What is the nasal valve area in the nose?
The nose is a non-uniform tubular structure from the inside. The narrowest points are the entry point, the nostrils, and the exit point at the nose's back. As the nasal valve is the narrowest point, it plays a critical role in how we breathe. The nasal valve area is the internal nose area we can view without instruments when we look in the mirror with the head tilted back.
Why is the nasal valve important in breathing through the nose?
Airflow in the nasal valve area follows Bernoulli's principle. When the airflow increases, the pressure falls and pulls the side walls with it. This is very similar to when a fast train pulls the air around it with it. As a result, people on the platform are advised to stand clear because there is a risk of getting pulled in.
How do I test if I have nasal valve collapse?
Nasal valve problems can be due to bent septum or weak cartilages in the nose's sidewall. Using Breathe Easy Strips can give you a clue if you have a soft nasal valve. If you are not sure and suffer from a blocked nose, you can book an ENT consultant appointment.
How can nasal valve obstruction be treated?
As mentioned earlier, nasal valve problems can be due to large and swollen turbinates, septal deviation or weaker cartilages on the sidewall.
Weaker side wall cartilages can be treated by non-surgical options such as using Breathe Easy Strips. Surgical options available to treat nasal valve cartilage strengthen them using your own cartilage graft, using a titanium implant or having Z-plasty to the nasal valve.
Can you tell me more about nasal valve surgery?
Nasal valve cartilage augmentation procedure is a surgical procedure in which the surgeon will harvest cartilage, most commonly from the back of your septal cartilage or ear cartilage, or rib cartilage, depending on what is available. The significant advantage of having cartilage augmentation is that surgeon is using your tissue.
Titanium butterfly implant is a surgical procedure in which the surgeon uses a thin titanium implant to support the nasal valve area when the patient is breathing in. Titanium is an inert metal that is used for most of the implants used in the body. As titanium is an artificial material, there is a small risk of the implant getting infected and rejected. In people with very thin skin, the implant can be visible, and in a tiny number of cases, the tip may look bossy and wide.
Suture augmentation or Z-plasty is a nasal valve procedure offered to patients who have lax mucosa in the nasal valve area. The significant advantage is that these techniques have a quick recovery and can be offered to patients who do not wish to have an implant or cartilage augmentation.
What are non-surgical treatment options for nasal valve collapse?
The options available are using internal or external splints of the nasal valve area.
External splinting options include Breathe Easy Strips, and internal splint options include Snore Stop, like a temporary splint.
It is imperative to stress optimising medical treatment of any nasal conditions before embarking on and discussing surgical options with patients with nasal valve collapse.
What are the complications of nasal valve surgery?
Bleeding
Nasal packs may be put into the nose at the end of the operation; they will stay there until the doctor advises their removal. On removal of the packs, it is usual for some bleeding to occur; this usually stops quickly. If the bleeding becomes severe, a further pack may need to be used.
Disappointment/failure
Whilst every care is taken for the end cosmetic appearance to be improved, occasionally, the patient is not happy with the result. Perfection or specific preference is not guaranteed. As the main aim of the procedure, a broad nose improves the nasal airflow; the nose may feel broad due to cartilage grafts used.
Infection
Infection usually occurs as a discoloured discharge from the nostrils several days after the operation, and you will need to see your family doctor (GP) regarding this. You may also experience dry, crusting mucous leading to discomfort; saline nasal douching should resolve this.
Intranasal adhesions
This can happen if the raw areas within your nose stick together or following an infection. These can be divided at a later date under a short general anaesthetic.
Shape change
Rarely, the shape of the nose can become “saddled”. This is due to the collapse of cartilage in the nose's centre. If this should occur, further surgery might be needed.
Septal perforation
There is a 1-2% risk of this happening. This is a hole in the middle partition of the nose, which will be permanent.
Bruising and Swelling
You may develop bruising and swelling around the eyes/nose; this will resolve but may take a few weeks. In this case, you are advised to sleep propped up for a few nights to prevent pooling of blood/fluid and encourage natural drainage. The application of ice packs will reduce this.
Nasal tip/teeth numbness
This should resolve but may take some time.
Scar
Sometimes, the surgeon will need to access the nasal bone externally, leaving a pinprick on each side of the nasal bone.
What should I do before the nasal valve surgery?
You will have a final preoperative consultation to discuss the surgical plan. Clinical photographs will be taken. Do not take herbal or any other medications which increase bleeding. This may lead to increased bruising.
What is post-procedure advice after nasal valve surgery?
• Your doctor will advise you on a specific period of recovery but in general rest for one to two weeks. If you need a sick certificate, please ask the medical staff before you leave.
• The nose will feel blocked due to post-operative swelling and can take a few weeks to settle down. If prescribed, apply any nasal drops/spray to decongest the nose and follow the recommended method of installation. You will be given an antibiotic ointment to apply to the scar.
• You may have a blood-stained watery discharge from the nose. This is normal and should settle after a few days.
• Scabbing within the nose may occur as it heals. Do not pick this off, as the area will bleed. You may have been advised to douche (rinse) the nose, and the nursing staff will advise you on the correct technique.
• For the first few days, avoid hot drinks, meals, baths or showers. For one week, avoid blowing your nose and sneeze with your mouth wide open. These all help to reduce any risk of bleeding.
• Avoid or cut down on smoking as smoking affects the body’s ability to heal and irritates the inside of the nose. Staff can advise you on quitting, provide you aids to help you quit (e.g., nicotine patches), and contacts to support groups.
• Avoid crowded or dusty places and people with coughs and colds, as infection can be picked up in the nose.
• If nasal splints or plaster are in place, do not touch and attend the arranged-out patient's appointment for their removal. You may also have a splint inside your nose to help keep the partition straight, this stays in for one week or two, and you will be informed if it is there.
• If you have an external plaster or splint, this will be secured with tape and stay in place for one to two weeks. This supports the nasal bones in their new position and must be kept dry.
• Avoid contact sports for eight weeks due to the risk of trauma and bleeding.
• If fresh, steady bleeding occurs, pinch the fleshy part of the nose, lean forward and apply ice to the forehead and bridge of the nose. A frozen bag of vegetables is a good alternative if you don’t have ice in the freezer. Avoid swallowing any blood as it can make you feel sick. If the bleeding does not stop after 30 minutes, ring the ward for advice.
When can I go to work or exercise?
You can start gentle exercise four weeks post-surgery but avoid vigorous exercise for eight weeks. If you can work from home on the computer, you will be able to do so after four to five days.
When can I get my nose pierced?
I would advise leaving the nose to be pierced again for six months. Early piercing of the nose can make your cartilage weaker and can lead to nasal obstruction.
When can I use steam and a sauna bath after nasal valve surgery?
I would be advised to leave steam and sauna bath for three months till all swelling has settled down. Early use of steam and sauna can lead to nose bleed and swelling to persist longer.
Will nasal valve surgery change my voice?
Rhinoplasty can be done for cosmetic reasons and functional reasons. If we are changing the looks and the airflow through the nose will be the same, then having rhinoplasty will not change your voice. If the person has a nasal voice due to crooked septum, later corrective functional rhinoplasty will improve the voice quality. The change will be more towards the natural sound. If you are a professional, who has to use his or her voice for work, then discuss with your surgeon how rhinoplasty will impact your career and quality of life.
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