AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 8

Although surgery readily corrects the nasal obstruction and may reduce chronic sinusitis and head- aches, studies have shown that correction of the nasal obstruction rarely cures sleep apnea, but it may improve tolerance of use of a continuous positive airway pres- sure machine. When the obstruction involves the nasal pyramid, it may be corrected by rhinoplasty . Rhinoplasty involves controlled chisel cuts of the bones (osteotomies) on either side of the nose and placement of the bones into the correct position. A splint is used to hold this posi-

50

Figure 8.4. View of the nose of a patient with a deviated nasal septum. Note that the cartilaginous septum extends into the right nostril, resulting in impaired airflow. Most septal deviations are not as dramatic as this, and can be visualized only with rhinoscopy.

tion for a week after surgery. Rhinoplasty can be combined with trimming of the nasal cartilage to subtly change the contour of the tip of the nose. When the obstruction involves the softer, cartilaginous middle third of the nose and/or the nostril openings, then nasal valve repair may be indicated. This surgery may entail placing cartilage grafts to widen or strengthen the lateral wall of the nasal cavity to relieve the nasal obstruction. This surgery can be performed concomitantly with a septoplasty or rhinoplasty.

Inferior turbinate hypertrophy is another common cause of nasal obstruction (Figure 8.5). While normal turbinate function is to warm, filter, and humidify inhaled air, edema or hyper- trophy of the turbinate will cause nasal obstruction. The hypertrophy can be mucosal, osseous, or both. Mucosal turbinate hypertrophy is associated with nasal inflammation from allergens, infections, or other environmental factors, and may improve with topical decongestion. Osseous hypertrophy does not change with topical deconges-

Figure 8.5. Right turbinate hypertrophy. The enlarged turbinate is in contact with the septum, causing nasal obstruction.

tion. Medical treatment consists of treating the underlying cause with topical nasal steroids, decongestants, or antihistamines. Surgery, usually

Primary Care Otolaryngology