What causes nasal obstruction following rhinoplasty?

Updated: Jul 13, 2021
  • Author: Samuel J Lin, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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As many as 10% of patients have been identified with nasal obstruction following rhinoplasty. [28] A study by Yu et al indicated that more than 60% of individuals seeking revision rhinoplasty experience concerns regarding nasal obstruction and mouth breathing. [29] Obstructive symptoms may be due to nasal valve contraction caused by improper placement of intercartilaginous incisions. [28] Others suggest that inaccurate trimming of the upper lateral cartilage can cause protrusion of the cartilage into the nasal airway, resulting in nasal obstruction. [30] The in-office Cottle maneuver tests lateral displacement of the cheek and can help to diagnose nasal valve obstructions. Improvement of nasal airflow, a “positive” Cottle test, may suggest collapse or obstruction of the nasal valve post-rhinoplasty.

A successful rhinoplasty is both aesthetically and functionally sound. The success of a postoperative external nose is diminished when the patient is unable to breathe through his or her nose. A narrowed supratip area due to overresection of the upper lateral cartilages may cause significant nasal obstruction. [31] The periosteum of the bony nasal vault serves to hold the nasal bones in place after osteotomy. Sachs states that getting the elevation of the periosteum to be exact is crucial. Periosteal elevation should begin 2 mm above the caudal edge of the nasal bones and proceed laterally to the extent that is half the distance of the width of the remaining nasal bones after hump removal.

Osteotomies may be the most destructive portion of the rhinoplasty, so careful planning is crucial. One approach to osteotomy first focuses on the glabellar area. Sachs believes that most glabellar regions do not need narrowing; thus, osteotomies do not have to be carried to their most superior extent in the nasal-frontal suture line. Sachs also states that periosteal elevation should be minimized. Insertion of the osteotome is also important to prevent the formation of scarring of the anterior vestibule; a nasal speculum should be used to retract the nasal vestibule as laterally as possible before insertion of the osteotome along the piriform aperture. As the literature has indicated, osteotomies are relatively contraindicated in patients with short or extremely thin nasal bones. [32]

Helal et al studied the effects of internal and external osteotomies on the internal nasal valve. [33] The authors found that both types of osteotomies cause narrowing of the internal nasal valve, but neither type of osteotomy caused more narrowing than the other.

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