When persistent congestion or difficulty breathing through the nose becomes a daily issue, it may signal an underlying anatomical problem that non-surgical treatments cannot fully correct. Chronic nasal obstruction significantly affects quality of life, leading to poor sleep, fatigue, and reduced exercise tolerance. When conservative options like nasal sprays and allergy medications fail to provide lasting relief, surgery becomes necessary to restore proper airflow. The goal of these specific nasal surgeries is to correct blockages within the nasal passages to improve breathing function.
Anatomical Causes of Nasal Airway Blockage
The nasal airway is a complex channel where obstruction can occur in three main areas. The nasal septum is a wall of cartilage and bone dividing the nose into two passages. If this wall is crooked or bent (a deviated septum), it severely narrows the airway, blocking airflow.
Located along the side walls are the turbinates, scroll-shaped structures that warm, humidify, and filter the air. Chronic inflammation, often due to allergies, can cause the turbinate tissue to swell. This condition, called turbinate hypertrophy, physically obstructs the air passage.
The narrowest part is the nasal valve area, divided into the internal and external nasal valves. If the supportive cartilage here is weak or collapses inward during inhalation, it significantly restricts airflow. These three issues—the septum, turbinates, and nasal valves—are the most common structural causes of chronic breathing difficulty.
Septoplasty for Deviated Septum
Septoplasty corrects a deviated nasal septum, the central partition of the nose. The septum is made of cartilage and bone, and displacement can be present from birth or result from injury. The surgery aims to straighten this wall and reposition it to the center of the nasal cavity, ensuring both air passages are open.
During the procedure, the surgeon makes an incision inside the nose and lifts the mucosal lining away from the underlying cartilage and bone. The deviated portions are trimmed, reshaped, or removed before being repositioned centrally. The lining is then secured with dissolving sutures or soft splints to hold the tissue in place during healing.
Turbinate Reduction for Swollen Tissues
Turbinate reduction procedures address turbinate hypertrophy, where the tissues along the side walls of the nose are chronically enlarged. The goal is to shrink the swollen tissue to create more space for breathing while preserving the crucial mucosal lining necessary for warming and humidifying inhaled air. This procedure is frequently performed alongside septoplasty.
Various techniques reduce turbinate volume, including minimally invasive methods like radiofrequency ablation and coblation. These techniques use controlled energy to heat the submucosal tissue, causing it to shrink without damaging the surface lining. Submucosal resection is another method, involving a microdebrider to shave away excess tissue from inside the turbinate, leaving the outer surface intact.
Nasal Valve Repair and Reconstruction
Nasal valve repair is necessary when the narrowest part of the airway collapses inward during inhalation. The internal nasal valve is the angle formed by the upper lateral cartilage and the nasal septum, and its collapse is a common cause of obstruction. This collapse can result from weak cartilage, trauma, or previous surgery.
The primary technique to strengthen this area is the use of spreader grafts, which are small strips of the patient’s own cartilage, often harvested from the septum. These grafts are placed between the upper lateral cartilage and the nasal septum to physically widen the angle of the internal nasal valve. This provides structural support, preventing the sidewall from collapsing during inhalation. For external valve collapse, surgeons may use a lower lateral strut graft, which reinforces the weak lower cartilages and improves sidewall stability.
The Surgical Journey: Preparation and Recovery
The surgical journey begins with a pre-operative consultation where the surgeon reviews all medications. Patients are advised to discontinue blood-thinning agents like aspirin and ibuprofen for five to fourteen days before the procedure. They are also instructed not to eat or drink anything after midnight the night before surgery. Most nasal breathing surgeries, including septoplasty and turbinate reduction, are performed on an outpatient basis, allowing the patient to return home the same day.
Post-operative care manages expected recovery symptoms. The nose commonly feels blocked for a few days due to internal swelling, and patients may use a “drip pad” beneath the nose for minor drainage. To minimize swelling and bleeding, patients should sleep with their head elevated for the first few days and avoid strenuous activity, heavy lifting, or bending over for one to two weeks.
Patients must avoid blowing the nose for about one week to prevent bleeding or disrupting healing tissues. Surgeons recommend frequent saline nasal rinses starting one to two days after surgery to gently clear crusting and promote a clean healing environment. While pain is managed with prescribed medication, final breathing results may not be apparent until the initial swelling subsides, which can take several weeks or months. Minor risks include temporary bleeding, infection, or a return of symptoms.