Nasal Obstruction and Rhinoplasty: A Focused Literature Review

Abstract

Background There is a significant variation in the assessment, treatment, and outcomes of nasal airway obstruction and management in the published literature. This study aimed to: (1) define key components of the nasal airway, (2) identify frequent causes of nasal obstruction, and (3) review existing treatment methods. Methods A systematic review of the literature was performed, and 135 studies were included via the following criteria: English, human subjects, and a primary endpoint of nasal airway improvement. Exclusion criteria were: abstract only, no airway data, pediatric patients, cleft rhinoplasty, sleep apnea, isolated traumatic nasal reconstruction, and cadaveric-only or animal studies. Results The relevant obstructive sites include the ENV, septum, inferior turbinates, INV, and nasal bones. Addressing the alar rim alone may be insufficient, and inspection of the lateral wall and crura may be indicated. Correction of septal deviation involves attention to the bony base. Mucosal sparing treatment of inferior turbinates improves outcomes. INVs are a major source of nasal obstruction, and treatment includes spreader grafts. The bony nasal vault can contribute to nasal obstruction, including due to surgical osteotomies. Conclusions Anatomic causes of airway obstruction include the alar rims and lateral nasal walls, deviated nasal septum, inferior turbinate hypertrophy, decreased INV angle, and narrowed nasal bones. Treatments include graft placement; septoplasty; mucosal sparing turbinectomy; and lateral wall support. Pitfalls include failing to address the bony septum, over-resection of inferior turbinates, and narrowing of the nasal vault. Appreciation of airway management during rhinoplasty will improve functional outcomes.

Allergic rhinitis improvement after septorhinoplasty in a sample of allergic rhinitis patients with septal deviation: a quasi-experimental study

“…Independently of the AR diagnosis, previous studies with different objective and subjective methods have demonstrated that a general improvement in nasal obstruction is achieved after STP. 8,9,11,[18][19][20] The results regarding determination of AR as a predictive factor for less improvement in STP have been contradictory in recent studies. Mondina et al studied 100 patients after STP, among whom 28 presented AR, using the NOSE and RhinoQoL questionnaires before and after surgery.…”

“…Independently of the AR diagnosis, previous studies with different objective and subjective methods have demonstrated that a general improvement in nasal obstruction is achieved after STP. 8 , 9 , 11 , 18 , 19 , 20 …”

Asymmetry of inferior turbinate in patients with nasal septum deviation and its significance for nasal ventilation surgery

“…NSD is the most common structural anomalies of the nasal cavity [5][6][7][8]. Nevertheless, the change of the sinonasal structure, which includes the MT, IT, nasal septum, anterior ethmoidal complex, uncinate process and nasal septal body, are also very common [12][13][14][15][16][17][18][24][25][26][27].…”

Nasal Obstructive Syndrome: a mini-review

“…Se deberá llevar a cabo un examen físico del paciente, principalmente del sistema respiratorio superior: oídos, nariz y garganta. (22) La exploración física se acompañará de un minucioso estudio de su historia clínica o Anamnesis, que incluirá una serie de preguntas, como son: (22) • ¿Cuándo y cómo comenzó la congestión nasal?…”

“…Es frecuente observar en estos pacientes la escoliosis y el pie plano. (15,22) Las características físicas comunes de estos pacientes se conocen como síndrome del respirador bucal o de disfunción respiratoria, y sus características típicas son: (25) 1. Fascie típica con expresión de angustia (ojeras, ojos caídos, ojos enrojecidos, cara alargada, surco geniano y nasolabial marcados).…”