Hello!
This is Dr. Chayoung Kang, director of Noselab Clinic. Today we will talk about relevant topics regarding nasal congestion.
More than 70% of all of our patients come to our hospital to undergo revision surgery, and about half of them present nasal congestion. Between all the factors that cause nasal congestion, today we will discuss about nasal cavity mucosal adhesion.
Since the space inside one’s nose is not visible with the eyes, there is no way to confirm if there is nasal cavity mucosal adhesion. The symptoms the patients often complain about are nasal congestion. However, at our hospital, when we take a CT scan and check the internal condition of the nose, there are often cases in which the septal cartilage and the surrounding tissue is different and are attached. In these cases, we perform an endoscopy to determine the location of the mucosal adhesion.
Preoperative Consultation and Endoscopy
Red * : Turbinates Black * : Septum
We were able to confirm that nasal cavity mucosal adhesion was present in the space between the turbinates and the septum on both sides. Because of this, I considered that there probably was nasal congestion and frequent nosebleed.
From the front, the patient’s nose appeared bent and the nose tip looked wide, as well as having significantly visible nostrils when seen from the front. The patient wanted to improve these parts, while also increasing the overall height.
Frontal view and lateral view photos of the consultation before surgery
Nostril view photo
Surgery Plan
- Intranasal mucosal peeling surgery to improve the nasal congestion
- Outer osteostomy to correct the deviated nasal bone, and a nose tip cartilage spreader graft to straighten it.in the direction.
- Nostril asymmetry is expected to improve by matching the direction of the deviated septal cartilage and the direction of the columella , and by reconstructing the suspected damaged alar cartilage with the septal cartilage. and repairing the nose tip cartilage.
- Septal extension graft using the self-rib cartilage in the nose tip to fix it upright in the middle, fixing the unnatural-looking wide parts. A slight lowering of the columella to set the nasolabial at an approximate 95-degree angle.
Photos were taken immediately before and after the surgery with the consent of the patient.
Photos were taken immediately before and after the surgery with the consent of the patient.
Photos were taken immediately before and after the surgery with the consent of the patient.
Photos were taken immediately before and after the surgery with the consent of the patient.
The surgery resulted as according to the preoperative plan., and the patient got satisfactory results. Only one thing that was unfortunately was that there was not enough skin to stretch out, so the nose tip was elevated to the safest point to give it a beautiful height, but the elevation was enough to make it look naturally beautiful.
90° angle | 45° angle | Frontal view. Photos taken after the surgery with the consent of the patient.
Medical Opinon: Nasal mucosal adhesion as cause of nasal congestion
The interior of the nose is wider than one may think, however the entrance (the nostrils) are narrow, so it is not a convenient space to perform surgery. For ENT specialists who have used an endoscope to perform many intranasal cavity surgeries before, this is not a problem, but for doctors who have not, they may possibly cause nasal mucosal adhesion.
Even though mucosal membranes are normally in contact with each other, no adhesion should occur. However, the situation changes when big or small wounds happen on the membranes during surgery. When the wounded membranes get in contact with each other, adhesion may occur and causes nasal congestion immediately.
Firstly, the most important principle is to avoid membrane damage as much as possible, and if damage occurs, trying to avoid the membranes opposite of each other to stick together is the most important thing. In the case that nasal mucosal adhesion happens, the adhesion has to be carefully peeled off under general anesthesia, and to prevent adhesion again, we can fix it with a silicone sheet in between for 2 weeks.
Today we talked about a deviated, wide nose corrective surgery, which also presented nasal congestion due to mucosal adhesion. I hope that this article will be helpful to anyone interested in having a revision rhinoplasty.
Dr. Chayoung Kang
Director of Noselab Clinic
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