Some time ago, we discussed the nasal airway and ways to improve air flow. We covered both over-the-counter and prescription medications to help you breathe better. We presented both allergy shots and surgery to maximize the amount of air passing through your nose. Each of these treatments can have a positive impact on your quality of life. Nasal surgeries, such as septoplasty and turbinate reduction, significantly improve nasal airflow, but what if you need more? What if you’re looking to go from good to better? What if you still find some nasal congestion despite the primary treatments? Fortunately, there’s an answer. Several tweaks exist to gain even more room in the already improved nasal airway. Like the main surgeries, none of these tweaks change the outside appearance of your nose.
The first principle to understand is that your nasal airway is only as good as its narrowest point. If surgery fixes the narrowest point, the next narrowest point becomes the site of obstruction. If the next narrowest point can be identified in advance, it can be addressed during the primary surgery. However, sometimes, the next narrowest point doesn’t present itself as a problem until after the narrowest point is fixed.
Most of the time, treating your allergies will solve the problem. Shrinking the membranes and reducing the mucus will help you breathe around the obstruction. The turbinate bone is usually removed during the primary surgery, but sometimes the soft tissue still causes obstruction. This can be reduced with radiofrequency. It is significantly easier than the primary surgery, and it doesn’t require packing your nose. The procedure can be done in the operating room or in the office, depending on what is more comfortable for you.
The second principle to understand is that air must get into your nose before you can breathe it. Straightening a deviated septum increases the diameter of your nasal cavity, but it doesn’t address the nasal valve. So, what’s the nasal valve? Basically, it’s your nostril. When you inhale, the subsequent vacuum can collapse your nostril, if it doesn’t have adequate support. The cartilage around your nostril usually keeps your nasal valve from collapsing, but sometimes the support is weak. This causes your nostril to pinch together and block your nasal airway.
The best way to diagnose nasal valve collapse is through the Cottle maneuver. If pulling gently on your face next to your nose in the upward and outward direction helps to improve your nasal airway, then repairing your nasal valve is likely to help. External nasal strips can be beneficial, but they must be changed every night.
Surgery to repair the nasal valve can be done as a tweak to the primary surgery without packing your nose. It can also be performed at the same time as the primary surgery if the problem is identified in advanced. Previous techniques required harvesting cartilage from the ear to support the weak cartilage around the nostril. However, the latest advancement involves the injection of a small, dissolvable implant, placed inside your nostril and beneath the skin of your nose. The procedure is minimally invasive, and the implant is unseen from the outside. After it dissolves, fibrous tissue continues to support your nasal valve preventing collapse. The technique is exactly what we needed to make the nose great again!