Nasal Surgery

Rationale: An open nasal airway establishes physiologic breathing and may minimize the use of the open oral airway. It should be remembered that when the mouth is open the lower jaw auto-rotates open and allows the tongue to fall back into the posterior airway space. In some patients improvement of the nasal airway may also improve CPAP tolerance and /or compliance.

Indications: Nasal airway blockage caused by bony, cartilaginous or hypertrophied tissues that interfere with nasal breathing during sleep.

Techniques: Septal and /or bony intranasal reconstruction, alar valve or alar rim reconstruction, turbinectomy.
Correction of any defects at this level assures the ability for minimizing oral breathing and certainly should decrease the possibilities of elevated nasal negative pressure breathing during sleep.

Clinical Outcomes: The ease and high success rate of nasal reconstruction makes this procedure a very valuable technique. It may not make a significant impact on moderate or severe SDB, such as the improvement seen with other procedures (palatal or tongue base surgery). However, it is still an essential part of the upper airway that should not be ignored in the overall treatment of SDB.

• Troell R, Powell N, Riley R, Li K: Evaluation of a new procedure for nasal alar rim and valve collapse: Nasal alar rim reconstruction. Otolaryngology Head Neck Surg 2000;122:204-211.

For a detailed treatment rationale, indications and outcomes continue to MANAGEMENT OF SLEEP-DISORDERED BREATHING