlarged or the polyps do not cause airway obstruction then these types of surgery will not help in improving breathing.
Allergies are the most common common cause of non mechanical airway obstruction. If the airway obstruction is caused by environmental allergies or other substances it can often be treated medically by a allergist specialist
Yes. The most common surgery that is performed simultaneously with air way obstruction surgery is a cosmetic rhinoplasty which improves the cosmetic appearance of the nose. Most other Plastic Surgery can be performed in the same setting.
Besides the generally very low risks of any surgical procedure such as bleeding, infection and anesthesia there is an additional uncommon risk of a hole developing in the septum. This hole can be asymptomatic and needs no further treatment. If a whistle noise occurs or a fowl smell this perforation will need to be repaired or placement of a non surgical button.
The fees of deviated septum surgery are based on the anesthesia used (local vs sedation or general anesthesia), the facility (minor surgical suite, outpatient operating room or hospital setting) and if combined with other procedures. All pre and post operative care is included. Some preoperative laboratory analysis may be required (usually covered by your medical insurance).
The most important factor to consider is seeking the opinion and services of a skilled, experienced and Board Certified Plastic Surgeon in California who are experts in airway obstruction caused by a deviated septum, large obstructing turbinates or space occupying turbinates.
The Imagine Plastic Surgery team uniquely provides the full array surgical techniques and can refer allergy specialists as alternative when non mechanical airway obstruction is found, thus filling our motto of “One Goal, Many Options”. For more information, call and schedule a consultation.
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