I have been to two otolaryngologists recently regarding surgery for a recurring stopped up nose which often interferes with my sleep. The first doctor recommended removing a large portion of one set of my turbinates. This seemed radical, and I was concerned about potential future dryness so I sought out a second opinion. The next doctor said that I was having problems as a result of a rhinoplasty operation performed eight years ago. He said that my nasal tip has collapsed somewhat, and that this often occurs after rhinoplasty operations. His recommendation was a surgery that would place stents in the nostrils using cartilage to keep them open and to widen the nasal passages. While he was doing this he would also work on the turbinates, however, he would do this in a submucosal fashion maintaining the physiology of the turbinates. He recommended that I see a plastic surgeon for a second opinion. Is this a common problem after rhinplasty operations? Is the surgery usually successful? Should it be performed by an otolaryngologist or a plastic surgeon? Also any additional advice would be appreciated. He suggested that I try the Breath-Right strips to see if they helped which they did tremendously. Unfortunately, I cannot wear one around the clock.
Reply: ------------------------
A potential complication of rhinoplasty is nasal airflow obstruction due to nasal valve or alar collapse. These are conditions related to weaknesses of the nasal tip cartilages. Patients who experience this complication frequently can improve their nasal airflow by lifting the tip of their nose or pulling their cheeks away from their nose. Breathe Right nasal strips can be highly effective in alleviating this type of obstruction. Surgical treatments are available to correct this problem and typically involve some type of augmentation of the nasal tip cartilages. Enlarged turbinates certainly could add to the nasal airway obstruction. Before recommending surgery for enlarged turbinates however, an adequate trial (a few months) of topical nasal steroid therapy such as Nasacort, Rhinocort, Flonase, Vancenase, etc should be tried first.
Ultimately, if surgery of either or both nasal tip and turbinates seems to be warranted, I would not recommend that you base your choice of surgeon on whether he/she is an otolaryngologist or a plastic surgeon. I would base it on the experience of the surgeon. Rhinoplasty is an operation done equally well by many otolaryngologists and plastic surgeons. Conversely there are otolaryngologists and plastic surgeons who are not as experienced in rhinoplasty. Generally, neither specialty is necessarily more adept than the other in this operation and therefore the decision should be based upon the experience of the individual surgeon as long as he/she is board certified in either otolaryngology or plastic surgery.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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