Respiratory tract surgery

In case of nasal obstruction due to nasal septum deviation, should the nose surgery be performed in two stages?

Although every surgeon may answers this question somewhat differently depending on his work style, but in general, in a case of the need to septoplasty (a corrective surgical procedure done to straighten the nasal septum) due to troubled breathing, if we guess the patient may be willing to do rhinoplasty surgery in the future, it is better to do septoplasty and rhinoplasty saimultaneously. Since, performing rhinoplasty on patients who have already undergone septoplasty by another surgeon is more difficult, and may even lead to somewhat weaker results. However, this is a general comment. Sometimes, the septoplasty can be even postponed until after rhinoplasty only if the nasal septum deviation has not a big impact on nose deviation.

However, in my opinion, it is not a good idea to adjourn rhinoplasty to the time after nasal septum surgery. That is, if the patient requires both surgery, it is often better to do both surgeries in one session.

Please explain about the polyps in the nose and breathing problems.

Nasal breathing problems can have many causes. However, the long-term respiratory problems in the nose are due to two reasons. The more common cause is nasal allergies, which can be accompanied by sneezing and rhinorrhea that sometimes occurs just as stuffy nose. Usually, it is bilateral; but sometimes, one side and sometimes the other side is involved. It often recur seasonally and in warm seasons; but sometimes, it is there all year long. The long term allergy that is not treated well causes the enlargement of redundancies in the nose called nasal turbinates. Allergies should be usually controlled with medication or improved somewhat with vaccination. However, in case of occurring permanent turbinate enlargement complication, drug treatment may not be enough and turbinate surgery would be needed. The turbinates normally exist in the nose and adjust the passage of air through the nose by intermittent shrinking and enlarging as a thermostat to thereby control the quality, humidity and temperature of the air entering the airways. Thus, they alternately keep one nostril in one side more open and the other more closed. One or two hours after, they switch the nostrils, which may be necessary for the intermittent resting of each of the nasal cavities.

However, the patients with nasal allergies should be reminded that although sometimes operating on nasal septum associated with rhinoplasty would have a positive effect on allergies, but allergy mechanism is rooted in the blood cells. In other words, the root of casing nasal allergies is in the blood and they only manifest in the nose. As a result, the surgery does not affect allergy correction. In some cases, it may aggravate allergies for some time after the surgery. Allergies are usually treated with medicine, and the treatment should be done sometimes more powerfully up to a year after the surgery and even longer.

The next most common cause of nasal obstruction is nasal internal septum deviation that usually causes one-sided stuffy nose. It is rarely a bilateral obstruction. However, even in unilateral cases, the patient may be sometimes unable to detect the obstructed side correctly. The treatment of nasal septum deviation is septoplasty that can be done alone or in conjunction with rhinoplasty. Nasal polyps is not a common disease. In addition to surgical treatment, it is usually treated by medicines. However, most patients suffering from internal nasal septum deviation mistakenly think to have nasal polyps. Thus, even the doctors tell those with chronic obstructive pulmonary disease that they have nasal polyps instead of the accurate diagnosis. Perhaps, this common mistake by patients is caused by this issue.

Dose breathing through the nose get worse after rhinoplasty?

Although the nose usually become smaller in rhinoplasty surgical operation, but if the surgery is done carefully and with proper technique, such shrinking does not occur in the air pathway and the breathing would not be affected. However, normally until 1-3 months after the surgery, a small amount of nasal congestion may be existed due to swelling inside the nose, which should be then improved. Otherwise, the problem must be followed up and fixed. In patients with allergic rhinitis, the allergies aggravate sometimes up to a year after rhinoplasty, which may need to take more medicine.

However, the breathing must be improved by using proper anti-allergic drugs. Sometimes, remained deviation inside the nose, and sometimes previous enlarged turbinates or nasal inward movement or escalated turbinates enlargement could be the reason for such obstruction. Rarely, cartilages overlapping may cause such breathing difficulties. All of these rarely occur in hands of a good surgeon, and even if happening, they can easily be fixed. In fact, after a good rhinoplasty, the patient’s breathing condition becomes better than before (of course, after 1 to 3 months) or does not change at all. Worsening is not normal in any way, except in cases of allergies, which can be relieved with medication.