Functional rhinoplasty – how can it help me?
A functional rhinoplasty is one that is undertaken to improve the function of the nose. The main function of the nose is breathing but when things are not working are number of other problems can occur. These problems include nasal congestion, snoring, sinus problems including infections and pain, ear blockage and nose bleeds. A functional rhinoplasty may be helpful for treating all these conditions.
When might I need a functional rhinoplasty?
A functional rhinoplasty may be necessary to treat the following conditions:
- External nasal valve collapse
- Internal nasal valve collapse
- A very severe deviated nasal septum
- A dislocated nasal septum
- A large perforation in the septum
- Stenosis (narrowing) of the nostrils
- Reconstruction after a skin cancer removal
These conditions can cause a range of clinical problems including:
- A blocked or congested nose
- Sinus or sinusitis
- Sleep apnoea
- Loss of smell and taste
- Facial pain
- Post-nasal drip
Here are some more detailed examples of where a functional rhinoplasty may be helpful.
The very severely deviated nasal septum
A nasal septum that has been damaged through injury or has simply grown in a very abnormal shape may require a rhinoplasty to reconstruct it into a normal shape. Functional rhinoplasty approaches offer unparalleled options in addressing severe septal problems compared to a traditional septoplasty. The nasal septum may be completely removed, reshaped then re-inserted with no reduction in the support of the nose. In fact the nose is usually stronger after the septum is approach in this way.
Septal problems that are visible on the outside of the nose often require additional cartilage grafts to be placed to straighten things out completely. A functional rhinoplasty can add in spreader grafts that can achieve this (see below).
Many patients who snore have nasal valve collapse. This is a problem where the soft tissues just above or including the nostril area collapsing inwards when you breathe in. Patients often obtain relief while awake by holding the skin on the side of their nose outwards or using “Breathe-right” strips.
A functional rhinoplasty can add support to this part of the nose to treat snoring. There are a number of techniques but they all generally involve adding extra stiffness or width to the areas that are collapsing.
Bent, collapse, twisted middle third of the nose
The middle third of the nose can collapse inwards after trauma or previous surgery. This can lead to conditions such as “the inverted V deformity” or “a saddle nose deformity”. A functional rhinoplasty can insert grafts called spreader grafts along the length of the nose that help to address these problems.
A very severely bent septum can crowd the ventilation pathways into the sinuses and predispose you to sinus infections or pain. A functional rhinoplasty can assist with treating this problem. Endoscopic sinus surgery may also be necessary and can be performed at the same time.
Most functional rhinoplasty surgery is performed by Ear, Nose and Throat (ENT) specialists. A functional rhinoplasty can also incorporate a cosmetic rhinoplasty if desired.
What does a functional rhinoplasty involve?
A functional rhinoplasty is generally an open approach rhinoplasty. It is usually combined with a septoplasty or nasoseptal reconstruction and a turbinoplasty (turbinate reduction) procedure. Mechanical blockages with the nasal airway are first addressed such as a bend in the septum, very large inferior turbinates or a bend in the bony nasal vault.
A number of cartilage or bony grafts are generally then needed to add support to the airway during breathing and prevent collapse. These grafts may include:
- Spreader grafts
- Alar batten grafts
- Lateral crural strut grafts
- Rim grafts (alar contour grafts)
- Columellar strut graft
What else do I need to know about a functional rhinoplasty?
The post-operative recovery and risks of a functional rhinoplasty are the same as for any open approach rhinoplasty procedure.
If you have full coverage you will be able to claim a rebate for some of your surgical, hospital and anaesthetic fees from your health fund and Medicare. Be aware that some medical insurance companies in Australia (e.g. Medibank Private) allow you to remove “Plastic and Reconstructive Surgery” from your coverage to reduce the premium cost. A functional rhinoplasty performed by an ear, nose and throat specialist for breathing/snoring/sinusitis is considered by these funds to be “Plastic and Reconstructive Surgery”. To be covered you would need to increase your coverage to include “Plastic and Reconstructive Surgery” or change to a different fund.