Nose Anatomy - Airway Obstruction

Entire books have been written about the different causes of airway obstruction. I will go over the essentials of what you need to know, so you are able to explain what you want corrected to your plastic surgeon.

If you have trouble breathing it is critical that you convey this to your surgeon; otherwise, it may go untreated. Not being able to breathe comfortably through your nose can be a torture. The amazing thing is you do not realize how uncomfortable it is until it is corrected.

Breathing comfortably through your nose is one of life’s unspoken pleasures. A person with an airway obstruction does not know this pleasure.

Different parts of the nose anatomy can combine to create this discomfort. Airway obstruction can be divided into two basic groups.

1. Those treated with surgery,
2. Those treated non-surgically; usually with medications

From a rhinoplasty standpoint, we are primarily concerned with the surgical issues. Far and away, the two most important surgical issues are deviated septum and enlarged turbinates.

It is not within the scope of this review to review in detail the causes for airway obstruction. However, I do feel it is very important for my patients to have a basic understanding of why they are having a difficult time breathing. This empowers them to understand exactly what is necessary to open their airway so they can breath normally.

Mechanics of airway obstruction simply demonstrate:

1. Normal Airway
2. Deviated Septum
3. Enlarged Turbinates

Treatment of Airway Obstruction Caused by Deviated Septum

When a plastic surgeon examines a deviated septum he has two issues that must be considered. One is the cosmetic concern and the other is the breathing concern. Often, deviated septum does NOT cause any airway problems and, therefore, does not need to be corrected. Somewhat along the lines of: “If it’s not broke, don’t fix it!”

If a deviated septum is causing obstruction than it needs to be treated. The most common treatment is to remove the portion of the septum that is causing the problem. Fortunately, the part of the septum that is responsible for most airway obstructions is not necessary and can be removed without causing a problem.

Profile view of the septum. The red area shows the most common area of airway obstruction

Septoplasty. Removing the deviated septum often corrects the airway problem

The two pictures above show the septum in profile. Keep in mind the septum is like a straight wall that divides the inside of the nose in half.

Air enters the nostrils and travels straight back over the area outlined in red. Therefore, if this red area is deviated it may very well cause airway problems. Fortunately, this area is not needed for support of the nose and can be removed without problems. This is demonstrated by the picture above to the right.

Treatment of Airway Obstruction Caused by Enlarged Turbinates

Think of the nasal turbinates as little pillows that line the wall of the nose. They perform many functions including humidifying and filtering the air before it gets to the lungs. These pillows get larger and smaller depending on if they become engorged with blood. When this happens the airway may become congested. Nasal sprays and decongestants help decrease this swelling.

Sometimes, the turbinates become chronically engorged and need to be reduced to allow air to flow. This can occur on its own but often occurs when the septum becomes deviated. A deviated septum combined with an enlarged turbinate makes the problem much worse.

There are many ways to reduce the obstruction caused by the enlarged turbinate. Most are based on two general principles:

1. Reducing the size of the turbinate or
2. Repositioning the turbinate so it is out of the way.

Both methods are commonly done in conjunction with a rhinoplasty.