Breathe Easier, Look Better

Nasal obstruction is a common complaint of many patients in the primary care sector.

While most cases can be treated with medications such as antihistamines or nasal sprays, some patients require special attention, especially those who have a ’crooked’ nose and underlying nasal septal deviation. In this article, we explore a case study of the surgical options available for a patient with a blocked nose.

Jennifer (not her real name) is a young, fit office worker who has a stable job and enjoys cycling during weekends. She has symptoms of runny and blocked nose on most days of the week and finds no alleviation of her symptoms, despite the regular use of nasal steroids. She has always noticed that her nose looked ‘crooked’.

 

Upon diagnosis, Jennifer has both allergic rhinitis (AR) as well as nasal septal deviation, which are very common conditions. Approximately 10-20% of the global population suffers from AR. Studies have found that the prevalence of deviated nasal septum (DNS) ranges from 20% in children to 90% in adults.

Treatment

Most patients with AR and DNS can be managed successfully with nasal steroids, oral or topical decongestants. However, there are a significant number of patients like Jennifer who need surgical intervention, as they have a significant septal deformity or may have other associated problems such as inferior turbinate hypertrophy or nasal polyps.

As with all young people, Jennifer is very tech savvy and familiar with beauty trends via social media avenues such as blogsites and Instagram. Like most young adults inundated with pictures of friends and celebrities, she feels the pressure to look good. She is keen to improve her breathing and is also concerned about how septorhinoplasty can help her look better.

Septorhinoplasty can be performed to:

  • correct nasal septal deviation
  • straighten the bridge of the nose
  • increase or reduce the height of the tip of the nose
  • reduce a bony or cartilaginous hump
  • narrow the nostrils
  • refine the tip of the nose

After a thorough consultation and analysis of the facial and nasal structures, the surgeon will determine the areas of deformity, the cartilaginous support of the patient’s nose as well as aesthetic ideals.

To achieve the cosmetic and functional goals, grafts are often needed to provide structural support and augmentation. The grafts can be harvested from the nasal septum, ear cartilage or rib cartilage. Allogenic grafts and alloplastic implants can also be used. The surgeon will discuss the choice of using grafts or implants with the patient extensively before a decision is made.

With more otolaryngologists trained in facial plastic surgery in Singapore and various parts of the world, more patients can look forward to achieving their functional and aesthetic goals.

Condition  Management
Deviated nasal septum (DNS)   Septoplasty or Septorhinoplasty
  • Septoplasty is a surgical procedure that is done to correct DNS, without changing the external appearance of the nose.
  • Septorhinoplasty corrects DNS and can also alter the framework of the nose, thereby improving the appearance of the patient. It can either be functional or cosmetic.
 
Inferior turbinate hypertrophy   Turbinate reduction procedures or partial excision
Nasal polyps   Medical treatment with oral/topical steroids or functional endoscopic sinus surgery

 

Dr Valerie Su-Lin Tay is an Associate Consultant in the Department of Otorhinolaryngology at Tan Tock Seng Hospital. She completed her undergraduate studies and otorhinolaryngology training in Singapore. To pursue her interests in facial plastic surgery, she completed a one-year fellowship in Navi Plastic Surgery Clinic, a high volume cosmetic surgery clinic in Seoul. She has experience with fillers, endonasal rhinoplasty, blepharoplasty as well as facial bone surgery.