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Improving Form And Function Of The Nose

Each year thousands of people undergo surgery of the noseNasal surgery may be performed for cosmetic purposes or a combination procedure to improve both form and functionIt also may alleviate or cure nasal breathing problemscorrect deformities from birth or injuryor support an agingdrooping nose.

At Integrated ENTwe believe nasal surgeryfor any reasonshould ensure that efficient breathing is as high a priority as appearance.

Can Cosmetic Nasal Surgery Create A “Perfect” Nose?

Aesthetic nasal surgery (rhinoplasty) refines the shape of the nose, bringing it into balance with the other features of the face. Because the nose is the most prominent facial feature even a slight alteration can greatly improve appearance (some patients elect chin augmentation in conjunction with rhinoplasty to better balance their features). Rhinoplasty alone cannot give you a perfect profile, make you look like someone else, or improve your personal life. Before surgery, it is very important that you have a clear, realistic understanding of what change is possible as well as the limitations and risks of the procedure. This can be accomplished by having a complimentary consultation to discuss all aspects of your surgery.

Skin type, ethnic background, and age will be among the factors considered preoperatively by one of our surgeons. Except in cases of severe breathing impairment, young patients usually are not candidates until their noses are fully grown, at 15 or 16 years of age. The surgeon will also discuss risk factors, which are generally minor.

To reshape the nose, the skin is lifted, allowing the surgeon to remove or rearrange the bone and cartilage. The skin is then redraped and sutured over the new frame. A nasal splint on the outside of the nose helps retain the new shape during healing. If soft, absorbent material is placed inside the nose to stabilize the septum, it will normally be removed the morning after surgery. External nasal dressings and splints are usually removed five to seven days after surgery.

When Should Surgery Be Considered to Correct a Chronically Stuffy Nose?

Millions of Americans perennially suffer the discomfort of nasal stuffinessThis may be indicative of chronic breathing problems that don’t respond well to ordinary treatmentThe blockage may be related to structural abnormalities inside the nose or to swelling caused by allergies or viruses.

There are numerous causes of nasal obstructiondeviated septum (the partition between the nostrils) can be crooked or bent as the result of abnormal growth or injuryThis can partially or completely close one or both nasal passagesThe deviated septum can be corrected with a surgical procedure called septoplastyCosmetic changes to the nose are often performed at the same time in a combination procedure called septorhinoplasty.

Overgrowth of the turbinates is yet another cause of stuffiness (the turbinates are the tissues that line the inside of the nasal passages)Sometimes the turbinates need treatment to make them smaller and expand the nasal passagesTreatments include injectionfreezingand partial removalAllergiestoocan cause internal nasal swellingan allergy evaluation and therapy may be necessary.

Can Surgery Correct a StuffyAging Nose?

Aging is a common cause of nasal obstruction. This occurs when cartilage in the nose and its tip are weakened by age and droop because of gravity, causing the sides of the nose to collapse inward, obstructing air flow. Mouth breathing or noisy and restricted breathing are common.

Try lifting the tip of your nose to see if you breathe better. If so, the external adhesive nasal strips that athletes have popularized may help.You can also talk to one of our ENT specialists about septoplasty, which will involve trimming, reshaping, or repositioning portions of septal cartilage and bone (this is an ideal time to make other cosmetic improvements as well). Internal splints or soft packing may be placed in the nostrils to hold the septum in its new position. Usually, patients experience some swelling for a week or two. However, after the packing is removed, most people enjoy a dramatic improvement in breathing.

Broken Nose Treatment

Bruises around the eyes and/or a slightly crooked nose following injury usually indicate a fractured noseIf the bones are pushed over or out to one sideimmediate medical attention is idealBut once soft tissue swelling distorts the nosewaiting 48-72 hours for a doctor’s appointment may actually help the doctor in evaluating your injury as the swelling recedes (apply ice while waiting to see the doctor)What’s most important is whether the nasal bones have been displaced rather than just fractured or broken.

