Thank you for the helpful information to my earlier question of whether or not the lower side bones can be brought in medially towards the dorsum of the nose. I was wondering if this proc edure changes the airway size in any way or impacts breathing ability?
Does Bringing in the Side Lower Bones of the Nose Affect the Airway in Any Way?
Doctor Answers (6)
Reduction rhinoplasty affects nasal airway
Narrowing the nose by moving in the nasal bones towards the middle (lateral osteotomies) is an important and frequently used part of the surgical treatment plan to improve nasal appearance, especially after hump reduction. The nasal bones are attached to the upper cartilages of the nose and so they are also narrowed with this procedure. The internal nasal valve is narrowed, causing additional airway resistance in the valve. There are compensatory maneuvers that can also be performed to minimize this effect, notable cartilage (spreader) grafts to widen the nasal valve at the upper cartilages. Your experienced rhinoplasty surgeon will discuss this with you and have you consider how rhinoplasty that will make your nose better looking may somewhat impair your nasal breathing.
Nasal airway and manipulation of nasal bones
What you are referring to is called a "lateral osteotomy" done to narrow a "wide nose" and also done to correct what is known as an "open roof" deformity, which is resultant after e.g. removing a nasal hump and having an underlying defect (that is closed by moving the nasal bones together). Normally this does not affect the nasal airway, but it can. I would recommend a thorough discussion with either a plastic surgeon or ENT specialist to discuss these issues. If it is felt that the osteotomy might affect the nasal airway, it is often possible to alleviate this problem at the time of surgery ( usually with the use of what are called "spreader grafts" ) intended to maintain the "respiratory valve" inside the nose which could be affected by the osteotomies.
Lateral Osteotomy, Airway Narrowing, and Spreader Grafts
Lateral osteotomies are performed to reduce/close an open roof deformity following dorsal hump reduction. In many situations this can be done without any airway compromise.
Attached to the caudal (lower) edge of the lateral nasal bones are the upper lateral cartilages. The upper lateral cartilages will move with the nasal bones following lateral osteotomy. Thus, as the lateral nasal bones are moved medially, the upper lateral cartilages move medially as well; this can narrow the airway, either by physically reducing the size of the passage, or by reducing the internal nasal valve angle.
The internal nasal valve is the caudal (lower) edge of the junction of the upper lateral cartilage with the septal cartilage -- it is where the lower edge of the medial portion of the upper lateral cartilage meets the (dorsal) septal cartilage. Sounds confusing, I know; but can be easily diagramed by your surgeon. The angle between the upper lateral cartilage and the septum is referred to as the internal nasal valve angle; normal is about 20 degrees.
Minimal changes in the internal nasal valve angle can have significant changes in our subjective sensation of good air flow vs. obstructed air flow. About half way between the nasal tip and the lower edge of the nasal bones, very gently/minimally pinch the dorsum of your nose. With even minimal pinching you sense a change in air flow; although the actual flow has not changed much, you perceive a significant reduction in flow. You may experience a similar sensation with deep inspiration through the nose, if the internal nasal valve angle collapses medially and narrows.
Lateral osteotomy can narrow this internal nasal valve angle. This narrowing can be prevented by the use of cartilage spreader grafts. This is a strip of cartilage placed along each side of the dorsal edge of the septum to stent and strengthen the internal nasal valve angle. A decision to use spreader grafts is made based upon your examination, amount of air flow present, and history of reduced/obstructed flow.
Have your surgeon discuss his findings and plans with you so you understand what is going to be done and why. Best wishes.
Web reference: http://www.drdembny.com/
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Lateral osteotomies are necessary to close an open roof deformity. It should not affect the airway significantly.
Narrowing the nasal bones and the nasal airway
When the nasal bones are narrowed you do run the risk of compromising the nasal airway. Essentially you are making the area smaller through which you are breathing. Depending on the amount of narrowing that is perfomed, you may have a sense of a tighter or more obstructed airway. Because the nasal bones are also attached to the cartilages just below them, as the bones are narrowed, they can bring in the upper lateral cartilages as well. This also can contribute to obstruction. It is important to know the details of what is to be done and how it is done to know for sure if your airway will be compromised with reductive rhinioplasty. There are techniques to prevent airway collapse and narrowing and you should discuss them in detail with your surgeon. Good luck.
Performing lateral osteotomies to bring in the sides is almost mandatory to close the open roof created by hump removal. If done properly there should be no problems
Web reference: http://www.drbray.com
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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