Normal Nasal Airflow
Nasal obstruction is usually the result of anatomic and functional problems, which can cause dysfunctional airflow in the upper airway, therefore playing an important role in OSA and snoring, and also can prevent CPAP use. The cause of nasal airflow problems can be a deviated nasal septum, enlarged nasal turbinates, narrowing or collapse of the nasal opening, nasal polyps, swollen nasal mucosa due to allergies or other irritants or commonly a combination of all.
Usually medical treatment options are the initial choice to target nasal obstruction, including nasal saline irrigations, steroids and antihistamine sprays, oral medication and an allergist evaluation. External nasal dilators as the Breathe Right® nasal strips can be used for some cases with narrowed or collapsible nasal aperture.
When medical treatment alone isn’t successful, surgery can improve the nasal airway either alone or in combination with these options. The most common nasal procedures include turbinate reduction and correcting any septal deviations (septoplasty). Sometimes correction of external nasal deformities (rhinosseptoplasty) or sinus surgery will be necessary and it may be performed in combination with one of our colleagues from the rhinology or facial plastic surgery team. Nasal surgery alone rarely successfully treats OSA. However, it usually improves sleep quality and CPAP adherence and compliance.
Turbinates: Normal and Abnormal Comparison
Turbinates are small structures inside the nose that cleanse and humidify air that passes through the nostrils into the lungs. They are made by a bony structure surrounded by vascular tissue and a mucous membrane outside, and can become swollen and inflamed by allergies, irritation or infection, causing nasal obstruction and producing an excessive amount of mucous which leads to congestion.
Radiofrequency Turbinate Reduction is a procedure in which a needle-like instrument is inserted into the turbinate and energy is transmitted to the tissue to cause a controlled damage, so by the time healing process occurs, the turbinates will be reduced, allowing improved airflow through the nose. It is an office procedure, performed under local anesthesia, and it takes about 10 minutes. Usually there’s no pain on the recovery process, no change on the physical aspect and no long-term side effects, such as loss on olfactory perception. The patient should be aware that he/she will have crusting on the nose for approximately 3 weeks. We recommend frequent use of nasal saline irrigations and use of antibiotic ointment during this period of time. There is a slight chance that the turbinates can get bigger again overtime, making another Radiofrequency procedure necessary.
We recommend 1 day out of work and 2 days without strenuous exercising after the turbinate reduction. Although rare, risks include bleeding and infection, and should be taken into consideration.
Airflow After Turbinate Reduction
Sagittal View of Septum
The septum is a structure made of bone and cartilage in the central portion of the nose that separates one nasal cavity from another. When the septum is deviated, it can block one side of the nose and significantly disturb airflow. Septoplasty attempts to straighten the septum as much as possible in the midline position and open the airway by removing the deviated portion and restructuring of the remaining bone and cartilage. Septoplasty is an outpatient procedure performed under general anesthesia. Risks associated may be infection, septal hematoma, perforation and bleeding.
When the septal deviation is more complex, or there is an associated deformity on the nasal external portion or nasal valve, a rhinosseptoplasty may be required to achieve adequate nasal breathing and we may request the expertise of our colleagues in Stanford's Facial Plastic Surgery division for some of these cases.
If the septal deviation is located in the more external portion of the septum, frequently a piece of a donor rib cartilage needs to be utilized in order to stabilize the nasal tip and preserve the external shape of the nose.
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