Rhinoplasty is a surgical procedure known for reshaping the nose and improving facial harmony. Although often sought for aesthetic reasons, it is fundamentally an operation on a complex, three-dimensional airway. The central question for anyone considering this surgery is whether altering the nose’s structure will compromise its function. Rhinoplasty profoundly affects breathing, with the potential to either significantly improve airflow or, in some cases, unintentionally obstruct it.
The Anatomy of Nasal Airflow
Breathing through the nose relies on a system of cartilage, bone, and soft tissue that manages airflow resistance. The nasal septum, a wall of cartilage and bone, divides the nasal cavity into two distinct passages. Within each passage are the turbinates, shelf-like structures that warm, humidify, and filter the air before it reaches the lungs.
The most critical area for managing airflow is the internal nasal valve, the narrowest point of the entire nasal passage. This valve is formed by the junction of the upper lateral cartilage, the septum, and the nasal floor. Airflow is optimized when the angle of this valve is greater than 15 degrees, as narrower angles significantly increase resistance. Even minor structural changes in this area can dramatically impact a person’s ability to breathe comfortably.
Addressing Functional Issues
Rhinoplasty is frequently performed specifically to correct pre-existing structural problems that impair breathing, a procedure often referred to as functional rhinoplasty. A common issue addressed is a deviated septum, where the septal wall is severely displaced, blocking one or both nasal passages. Correcting this deviation, known as septoplasty, is often combined with the external reshaping of the nose.
Another functional concern is nasal valve collapse, which can be caused by trauma or natural weakness in the cartilage. To address this, surgeons often use small pieces of the patient’s own cartilage, known as spreader grafts, to reinforce the middle vault of the nose. These grafts are strategically placed between the upper lateral cartilage and the septum to physically widen the internal nasal valve. This technique effectively lowers airflow resistance and improves breathing, ensuring the airway remains open.
When Cosmetic Changes Affect Airflow
While functional rhinoplasty aims to improve breathing, purely aesthetic maneuvers carry the risk of inadvertently compromising the airway. The desire for a smaller, more refined nose can sometimes lead to the removal of too much cartilage or bone, weakening the natural support structures. This over-resection can destabilize the nasal architecture, particularly in the middle vault and tip regions.
Narrowing the bridge or aggressively refining the nasal tip may cause the cartilage of the nasal valves to lose support and collapse inward. This structural failure, known as nasal valve collapse, manifests as difficulty breathing, especially during deep inhalation. The pressure drop during a strong breath can pull the weakened structures inward, physically obstructing the airway. Reports suggest that up to 10% of patients may experience nasal valve collapse following rhinoplasty, sometimes necessitating a revision procedure.
The Importance of Pre-Surgical Evaluation
A thorough pre-surgical evaluation is necessary to identify any pre-existing breathing issues and mitigate the risk of post-operative impairment. The surgeon must conduct a detailed physical examination to assess the condition of the septum, turbinates, and nasal valves. A standard diagnostic tool used in this assessment is the Cottle maneuver.
The Cottle maneuver involves the surgeon gently pulling the cheek skin laterally, which temporarily opens and widens the internal nasal valve. If the patient reports significant improvement in airflow, it suggests the obstruction is located in the nasal valve area and can be corrected surgically. Objective measurements, such as acoustic rhinometry, may also be used to measure the cross-sectional area and volume of the nasal passages. This comprehensive assessment ensures the surgical plan addresses both cosmetic changes and the preservation or improvement of breathing function.