What are the options after 1 Septoplasty surgery and a second one where the entire cartilage was cut out from the nose???

Question

My cousin had breathing problems and she had the septoplasty surgery to fix it. After 2 years and 4 months, the same breathing problems arose and she went back to the doctor. They then decided to cut it out permanently and after 2 years and 9 months she is today having the same breathing problems. What is her next course of action???

Amy K Hsu, MD, FACS · Answer

Dear Vishram Boodoo~

Thank you for your question.  Sometimes patients require revision surgery after septoplasty. It's not clear from your description exactly what was done during your cousin's second procedure, but there are many possible causes of breathing issues after surgery.  There may be a residual septal deviation, scarring inside the nose, enlarged turbinates, or some other area of narrowing around the nasal valves.  It’s not possible to say more specifically without an exam.

I would recommend seeing an ENT or rhinoplasty specialist for a consultation and thorough exam.  It would be helpful if she could bring copies of the operative reports from her prior procedures with her.

Best wishes,
Amy Hsu

Ivan Wayne, MD · Answer

It sounds like your cousin has been having a difficult time with two surgeries and no reflief. There are many causes for nasal obstruction and a deviated septum is only one of them. Patients may experience persistant obstruction after a septoplasty if they have nasal allergies, large nasal turbinates, or the most common reason is the nasal valve is blocked (the sides of the nose). To determine what is going on an evaluation in person by a surgeon experienced with revision rhinoplasty is the best next step. Hope this helps and good luck,

Garrett H. Bennett, MD · Answer

Much of the cartilage may have been removed but the nose will completely collapse if you remove all of the cartilage. The surgeon may have said that he took all of the cartilage he was comfortable taking. There may still be a deviated septum as surgeons will have different tolerances for risk during surgery. There are other reasons for nasal obstruction with the most likely ones being valve collapse and inferior turbinate hypertrophy. Have a consult with a board certified facial plastic surgeon who is also board certified in otolaryngology. They have the highest level of training inside the nose and can advise you on what to do.

Stephen P. Smith, Jr., MD · Answer

I
recommend that your cousin see a board certified facial plastic surgeon who
specializes in functional nasal airway surgery. 
If your cousin still has nasal breathing problems after two
septoplasties, then there may be other issues in besides the septum.  She may have dynamic nasal valve collapse,
enlarged inferior turbinates, sinusitis, enlarged adenoids, nasal polyps, or even an intranasal tumor.  A complete nasal evaluation by a functional
nasal airway specialist can diagnose the problem and recommend the best
treatment.

What are the options after 1 Septoplasty surgery and a second one where the entire cartilage was cut out from the nose???

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