Nasal Obstruction and Rhinoplasty: A Focused Literature Review
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REVIEW
RHINOPLASTY
Nasal Obstruction and Rhinoplasty: A Focused Literature Review Lauren Wright1 • Katherine A. Grunzweig2 • Ali Totonchi3
Received: 20 January 2020 / Accepted: 16 March 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Abstract Background There is a significant variation in the assessment, treatment, and outcomes of nasal airway obstruction and management in the published literature. This study aimed to: (1) define key components of the nasal airway, (2) identify frequent causes of nasal obstruction, and (3) review existing treatment methods. Methods A systematic review of the literature was performed, and 135 studies were included via the following criteria: English, human subjects, and a primary endpoint of nasal airway improvement. Exclusion criteria were: abstract only, no airway data, pediatric patients, cleft rhinoplasty, sleep apnea, isolated traumatic nasal reconstruction, and cadaveric-only or animal studies. Results The relevant obstructive sites include the ENV, septum, inferior turbinates, INV, and nasal bones. Addressing the alar rim alone may be insufficient, and inspection of the lateral wall and crura may be indicated. Correction of septal deviation involves attention to the bony base. Mucosal sparing treatment of inferior turbinates improves outcomes. INVs are a major source of nasal obstruction, and treatment includes spreader grafts. The
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00266-020-01710-5) contains supplementary material, which is available to authorized users. & Ali Totonchi [email protected] 1
Hurwitz Center for Plastic Surgery, Pittsburgh, PA 15313, USA
2
University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
3
MetroHealth System, Case Western Reserve University, Cleveland, OH 44113, USA
bony nasal vault can contribute to nasal obstruction, including due to surgical osteotomies. Conclusions Anatomic causes of airway obstruction include the alar rims and lateral nasal walls, deviated nasal septum, inferior turbinate hypertrophy, decreased INV angle, and narrowed nasal bones. Treatments include graft placement; septoplasty; mucosal sparing turbinectomy; and lateral wall support. Pitfalls include failing to address the bony septum, over-resection of inferior turbinates, and narrowing of the nasal vault. Appreciation of airway management during rhinoplasty will improve functional outcomes. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. Keywords Airway Rhinoplasty Nasal obstruction
Introduction Airway obstruction can be structural or physiologic with static and dynamic components [1, 2]. The diagnosis and management of nasal airway obstruction require a comprehensi
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