Why Is a Nosejob Sometimes Necessary to Resolve Nasal Obstruction?

A very common complaint for a patient to see an ENT surgeon is to resolve nasal obstruction. The most common surgeries to resolve nasal obstruction include septoplasty, adenoidectomy, and turbinate reduction. All of theses procedure are performed within the nasal cavity and does not affect appearance.

However, sometimes in order to resolve nasal obstruction, the appearance of the nose MUST change especially if the nostril openings are very narrow. By looking at these example pictures of the nostril openings, it's pretty obvious that breathing would be an issue. So even though a nosejob is typically performed for cosmetic reasons, it may also be recommended for medical reasons should nasal breathing be inadequate.

For both these patients, the nasal columella is crooked to one side resulting in one nostril opening being larger than the other which causes nasal obstruction on the more narrow side.

Correction of this crooked nasal columella into a straight and midline appearance would result in improved nasal breathing as well as a change in appearance.

Sometimes the nasal columella may be straight, but the nostril openings are both too narrow leading to nasal obstruction. Correction would require enlarging the nasal opening by use of alar batten and spreader grafts which would result in not only improved nasal breathing, but also a wider nasal appearance overall.

The explanation for why the nasal appearance does not change especially after septoplasty which requires cartilage and bones removal is actually quite simple. The analogy would be a house where the appearance on the outside would not change even though you may knock down a wall between two rooms inside the home.

SO... Here is a side view of the septum. The blue arrow is pointing to the nostril opening and the red arrow is pointing to the lip.

In this picture below, the septum has been removed.

As you can see, the outside appearance of the nose remains unchanged as the rim of the nose is kept intact as shown by the red arrows here:

So that in a nutshell is the explanation for why deviated septum surgery does not change the outside nasal appearance.

Read more about the septoplasty surgery here.

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Actress Jennifer Aniston Underwent Septoplasty Twice

Though not entirely recent news, actress Jennifer Aniston reportedly underwent septoplasty nasal surgery not just once, but twice. The first was done in 1994 and a revision septoplasty was performed in January 2007. [link] [wiki]

This type of surgery is performed to help improve nasal breathing, an issue that Jennifer Aniston apparently had.

Septoplasty, unlike rhinoplasty or nosejob, does NOT change the outside appearance of the nose. All the work is done internally. (Watch video here).

The explanation for why the nasal appearance does not change after septoplasty is actually quite simple. The analogy would be a house where the appearance on the outside would not change even though you may knock down a wall between two rooms inside the home.

SO... Here is a side view of the septum. The blue arrow is pointing to the nostril opening and the red arrow is pointing to the lip.

In this picture below, the septum has been removed.

As you can see, the outside appearance of the nose remains unchanged as the rim of the nose is kept intact as shown by the red arrows here:

So that in a nutshell is the explanation for why deviated septum surgery does not change the outside nasal appearance.

The way the deviated septum itself is removed can be more simply understood looking at the nose from a different vantage point.

Step 1: A small incision is made inside the nose and the mucosal lining carefully lifted away from the septum on one side. It is during this stage of the procedure that one of the complications of the procedure, septal perforation, may occur. This complication occurs when the lining gets torn resulting in a hole as the mucosa is lifted away from the septum.
Step 2: The septum is incised immediately in front of the deviation and the nasal mucosal lining is lifted away from the septum on the opposite side.
Step 3: The deviated septum is now physically removed. One removes the deviated septum completely instead of forcing it into a midline position. Why? Because just like a young tree sapling, the nasal septum has "memory" and bending or forcing it into a certain position will last only temporarily before it springs back into its original position.
Step 4: The nasal mucosal lining is reapproximated in the midline. There are several methods how this last step is performed. One method is to suture the lining back together like a quilt (NO nasal packing or septal splints are used). Occasionally, the nose is packed with septal splints or nasal packing material. Both methods are used in our practice depending on the physician and the condition of the septum itself.

Read more about the septoplasty surgery here or watch a video!

Source:
The one where Jennifer Aniston Fixes Botched Surgery. PopSugar 6/7/10

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Stabbing Headache Around Eye or Cheek

Do you suffer from a stabbing headache in the areas denoted in red? Do these headaches seemingly come out of nowhere one day? Perhaps started after a viral upper respiratory infection?

You may be suffering from a condition known as contact point headache. This type of headache is also known as:

• Sluder's neuralgia
• Anterior ethmoid neuralgia
• Sphenopalatine ganglion neuralgia
• Pterygopalatine ganglion neuralgia

This type of headache has often been confused with cluster headache, migraine without aura, sinusitis, or other undefinable pathology especially since CT scans and MRI scans that are obtained often do not reveal any tumor or presence of infection.

Click here for more information.

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Why Does the Nose Whistle in Some People?

Though most people like the professional nose whistler shown here require an instrument to enable the nose to whistle, in others it occurs naturally due to unique anatomic features within the nose.

Why might someone's nose whistle?

Septal Perforation

The most common reason it may occur constantly is due to a hole in the septum (septal perforation). The septum is a wall that divides the right nasal cavity from the left side. Normally, it should be straight and without any openings.

However, when a hole is present in the septum and it is in just the right size and place, whenever air is breathed in and out the nose, it will whistle. In this situation, the hole is the "window" of the whistle and the nose itself is the mouthpiece.

Correction of this problem is by either closing the hole (septal button or surgery) or making it bigger such that the aerodynamics eliminate the conditions conducive to nasal whistling. As an FYI, surgical correction of a septal perforation is quite difficult.

Septal Deviation and Some Nasal Congestion

The other situation when the nose may whistle, but only intermittently, is when there is a deviated septum. In this scenario, the septum rather than being straight, it is slightly crooked to one side making one side more narrow than the other.

Add some slight swelling of the nasal lining such that the opening of the nose is restricted to just right size and shape, and it may whistle.

This type of nasal whistling is akin to grass whistling (blowing between two thumbs holding a blade of grass).

Thankfully, the nasal conditions that lead to nasal whistling is quite rare and requires the perfect storm of just the right amount of septal deviation with just the right amount of nasal congestion.

As such, correction of this problem is fairly easy as one needs to change either the congestion causing the nasal lining to swell with a nasal spray or anti-histamine OR fix the deviated septum. If the inferior turbinates are enlarged, they can be reduced in size as well.

Of course, one can take this unusual condition and make it a positive feature worthy of a concert hall... WITHOUT the assistance of any instrument!

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