Rhinoplasty and Septoplasty

Rhinoplasty and septoplasty: surgical reshaping and correction of the nose

The nasal septum is the bony-cartilaginous wall that separates the nostrils and the nasal cavities. The septum is covered by the internal lining of the nose that is a richly vascularized and innervated structure. Ideally, the septum should be a straight midline structure, but in reality, it is never perfectly vertical. What causes nasal septum deviation? Developmental or traumatic causes can lead to deviations of the septum. Nasal septum deviations can be asymptomatic or provoke breathing difficulties, nose bleeds, and sleep disorders such as snoring and sleep apnoea syndrome. When a deflected or displaced septum jeopardizes the regular inflow and outflow of air during sports, sleep, or waking hours, it may require surgical correction.

As the name suggests, septoplasty is the surgical correction of deviations, asymmetry, excessive length, or unnatural positions of the nasal septum. Can septoplasty and rhinoplasty be done together? Septoplasty can be combined with rhinoplasty when the patient requires simultaneous modification of the external nose. Although the terms rhinoplasty, septoplasty, and septorhinoplasty, may be considered as different entities, we must be aware that form and function go hand in hand in any nasal surgery. Structural derangements of the septum may have consequences on the shape, and cosmetic alterations may affect the function. Hump excision or the correction of the nasal tip may involve modifications of the nasal septum, i.e., septoplasty.

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The nasal septum: characteristics, purpose, anomalies, and surgical correction

The nasal septum plays a crucial role in the respiratory system. The midline wall of the nose, it consists of bones and cartilage covered by a vascular coat that is rich in nerves, blood vessels, and plays a vital role in immune defence against airborne infections. The septum divides the nasal cavities from each other. Its structure determines the shape, size, and projection of the external nose. Moreover, it is attached to a muscle called nasal septum depressor, whose hyperactivity can alter the tip dynamics (the tip lowers when the subject speaks or laughs).

What problems can a deviated septum cause? A healthy nasal septum is a straight midline structure. However, deviations, asymmetries, excessive length, and atypical projection can alter its shape. A deviated septum can cause several common dysfunctions such as respiratory and sleeping disorders, including snoring or sleep apnoea. Less frequent symptoms, such as nasal dryness or nose bleeds, can also appear. The surgical remodelling of the deviated nasal septum (septoplasty) can be combined with the modification of the external nose (septorhinoplasty).

Rhinoplasty and septoplasty: differences, purposes, and indications

Many patients with respiratory symptoms (including nose occlusion, snoring, and sleep apnoea) consult the specialists for functional nasal surgery. After appraising the general conditions, the surgeon decides whether to perform a septorhinoplasty or a septoplasty (correction of the deviated, long, or atypically projected septum). However, in the vast majority of cases, operating a deviated septum implies the simultaneous treatment of the inferior turbinates – especially in case of alternate nostrils breathing difficulties. Inferior turbinates are present on both sides of the nose. They have an inner bony core and a very vascular coat that is often a significant factor in reducing nasal airflow and creating a “blocked nose” feeling.

    1. Rhinoplasty and septoplasty to resolve nasal obstructions (stuffy nose)

This diagnostic procedure detects anomalies of the septum, nasal valve, and other parts of the internal nose. In expert hands, it is safe, simple and may not require local anaesthesia. If necessary, the specialist will advise CT scanning of the nose and sinuses, almost always without contrast medium.

    1. Rhinoplasty and septoplasty to resolve snoring and sleep apnoea

Snoring and sleep apnoea depend on complex clinical situations, not limited to a deviated septum or hypertrophic turbinates. As clinical and scientific evidence shows, these sleeping respiratory disorders result from multi-level obstructions distributed all along the airway. Adjusting the septum or the turbinates can reduce snoring and sleep apnoea, though surgery is not a definitive or exclusive solution. Therefore, the specialist must be prepared to also recommend non-surgical snoring remedies.

Rhinoplasty and septoplasty with Dr. Pietro Palma in Milan

The minimally invasive approach tends to reduce the unpredictability of results in modern rhinoplasty. In recent years, minimally invasive techniques have also extended to the treatment of respiratory diseases or dysfunctions, structural reconstructions, and revision surgery. Alongside the traditional procedures, Dr. Palma has conceived and improved a crossbreed system called Hybrid Rhinoplasty™ that combines the advantages of external or “open” rhinoplasty (opencast vision of the skeleton) with endonasal or “closed” rhinoplasty (absence of external scars). Even the reshaping of the tip follows an advanced preliminary study of anatomy and aesthetics, today an essential precondition for minimally invasive changes.

The correction of a nasal hump must encompass the principle of due anatomical balance. Rhinoplasty of the hump is seldom a simple levelling of the dorsum: on the contrary, it usually requires a “profiloplasty.” This expression indicates that nasal surgery must concern the profile as a whole as the rotation of the tip and the position of the root are not irrelevant to the perception of the hump. Every modern rhinoplasty and septoplasty should aim to provide natural results and soft contours that do not drastically alter natural features. Rhinoplasty should always be a tailor-made intervention: that’s why we call it YOUnique Rhinoplasty™.

Designing and performing a tailor-made nose operation is the task of the specialist rhinoplasty surgeon

A patient-specific surgery can only result from an accurate and systematic pre-operative diagnosis, where the feasibility of the expressed desires is evaluated in the context of individual anatomy. Professional ethics require rhinoplasty surgeon not to accept patients solely based on photos or contacts via the Internet. For more detailed information on rhinoplasty, septoplasty and procedure costs, contact Clinica del Viso (Piazza Repubblica, 21 – Milan – Tel 0263611932 – info@youniquerhinoplasty.com) or Casa di Cura “LA MADONNINA” (Via Quadronno, 29/31 – Milan – Tel 0258395555 – cup.cclm@grupposandonato.it ) and arrange an interview with Dr. Palma, one of the leading experts in rhinoplasty and septoplasty in Italy and on an international level.