Physiologic Concerns During Rhinoplasty
The internal and external nasal valves are key to a patient’s breathing function, playing a critical role in rhinoplasty so an esthetically pleasing external nose can result without disturbing nasal breathing. The valve physiology is reviewed and a new cl
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E.B. Kern
Keywords
Internal nasal valve • External nasal valve • Premaxillary wing • Piriform aperture • Head of the inferior turbinate • Upper lateral cartilage • Lower lateral cartilage • Breathing dysfunction after rhinoplasty
Core Messages
• The prime physiologic concern during cosmetic rhinoplasty centers on the breathing function, correcting a present breathing dysfunction or preventing a postoperative breathing disturbance while improving the patient’s appearance. • The nasal valve is the most important part of the nose (internal and external) causing breathing disturbances. • Managing the entire nasal valve area is the main issue in protecting the patient’s breathing function during cosmetic rhinoplasty.
E.B. Kern, MD, MS Department of Otorhinolaryngology, State University of New York, 1237 Delaware Ave, Buffalo, NY 14209, USA Rhinology and Facial Plastic Surgery, Mayo Clinic Medical School, 200 1st St SW, Rochester, MN 55905, USA e-mail: [email protected]; [email protected]
36.1
Introduction
Truth is as you see it, and as I see it, after evaluating thousands of rhinologic patients, the most common symptom that I observed after failed rhinoplasty was difficulty breathing. This statement is based on my almost 50 years of working in otorhinolaryngology (primarily rhinology) and the findings of almost 9,000 breathing test patients (anterior mask rhinomanometry) and numerous papers presented to the profession over many years from data collected on patients at the Mayo Clinic in Rochester, Minnesota, USA, between the years 1972 and 2003 (Gordon et al. 1989; Kern 1973, 1977b, 1979, 1988; Mertz et al. 1984; McCaffrey and Kern 1979, 1986; Pallanch et al. 1985, 1993; De Bonilla SantiagoDiez et al. 1986). After prolonged study and writing regarding nasal physiology, I choose to summarize (simplify) and emphasize four primary functions of the nose (Bridger 1970; Bridger and Proctor 1970; de Wit et al. 1965; Kern 1975, 1984; Knops et al. 1993; McCaffrey and Kern 1980; Whicker and Kern 1973a, b). These primary functions are listed as follows: 1. Olfaction 2. Defense (sneeze, mucociliary transport, defensive proteins, and the immune system)
T.M. Önerci (ed.), Nasal Physiology and Pathophysiology of Nasal Disorders, DOI 10.1007/978-3-642-37250-6_36, © Springer-Verlag Berlin Heidelberg 2013
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Nose jobs: Hazardous to your health? May 14, 1996 Web posted at: 6:00 p.m. EDT From Corresponding Dan Rutz NEW YORK (CNN) -- At 21, Barbara wanted the perfect nose At 42, she would be happy to be able to breath though her nose again. Barbara is not alone in needing to have a “fixed” nose fixed again. In fact, as many as one in every five nose jobs in the United States is performed to correct a previous surgery.
Fig. 36.1 Report from CNN (Cable News Network) Food and Health May 1996 claiming that one in five “nose jobs” (rhinoplasty operations) needs to be “fixed” again because of a postoperative breathing disturbance. Realizing that the range of complications after rhinoplasty presented in literature
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