For markedly displaced bonesour surgeons often attempt to return the nasal bones to a straighter position under local or general anesthesiaThis is usually done within seven to ten days after injuryso that the bones don’t heal in a displaced positionBecause so many fractures are irregular and won’t “pop” back into placethe procedure is successful only half the timeDisplacement due to injury often results in compromised breathing so corrective nasal surgerytypically septorhinoplastymay then be electedThis procedure is typically done on an outpatient basis and patients usually plan to avoid appearing in public for about a week due to swelling and bruising.

Will Insurance Cover Nasal Surgery?

Insurance usually does not cover cosmetic surgeryHoweversurgery to correct or improve breathing functionmajor deformityor injury is frequently covered in whole or in part.

Sinus Surgery

Integrated ENT physicians will prescribe many medications (antibioticsdecongestantsnasal steroid spraysand/or antihistamines) and procedures (flushing) for treating acute sinusitisThere are occasions when our physicians and patients find that the infections are recurrent and/or non-responsive to the medicationWhen this occurssurgery to enlarge the openings that drain the sinuses is an option.

A clinical history of the patient will be created before any surgery is performedA careful diagnostic workup is necessary to identify the underlying cause of acute or chronic sinusitiswhich is often found in the anterior ethmoid areawhere the maxillary and frontal sinuses connect with the noseThis may necessitate a sinus computed tomography (CT) scan (without contrast)nasal physiology (rhinomanometry and nasal cytology)smell testingand selected blood tests to determine an operative strategy(Note: Sinus x–rays have limited utility in the diagnosis of acute sinusitis and are of no value in the evaluation of chronic sinusitis.)

Sinus Surgical Options

Functional endoscopic sinus surgery (FESS): Developed in the 1950sthe nasal endoscope has revolutionized sinusitis surgeryIn the pastthe surgical strategy was to remove all sinus mucosa from the major sinusesThe use of an endoscope is linked to the theory that the best way to obtain normal healthy sinuses is to open the natural pathways to the sinusesOnce an improved drainage system is achieved the diseased sinus mucosa has an opportunity to return to normal.

FESS involves the insertion of the endoscopea very thin fiber-optic tubeinto the nose for a direct visual examination of the openings into the sinusesWith state of the art micro-telescopes and instrumentsabnormal and obstructive tissues are then removedIn the majority of casesthe surgical procedure is performed entirely through the nostrilsleaving no external scarsThere is little swelling and only mild discomfort.

The advantage of the procedure is that the surgery is less extensivethere is often less removal of normal tissuesand it can frequently be performed on an outpatient basisAfter the operationthe patient will sometimes have nasal packingTen days after the procedurenasal irrigation may be recommended to prevent crusting.

Image guided surgery: The sinuses are physically close to the brainthe eyeand major arteries, are always areas of concern when a fiber optic tube is inserted into the sinus regionThe growing use of a new technologyimage guided endoscopic surgeryis alleviating that concernThis type of surgery may be recommended for severe forms of chronic sinusitisin cases when previous sinus surgery has altered anatomical landmarksor where a patient’s sinus anatomy is very unusualmaking typical surgery difficult.

Image guidance is a near-three-dimensional mapping system that combines computed tomography (CT) scans and real-time information about the exact position of surgical instruments using infrared signalsIn this wayour surgeons can navigate their surgical instruments through complex sinus passages and provide surgical relief more precisely.

Caldwell Luc operation: Another option is the Caldwell-Luc operation which relieves chronic sinusitis by improving the drainage of the maxillary sinusone of the cavities beneath the eyeThe maxillary sinus is entered through the upper jaw above one of the second molar teethA “window” is created to connect the maxillary sinus with the nosethus improving drainageThe operation is named after American physician George Caldwell and French laryngologist Henry Luc and is most often performed when a malignancy is present in the sinus cavity.

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