Rhinoplasty and Turbinate Woes

Patients sometimes see rhinoplasty specialists because they have breathing problems and may require surgery inside the nose.

Typical breathing problems are usually caused by one of two things:

• A deviated septum, the wall that separates the nostrils
• Imperfect turbinates

Turbinates are long, narrow structures made of spongy bone inside the nose. Also known as nasal concha, turbinates have a number of functions, including:

• Good breathing
• Playing a role in immunological defense
• Keeping the olfactory receptors (for your sense of smell) working

But if the turbinates swell too much, your breathing may be blocked. The swelling can be caused by:

• Allergies
• Irritants in the environment
• Persistent infection in the sinuses
• Disease

The actual function of turbinates is to swell and subside many times  during the day to change the size of the air pathway.  Turbinates even cause you to roll over in your sleep!

In some cases, nasal surgery on the turbinates is done. But due to their role in breathing, only small amounts should be removed.

However, if the surgeon is too aggressive, a separate condition known as “empty nose syndrome” can be created.

Results?

Affected patients frequently complain about chronic dryness, stuffiness and a congested feeling in the nose, along with breathing difficulties and, sometimes, a feeling of not being able to get enough air into their lungs.

Others complain of burning, crusting and pain inside the nose.

Difficulties sleeping may crop up, too.

Empty Nose Syndrome (ENS) happens often enough that a self-help website, EmptyNoseSyndrome.org, was created in 2005.

The website offers a forum for Empty Nose sufferers along with information from plastic surgeons who specialize in the condition. And yes, treatments do exist for ENS.

We’ve often said that rhinoplasty is one of the most difficult surgeries for surgeons to learn and master due to the complexity of the human nose.

So checking your surgeon’s training, credentials and certification is more important than ever.

ENS is just one example of why.
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Insomnia Sufferer Didn’t Know He Needed Rhinoplasty

The first doctor missed something in his nose.

If you’ve followed any of the California Surgical Institute blogs, you know we recommend using well-trained, board-certified surgeons.

No, not to pump up their business but to protect your own bottom line.

Using a doctor who doesn’t fully know or understand what he or she is doing can be really, really expensive due to:

• Repeat surgeries and hospital costs
• Time lost from the job

The cost of a rhinoplasty going for $6,000 can cost three times that much if the job is bungled.

Even after all the extra training, (four to seven years after medical school!) it can take years to fully understand nasal anatomy and how a nose heals over time after surgery.

Thanks to all the extra training and experience, a board-certified plastic surgeon or head and neck surgeon with many years experience not only knows all the complications that crop up, he or she knows how to treat them.

Never was that situation better demonstrated than in the case of “Doigy” who moved to a new location near the sea in England and found he had massive trouble breathing through his nose.

Eventually, Doigy, a 33-year-old Scottish teacher, went to see a doctor who found our lad had nasal polyps and performed a minor operation to remove them. Then, Doigy moved back to Scotland where he and his wife had two children.

By the time the kids were five and six, Doigy started wondering why he still could not sleep, had constant sore throats and “grotty” morning mouth.

His brothers also had nasal woes so he, Doigy, figured something was still wrong with his schnooze.

When Doigy went to see a fully trained nasal surgeon, he learned he had a deviated septum (the wall of cartilage that separates the two nostrils) and that only one worked. No wonder breathing while sleeping was tough!

The first physician — who had to be competent to hold his job in Britain’s National Health Service — completely missed the deviated septum.

What’s next?

Nasal surgeons have two basic marching orders:

• Provide a functional nose, i.e., one the patient can breathe through
• Provide an attractive nose that fits into the patient’s face

Doigy is now scheduled for surgery to straighten the septum and trim away some nasal bone.

Doigy’s blog follows his nasal surgery.

For Sinusitis: the Balloon Sinuplasty

The nose can cause some serious medical woe.

Sinusitis, one of America’s largest health problems, is endured by some 37 million people each year. That’s about 16 percent of the adult U.S. population.

But, interestingly, the sinuses themselves are rarely diseased. The culprit is more likely to be inside the nose where the sinuses become infected because they don’t drain properly.

The blocking is often due to structures inside the nose being bent or twisted due to accidents or simply the way a patient was born.

You’ve probably heard of a deviated septum. The septum is a thin wall separating the two nasal passages. If it is bent, crooked or twisted, airflow to the sinuses can be blocked. (Correcting only the septum will not make the nose look better.)

Other nasal structures inside the nose can react and swell because they are sensitive to allergies or other environmental insults like cigarette smoke or mold.

For years, one of the most common treatments has been relieving the blockage between the sinuses and the nasal passages by removing from inside the nose some very small pieces of bone or tissues.

Now, a new treatment has been approved by the FDA.

Known as Balloon Sinuplasty, the technique uses a small catheter which the nasal surgeon or otolargyngologist (a specialist in surgery of the head and neck) inserts into the nasal passage at the point of the blockage. Then he or she gently inflates a tiny balloon device which pushes the blockage away to restore normal draining.

But if you’re looking for a more attractive nose, balloon Sinuplasty alone won’t change its appearance.

(Read more about rhinoplasty and see some before and after nose surgery pictures.)

A 2006 Australian study printed in a profession journal for surgeons described the procedure used on 10 patients. The researchers found the technology appears to be safe and effective.

However, scientists (plastic surgeons are also considered scientists) want to see the results of a new procedure performed on hundreds  or thousands of patients before fully backing it.

So for some plastic surgeons, the jury might still be out.