Septoplasty alone is not suitable for most structural nasal obstructions

Abstract

Septoplasty is widely used in the treatment of structural nasal obstructions, and it also has a good effect and a high degree of postoperative satisfaction. However, there a large number of structures demonstrate abnormalities related to structural nasal obstruction, including the external nose, maxilla, nasal cavity and paranasal sinus. Nasal septum deviation is only one signs of structural nasal obstruction and does not represent all possible structural abnormalities of the nasal cavity and its surrounding structure. Septoplasty is only performed to correct deviations of the nasal septum, which in many cases is obviously insufficient in restoring the symmetry of the nasal structure. Therefore, septoplasty alone is not suitable for the treatment of most structural nasal obstructions. Nasal ventilation expansion surgery, which typically covers more abnormal structural correction procedures than septoplasty, should be used when describing the treatment of structural nasal obstruction.

Keywords: Nasal cavity; Nasal septum deviation; Nasal ventilation expansion surgery; Septoplasty; Structural nasal obstruction.

Fig. 1

Aetiological derivation of structural nasal obstruction. Structural abnormalities of the external nasal morphology, nasal septum, nasal cavity, maxilla and anterior ethmoid complex, which cause remodelling (compensation) of the nasal structure (including the inferior turbinate, middle turbinate and anterior ethmoid complex). Failed compensation leads to structural nasal obstruction. Nasal septum deviation is only one of a number of structural anomalies in structural nasal obstruction.

Fig. 2

A patient with external nostril stenosis caused by cartilage bracket malformation (Fig. 2A) and the shape of the external nose after external rhinoplasty (Fig. 2B).

Fig. 3

The range of nasal ventilation expansion surgeries (NVESs) and the relationship of NVES with septoplasty. NVES covers most of the surgical aspects of structural nasal obstruction, and septoplasty is only one part of NVES. FESS: functional endoscopic sinus surgery; MS: maxillary sinus; ES: ethmoidal sinus.

Fig. 4

Estimations of the plasticity of the nasal cavity and paranasal sinus with age. During the development of the paranasal sinus, the osseous structure and mucosa have strong plasticity. If nasal septum deviation occurs during this period and results in asymmetry of the bilateral nasal cavity, compensatory remodelling of the osseous and mucosal structures will occur due to their strong plasticity. However, in adulthood, the plasticity of the osseous structure decreases significantly, and compensatory changes are mainly mucosal.