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Nasal Surgery Rationale: An open nasal airway establishes physiologic breathing and may minimize the use of the open oral airway. It should be remembered that when the mouth is open the lower jaw auto-rotates open and allows the tongue to fall back into the posterior airway space. In some patients improvement of the nasal airway may also improve CPAP tolerance and /or compliance. |
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Indications: Nasal airway blockage caused by bony, cartilaginous or hypertrophied tissues that interfere with nasal breathing during sleep. Techniques: Septal and /or bony intranasal reconstruction, alar valve or alar rim reconstruction, turbinectomy.
Clinical outcomes: The ease and high success rate of nasal reconstruction makes this procedure a very valuable technique for those with nasal obstruction and SDB. By itself it is not likely to make a significant impact on moderate or severe SDB, such as the improvement seen with palatal or tongue base surgery. However, it is still an essential part of the upper airway that should not be ignored in the overall treatment of SDB. Correction of any defects at this level assures the ability for minimizing oral breathing and certainly should decrease the possibilities of elevated nasal negative pressure breathing during sleep. An example of an often missed cause of nasal obstruction is unilateral or bilateral nasal alar collapse on inspiration. This is seen frequently in subjects with OSAS (SDB). It is commonly seen on both sides, and can be easily corrected with a minor surgical procedure under local anesthetic as an outpatient. For a detailed treatment rationale, indications and outcomes continue to MANAGEMENT OF SLEEP-DISORDERED BREATHING under "Surgical Procedures". |
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