We offer treatments for the following:
- Nasal congestion caused by external nasal deformity post-trauma
- Nasal congestion associated with nasal obstruction
- Nasal congestion not resolved after nasal septum correction
- Paleolithic nasal bone fracture
Clinic features
- Open sepotorhinoplasty performed solely by plastic surgery
- Endoscopic septoplasty
- Comprehensive reconstruction of bone and cartilage
One of the causes of nasal congestion (nasal obstruction) is nasal septal deviation, a condition in which the nasal septum, the pillar of the nose, is bent and narrowing the inside of the nose, causing nasal congestion. If the curvature is severe, septoplasty can be performed to widen the inside of the nose by cutting away the curved nasal septum, thereby removing the obstruction to air passage when nasal breathing is used. Septoplasty surgery has been performed in Japan by otorhinolaryngologists. Bending of the apparent nose (external nose) due to injury or other trauma can also cause nasal congestion. Until now, nasal osteotomy has been performed mainly in plastic surgery for external nasal curvature (deviated nose).
Conventional Septoplasty and Problems with Osteotomy
The external nose is formed by the upper 1/3 of the nasal bone and the lower 2/3 by cartilage. However, if the curved part of the nose extends into the pillar or roof that forms the external nose, removal without reconstruction of the curved part (lordosis and kyphosis) may cause structural failure, resulting in complications such as a bent or concave nose after the surgery. This can lead to complications such as a bent or a dented nose after the surgery and the nasal congestion may not improve. Conversely, if only the curvature of the wall is resected without curving the roof or pillars, the nose may be structurally weakened as well, resulting in nasal deformity or worsening nasal congestion. In addition, if the nasal septum is bent or dented, healing the nasal septum may not improve the appearance or function of the nose. Even if only a nasal osteotomy was performed for a nose deformity, improvement of nasal congestion could not be achieved without reconstruction of the supporting nasal septum.
Open Sepotorhinoplasty
One of the targets of open sepotorhinoplasty is the treatment of the pillars and roof (lordosis and kyphosis) of the nasal septum, which are difficult to treat with septoplasty techniques.
The nasal septum is straightened by aligning the length of the external nasal roof and pillars, or by taking tissue from the inside of the nose (nasal septum cartilage, ethmoid bone) or rib cartilage to strengthen the pillars and roof. If the bone is crooked, nasal osteotomy is added to straighten the bone. In Japan, external rhinoplasty of the nasal septum is often divided between otorhinolaryngology for development of the nasal septum and removal of bent tissue, and plastic surgery for structural surgery of the nose, but at our clinic, everything is performed by a single plastic surgeon.
Rhinoplasty has undergone significant changes since the Preservation Rhinoplasty published by Daniel in the United States in 2018. Among them is Dorsal Preservation Rhinoplasty for the treatment of crooked noses. This is a new concept in which bone and cartilage are treated together in a single procedure, which is difficult to divide and perform.
We also give many lectures at academic conferences and strive to hunt for new knowledge and improve our techniques on a daily basis. It is a very beneficial treatment method for patients as it shortens the surgery time by having a single day surgery and allows for a single treatment from function to cosmetic surgery.
Most of the surgeries are "Open Rhinoplasty", in which an incision is made at the nasal pole and the external nasal structures are firmly deployed. In cases of trauma or congenital deformity, the large nasal wing cartilage at the tip of the nose is often deformed and the entrance to the nasal passageway is narrowed, and reconstruction of that area (external nasal valve) is performed.
1/3 is in the middle, where reconstructing the central pillars of the nose such as the lateral nasal cartilage and nasal septum cartilage takes place. The pillars are reinforced and deflected tissue is removed to balance and centralize the nose. The upper 1/3 is the nasal bone area.
If a nose deformity, an osteotomy is performed. The bone is cut so that the length of the left and right nasal bones are aligned. Since the central part and bones are in close, they should be reconstructed in one lump for safe and long-term stable results.
The curved portion is centralized by resecting the deflected portion and balancing the length and cartilage grafts may be used as reinforcement to strengthen the structure.
The cartilage used is the removed nasal septum cartilage or bone (ethmoid bone), but rib cartilage or auricular cartilage may be extracted if the deformity is severe enough to require a lot of material.
Corporeal septoplasty
Corporeal septoplasty is used when the curvature of the nasal septum is too severe to be treated by the above methods. This is a procedure in which most of the nasal septum is removed and a new nasal septum is created using rib cartilage. Since the introduction of preservation rhinoplasty, the use of this procedure has decreased, but it is still necessary in some cases such as for severe post-traumatic deformities.
Progress of Open Sepotorhinoplasty
A blood drain tube may be placed in the nose. The timing of drain removal depends on the nature of the surgery. A silicone plate may be placed inside the nose to prevent nasal septal hematoma. If an osteotomy is performed, a cast is placed on the external nose.These will be removed at the time of suture removal one week after the surgery. The swelling from the surgery, the drain and the silicone plate that are placed inside the nose will give the patient that the feeling of nasal congestion seems to be worse than before the surgery. However, at the time of the stitch removal, all of these will be removed and the congestion will improve.
The swelling often gets better as the nasal congestion gradually improves, which will take about a month after the surgery. Prominent swelling will largely subside about 2weeks after the surgery. The cast should be worn all day for one week after the surgery.
For the week after that, the cast should be worn only at bedtime. In some cases, the patient may be asked to wear a retainer, a brace that is placed inside the nostrils. Blowing the nose is prohibited for one month after the surgery. It is recommended to clean the nose with a nasal gargle or nasal rinsing.
Precautions of Open Sepotorhinoplasty
The appearance of the external nose will change to greater or lesser extent. Since there is a strong element of correction such as straightening, the entire nose will be stiffer after the surgery than before.
The insurance covers the functional treatment, so if the patient's main concern is to improve the look of the nose, the treatment will be at his/her own expenses. In principle, a letter of referral is required.
Open Sepotorhinoplasty is a surgery to straighten the inside of the nose to make it look straighter. Depending on the condition of the bones and cartilage, it may be difficult to straighten the nose completely. If the axis of the nose and the axis of the occlusion are misaligned, correction may be done leaving a bend. Nasal congestion can be caused not only by external nasal deformity and nasal septum deviation, but also by allergies, nasal valve obstruction, empty nose and many other conditions. There is a possibility that nasal congestion will continue even after the surgery.