Nasal Surgery

Nasal Obstruction: Nasal Cycle

The role of nasal obstruction in obstructive sleep apnoea has now been more or less defined. There is a phenomenon called the nasal cycle where at any point in time one nostril is blocked and the other is unblocked.

This oscilates or cycles with enormous irregularity usually about 2 hours in any individual. If the partition separating the two nostrils of the nasal septum is not in the midline then when the more patent or wider side becomes blocked by the nasal cycle patients are not able to breath through the narrowest side so they breath through their mouth, snore and/or become obstructed.


Nasal Obstruction

Surgery for obstructive sleep apnoea usually revolves around one of four operations or a combination of the four listed below.


Nasal septal reconstruction

Nasal septal reconstruction involves repositioning or reconstructing the partition between the two nostrils in the midline. It is usually performed under general anaesthesia using either little telescopes or loops in the nose. The operation takes about 1 hour and in 50% of cases this is done as a day only procedure but some people stay in hospital for one night.

Nasal tip resuspension

As we get older the tips of our noses droops. Even minimal drooping of the nose causes a significant increase in the resistance to breathing often necessitating a mouth open posture at rest which again contributes either to snoring and/or reflex apnoeic episodes. Nasal tip resuspension usually involves harvesting cartilage either from the patient’s septum or occasionally from a distal site (either behind the ear or from a rib) to resuspend the nasal tip, reduce the resistance to breathing and improve the airway.

Turbinoplasty

There is erectile tissue in the nose. Most of this erectile tissue is over the lowest of the three turbinates on the side wall of the nose, some of it is on the nasal septum itself in a structure called the nasal septal swell body and some of it is at the front of the middle turbinate, and occasionally in people who have low grade allergic rhinitis or chronic rhinitis the aforementioned erectile tissue becomes very swollen and a little like an elastic band that has been stretched a million times loses the ability to shrink back down either physiologically or by the application of either topical or oral medications. This erectile tissue can be trimmed and this technique is called turbinoplasty. More often than not the mucosa of the nose is preserved as much as possible and incision is made in the turbinate and under the lining the erectile tissue is removed by a variety of techniques such as the use of a small oscilating suction device called a microdebrider, the application of electrical energy either by way of diathermy or coblation or by the use of a diolaser. Preservation of the lining is associated with a more rapid recovery, less crusting and maintenance of normal hair cell function which is integral in the normal functioning of the nose.

Nasal valve repair

The meaty part of the nose has several complicated cartilages and as we get older these cartilages become weaker and when we take a big breath in this area of the nose referred to as the nasal valve can collapse. Nasal valve collapse is a common cause of nasal obstruction and is appropriately treated surgically by way of nasal valve reconstruction. There are a number of techniques to do this, often the simplest is by way of scarification but more often than not what is required is importing tissue which can be laid over the existing cartilages to strengthen them by way of an ala splint or baton or by reconstructing the internal nasal valve and widening the nose. Cartilage is harvested either locally from the septum in the nose, from behind the ear or from ribs.


If you doubt nasal obstruction is the reason for your sleep apnoea, please call (02) 9387 7360 to arrange a consultation with Prof. Thomas Havas at Havas ENT Clinics.