Q: I had a rhinoplasty several years ago. One of my reasons for having the operation was to get a large hump on my nose removed. Since the surgery I have had trouble breathing through my nose. What can be done to correct the breathing problem resulting after hump removal? Is the cause of these breathing difficulties the enlarged inferior turbinates?
A: In removing a large nasal hump, several structures are taken down. While most people think a hump is made up of bone, it is really as much cartilage as it is bone. This cartilage includes the upper half of the septum and portions of the upper lateral cartilages. The merging of the upper lateral cartilages and the septum make up what is known as the internal nasal valve. This internal nasal valve is an important area that has great influence on how easily air moves through the nose. With larger hump reductions, the internal nasal valve may become compromised, causing postoperative breathing problems. While the size of the inferior turbinates may have an effect on your breathing, the most likely cause is internal nasal valve collapse.
Reconstruction of a collapsed middle vault (compromised internal nasal valve) is done primarily through cartilage grafts, a procedure known specifically as spreader grafting. This is done through an open rhinoplasty approach. Reduction of the inferior turbinates can be done at the same time to eliminate any other airway obstructive factor.
Dr. Barry Eppley