Breathing is necessary to live and is a natural bodily function, but for many people, breathing takes work. These people may suffer from nasal obstruction, which means breathing through the nose is uncomfortable or difficult. With severe nasal obstructions, a person may be forced to breathe through the mouth because the nose is closed off. The patient may snore or develop sleep apnea.
Other problems associated with severe nasal obstruction include dry mouth because of mouth breathing and losing the sense of smell because there is insufficient airflow going to the body’s olfactory receptors. Treating a nasal obstruction is most effective when the root cause is dealt with, such as a deviated septum or turbinate dysfunction. With minimally invasive endoscopic procedures, patients could get relief and breathe better.
Made of bone and cartilage, the septum separates the right and left nasal cavities and is lined with mucous membranes. When the septum is not straight, it is crooked, or deviated, which could lead to nasal obstruction. Surgery to correct this deviation is called septoplasty.
Septoplasty is the third most common head and neck surgical procedure in the United States, which is due to how common a problem the deviated septum is. The procedure takes up to an hour-and-a-half as outpatient surgery. On the inside wall of one nasal passage, an incision is made. The physician may do a killian incision toward the back of the area when the problem does not affect a straight anterior septum. Or, the doctor may do a hemitransfixion incision to get to anterior and posterior deviations. After the incision, the mucous membrane is elevated, and the doctor repositions or removes the cartilage or bone causing the blockage. Mucous membrane is reattached, and the nose is packed with spongy material to prevent bleeding.
On the inside nasal walls, there are three pairs of bones. Long and thin, these bones are covered in a thin tissue and called nasal turbinates. Because of nasal problems, such as allergies, turbinates can enlarge or swell, which causes a nasal obstruction that blocks airflow. Turbinate dysfunction is common, affecting everyone at some point. The obstruction could be as mild as congestion or as serious as a total nasal blockage. Causes of turbinate dysfunction can include allergic rhinitis, vasomotor rhinitis, upper respiratory infection, drugs, and hormones. While some cases may see temporary relief with over-the-counter decongestants, surgery repair blocked airways and improve breathing.
Turbinectomy is surgery to remove the lower turbinate. Doctors sometimes use a high-speed microdebrider to shave off extra tissue, or surgery may be performed through an endoscope placed inside the nose. Turbinoplasty involves the use of a tool to shave tissue and change the turbinate’s position. Sometimes radiofrequency or laser ablation is used. A thin probe is inserted in the nose, and radio frequency energy or laser light is sent through the tube and directed at the turbinate tissue to shrink it. While this procedure can be performed in a doctor’s office with local anesthesia, turbinectomy and turbinoplasty require general anesthesia.