Septal Deviation, Nasal Polyposis, and Alar Collapse: A Functional and Aesthetic Approach

Combined Surgical Approach for the Treatment of Septal Deviation, Nasal Polyposis, and Alar Collapse

We performed open technique septorhinoplasty surgery (assisted by micromotor and ultrasonic devices), nasal valve surgery, bilateral endoscopic sinus surgery and nasal polypectomy operations on the patient who had complaints of severe nasal congestion, nasal deformity, and collapse of the nasal wings during breathing.

The Effects of Nasal Obstruction on the Patient

Our patient, who had previously undergone rhinoplasty at a different clinic and developed nasal deformity and breathing difficulties following a nasal trauma in childhood, presented to our clinic with the following complaints:

• Severe nasal obstruction
• Nostril collapse
• Significant deterioration in sleep quality
• Fatigue and weakness in daily life
• Aesthetically pleasing nasal deviation (crooked nose deformity)

This condition required a comprehensive surgical approach for both functional and aesthetic reasons.

He also stated that it was very difficult for him to smell through his nose. After the surgery, his complaint of decreased smelling ability completely disappeared.

Previous Intervention: Reason for Inadequacy

The patient had previously undergone inferior turbinate reduction with radiofrequency at a different clinic. No other procedures had been performed to address the other problems causing nasal obstruction and increased intranasal airway resistance. Reasons for persistent nasal obstruction:

• The obstruction persisted due to the severely deviated septum.
• Nasal polyps persisted.
• The nasal alae were weak, and the complaint of collapse persisted.

Therefore, a more extensive surgical procedure was planned.

Imaging Findings

It was thought that the nasal septum was deviated to the right with very sharp edges, and that the upper and lower parts in the deviation area were angled very perpendicular to each other, and that there was a serious curvature following trauma in childhood.

CT scan and endoscopy examinations revealed:

• Fracture area and deviation of the nasal septum narrowing the right nasal cavity, contact with the right lateral nasal wall
• Bilateral nasal polyps were filling the nasal cavity.
• The nasal valve area was narrowed.

These findings demonstrated that surgical planning should include both functional and aesthetic considerations.

Surgical Procedures Performed

Open Septorhinoplasty

• The severely deviated septum was corrected.
• The nasal midline was reshaped.
• The crooked nose deformity was corrected.

Nasal Valve Surgery

• The collapsed alae was corrected.
• The nasal tip cartilage support was reconstructed using the Tongue-in-Groove technique, and the nasal valve area was supported with alar batten grafts and spreader grafts.

• The nasal wings were stabilized during breathing.

Endoscopic Sinus Surgery

• Bilateral polyps were removed.
• The paranasal sinuses were opened (both maxillary sinuses and the anterior-middle ethmoid sinuses).
• Nasal sinus drainage and airflow were restored.

Why is the Nasal Valve So Important?

The nasal valve is the narrowest region in the nose and a critical passage for air during breathing.

When this space is narrowed, the patient experiences severe breathing difficulties.

The collapse of the nasal wings completely impairs valve function.

Septum surgery alone is usually not sufficient; supportive surgery is absolutely necessary.

Nasal Polyposis and Its Effects

Nasal polyps are small, grape-like structures that can grow inside the nose over time. They are painless to the touch, turbinate, and paler than the normal nasal mucosa. Definitive treatment is not yet available. You can find detailed information at https://www.ent-istanbul.com/2019/10/nasal-polyp.html

Nasal polyps;

It causes nasal congestion, recurrent sinusitis, loss of smell, and sleep disturbances.

Because the polyps were quite extensive in our patient, they were removed with endoscopic sinus surgery.

Post-Operative Benefits

The patient experienced the following benefits after surgery:

✅ Nasal congestion was significantly improved.

✅ Sleep quality improved, and snoring decreased.

✅ The complaints of collapsed nasal wings disappeared.

✅ A more aesthetically pleasing and natural-looking nose was achieved.

✅ Recurrent sinusitis episodes were prevented.

Frequently Asked Questions (FAQ)

What is a deviated septum?

The septum is the structure that divides the nasal cavity. It is normally located in the midline, but when deviated, it causes nasal congestion. In severe deviations, breathing is severely impaired.

What is the recovery process after septum deviation surgery?

Mild swelling, crusting, and congestion may occur in the first few days after surgery. Patients usually begin breathing comfortably within 1-2 weeks. Full recovery takes 1-3 months.

Do nasal polyps recur?

Nasal polyps are caused by chronic inflammation. Even if surgically removed, they can recur if the underlying causes (allergy, chronic sinusitis, asthma) persist. Therefore, postoperative medical treatment and regular follow-up are important. Regular follow-up and medical treatment can prevent or slow down the development of nasal polyps.

What is alar collapse (nostril collapse)?

This is a condition in which the nostrils collapse inward during breathing. It is usually due to a weakness in the nasal valve area and requires surgical support. In some patients, the cartilages at the nasal wings may be looser or weaker than normal from birth, and in some patients, these cartilages may be weak or prone to collapse due to traumatic factors. After other procedures, the cartilages in this area can weaken, leading to collapse of the nasal wings. It's particularly important for patients with thick nasal skin to maintain the whiplash support at the tip of the nose. In these cases, it's crucial to support the nasal cartilages as much as possible and prevent collapse.

Is endoscopic sinus surgery a difficult procedure?

Endoscopic sinus surgery is a safe procedure when performed by experienced surgeons. Because it is performed through the nose, there are no external facial incisions. Postoperative recovery is generally rapid. As the number of affected sinuses increases, the duration of endoscopic sinus surgery may increase and the surgery may become more complicated. The CT scans I've shared with you here show soft tissue thickening in both ethmoid sinuses, mucosal thickening, particularly in the left maximal sinus, and polyps in various areas within the nose.

Do these types of combined nose surgeries also provide aesthetic results?

Yes. When functional surgeries (septum and valve repair) and cosmetic surgery (septorhinoplasty) are performed in the same session, both healthier breathing and a natural appearance are achieved. In the patient I've shared with you in this article, the collapsed nasal wings were corrected, the nose was reshaped, and the sinuses were made more functional. A surgical procedure was planned for both functional and aesthetic purposes.

What changes may occur in the patient's quality of life after surgery?

• Easier breathing
• Increased sleep quality
• Reduction in sinusitis attacks
• Increased energy in daily life
• A more aesthetically pleasing nose

Search result link where you can find articles about alar collapse prepared by Dr. Murat Enöz and published on this website (you can also access previous articles by clicking "more posts" at the end of the page) >> https://www.ent-istanbul.com/search?q=alar+collapse

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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