The objective in nasal reconstruction is to create a nasal airway passage with laminar air flow. Patient with obstructive sleep apnea (OSA) or snoring could have blockage or decrease and turbulent nasal airway passage. Patients with OSA will not be able to adequately use their Continuous Positive Airway Pressure (CPAP) machine. Nasal reconstructive surgery can reduce or alleviate snoring as well aid patients with OSA to have maximum benefit of their CPAP machine. The main anatomical locations controlling laminar air flow are at the nasal septum, the turbinates, the internal nasal valves and external nasal valve also described as the nostrils. The correction of deviated nasal septum (septoplasty) and the reduction of hypertrophied inferior turbinates (partial turbinectomy or radiofrequency reduction) are described else where in this website. Nasal polyps may also create decrease or turbulent airflow. Nasal polyps are surgically excised.

The internal nasal valve is anatomically made up of the nasal septum, the mid line structure that divides the nose and the nasal cartilage following the nasal bone (upper lateral cartilage). when these two structure form an angle less then 15 degrees, it will decrease and create turbulent airflow through the nasal airway passage. This could be as a result of history of nasal trauma, aggressive nasal surgery (rhinoplasty) or birth defect.

This is corrected via use of cartilage graft (spreader graft) between the septum and upper lateral cartilage. This procedure will increase the angle at the internal nasal valve and promote laminar air flow. The cartilage graft is usually taken from the nasal septum at the time of surgery.

The external nasal valve and the nostrils are the rate limiting factors in how much air will flow through the nasal air passage. This structure is created by the nasal tip cartilage (lower lateral cartilage) which has an arch shape and nasal septum. When there is an anatomical distortion of the lower lateral cartilage with collapse, it will decrease and create turbulent airflow through the nostrils. A history of aggressive trimming of the lower lateral cartilage during rhinoplasty is the main cause of collapse as well as nasal trauma and birth defects. A cartilage graft (Alar graft) harvested from the nasal septum or ear is placed on top of the lower lateral cartilage elevating the collapse arch and nostril. This will increase the radius of the nostril and the flow of laminar air.

In our practice we preform closed nasal reconstruction also known as secondary Endo-Rhinolpasty. This will lead a more natural appearance of the nose following the surgery. The surgery is preformed majority of the time as an out patient at a surgical center. If the patient has medical conditions such as moderate to severe OSA, patients are treated at the hospital and monitored for 24 hours or more. Complications of nasal reconstruction include:

• Infection, very rarely seen when antibiotics are used
• Bleeding that will require hospital admission or blood transfusion
• Failure, need for further surgery

Complications are rare and infrequent in the hands of highly qualified and experienced surgeons.