Other Nasal Procedures
ANATHOMY OF THE NOSE RHINOPLASTY (NASAL SURGERY)
A septoplasty or sometimes referred to as a “submucosal resection” or “SMR” refers to straightening out the septum. This requires lifting the lining of the nose off the septum and removing or carving the underlying cartilage and/or bone. A light nasal dressing is placed in the nostrils and is removed the following day. Sometimes, a septoplasty may be performed to obtain cartilage for grafts if a rhinoplasty is performed. If only a septoplasty is performed,there is no external evidence that surgery has been done. There is no external bruising or swelling. All incisions are inside the nose, and dissolvable sutures are used so none have to be removed. There is typically very little pain involved. There is more discomfort for the first week since there is swelling inside the nose. Sometimes one may experience temporary numbness of the upper teeth.
There are numerous ways to reduce the size of the turbinates. Dr. Liu has been using recent technology involving radiofrequency to shrink them – this results in less pain, less crusting in the nose, and faster recovery.
Evaluation is primarily made by physical examination. X rays may show a nasal bone fracture, but often this does not change the management. Most fractures that are not “displaced” (pushed from the normal position) do not require any special treatment. Immediately, ice should always be placed to reduce swelling. Bleeding often occurs but resolves on its own within a short time.
There are two time points that surgery, if needed, can be considered. The first is within roughly 10 days after the injury. The bones have not yet healed in the “wrong” place and can be reset during this time. A “closed reduction” can be performed which involves manipulation of the bones under light anesthesia followed by a nasal splint or cast for one week. A light intranasal packing is placed for 1-2 days. An initial closed reduction can only be performed if there is minimal swelling so that the surgeon can adequately assess if the fracture has been returned to its normal position.If there is a significant amount of swelling initially, then surgery often must be delayed because it is difficult to judge exactly how the nose really looks. Also, if there is a significant deformity inside the nose (such as a severely twisted septum) often it is best to wait for a more formal surgery. The second time point would be to wait at least 3 months to completely allow for all swelling to resolve and allow any fractures to heal.
An “open reduction” can then be performed. This is a more involved surgery which requires more manipulation of the nasal bones. Postoperatively, swelling and bruising can be expected for about 1 week. Again, a cast or splint is worn for 1 week. Any internal deformities can be addressed at the same time and often a septoplasty will be performed at the same time. Deeper anesthesia is often required. Success is overall higher with open reductions but then again the procedure is more involved.
There is a complex relationship between the nasal bones and nasal cartilages. Often simply repairing the bones is not enough, and an open reduction becomes essentially a formal rhinoplasty.
ENDOSCOPIC SINUS SURGERY
The basic premise of sinus surgery is to open the drainage pathways of the sinuses since they all empty into the nose. It is not to go into every little sinus air cell. Again, the sinuses function properly when air is able to constantly circulate in and out. Technology is at a point today where the entire procedure can be performed through special telescopes and instruments entirely through the nostrils (endoscopic approach). There are no external incisions, and there is no change in appearance to the nose. There is no external bruising or swelling. All incisions are inside the nose, and dissolvable sutures if necessary are used so none have to be removed.The procedure is typically performed under general anesthesia. A Cat Scan (CT) of the sinuses is essential before surgery to determine the extent of the disease and the exact layout of your individual sinus anatomy. There is typically very little pain involved. There is more discomfort for the first few weeks since there is swelling inside the nose. After the surgery, you will be advised to keep the inside of the nose moist with salt water nose sprays and ointment. You will be seen as often as necessary to clean out the nose in the office – maybe even once a week for the first few weeks. The post-operative care is equally as important as the surgery in obtaining a good result
Age. Children – There is no one specific cutoff age to perform nasal surgery. The reason why most surgeons wait until at least the mid to later teenage years is because the middle of the face and nose is a center of growth for the entire face. Therefore, manipulation of this area should only be performed after one has finished most of his or her growing. As a general rule, if the person has not had any changes in height or shoe size over 2 years, then surgery may be undertaken. Often nasal obstruction in children occurs secondary to increased adenoid tissue. The adenoids are tissue located in the most posterior potion of the nose. It is similar to the tonsils but instead of in the back of the mouth, it is located in the back of the nose. If enlarged, the adenoids may block nasal breathing. Usually the adenoids shrink by age 10 in most but not all children.
Ethnicity. It is important to consider one’s heritage when analyzing the nose. Facial features in general vary depending upon gender and race. Again, the primary goal is to achieve harmony and symmetry with the other facial features.