Breathing Problems

No rhinoplasty should be performed without at least considering improving or maintaining a good nasal airway.  Many older rhinoplasty techniques will interfere with one’s breathing and may cause stuffiness, but there are a variety of techniques that can be performed during surgery to maintain or improve breathing.  What is often attractive for the nose is also often good for breathing. Many patients are unaware that their septum is crooked and affecting their airway on one side.  It is an important part of rhinoplasty to make the septum straighter when the opportunity arises as it often does.  Dr Hubbard performs works on the septum in almost all rhinoplasty cases.
 
We must recognize though that many other factors play a role in breathing ability through the nose. The most sensitive and important anatomic location for ease of breathing is the internal valve area.  The septum only makes up one of its borders.  The location is a little less than half way up the nose in the middle of the nasal bridge and below the bony area of the nose. The internal valve is extremely sensitive to even a little swelling.  It is the narrowest part of the airway from the tip of the nose to the base of the lungs.  The internal valve area is extremely sensitive to any change and one can recognize this by using “Breathe Rite” strips as this is where they typically work.  Who would have believed 20 years ago that adhesive tape strips on the outside of the nose could actually improve breathing?  This is a testament to the sensitivity of the internal valve area.  Anytime a rhinoplasty affects the bridge of the nose height or width, the internal valve is affected.  There are maneuvers such as spreader grafts and sutures that reconstruct the cartilage attachments which maintain a good passage in the internal valve region.

There should always be consideration of the size and position of the turbinates at the time of rhinoplasty.  These are swellings along the side walls of the nose.   They swell greatly during upper respiratory tract infections or colds.  They can have chronic swelling, which affects breathing causing problems such as allergies.  The turbinates are easily addressed with partial removal or cautery.  This can greatly improve breathing in some individuals.  Other factors that affect breathing must be kept in mind during the rhinoplasty evaluation, planning, and execution.  Another such example is the tip dropping down with age.  This can have a subtle or profound affect on the airway and is easily corrected during rhinoplasty.  It is another example of how you can improve the appearance of the nose at the same time you improve breathing. Occasionally improved breathing adds width to an area of the nose that the patient is familiar with being quite narrow.  This situation requires more discussion in the consultation process to consider what the options are and the pros and cons of each.