Disorders of the Lateral Nasal Wall and Nasal Septum in Patients Candidate for Septorhinoplasty

Septorhinoplasty is among the most frequently performed plastic surgeries and a common surgical procedure in the field of head and neck. A minor modification of 1 mm can significantly affect the surgical result, necessitating an in-depth understanding of nasal anatomy and adjacent structures on the part of the surgery. The surgical goal for these patients is to address both aesthetic and functional issues, ultimately enhancing their quality of life.

Advancements in understanding the anatomy and physiological characteristics of the nose have paralleled the evolution of surgical remedies for obstructive and aesthetic nasal issues.

The nasal septum carries out several functions, such as splitting the nasal passage into two distinct compartments, maintaining the shape of the nasal dorsum, columella, and nasal tip. Disruptions, be it from injury or innate malformations, in the septum can result in substantial nasal obstruction and visible nasal deformities. The architecture of the nasal septum is composed of distinct osseous and cartilaginous elements, which encompass the perpendicular plate of the ethmoid bone, the vomer bone, and the septal cartilage.

A flawless, undeviated septum ensures that incoming air is humidified, warmed, cleansed, and made appropriate for gas exchanges in the lung alveoli. However, a deviated septum can create various degrees of nasal blockage and modifications in nasal respiration. Disruptions in the airflow can result in olfactory impairment, impairment in the purification and humidification of respiratory air, and diminished oxygen intake. Additionally, anatomical aberrations in the septum can cause epistaxis (nosebleeds), chronic sinusitis, and commonly manifest as visible alterations in the nose's exterior appearance. Septum deviation indicates a departure from the midline, whether of the bone or cartilage, or both.

Common deformities associated with the septum include the subluxation of the rectangular cartilage from the maxillary ridge, or its deviations, which block the nasal floor and distort laminar airflow. Also, Deviation of the caudal portion of the nasal septum may result in nasal obstruction, a crooked nose, and columellar irregularities. The correction of a severely deviated caudal septum is one of the most difficult challenges for the otolaryngologist.

One potential cause of treatment failure may be misidentification of other comorbid causes of nasal obstruction, specifically nasal valve collapse (NVC). Nasal valve collapse not only affects function but also shape of the nose, concurrent NVC is often viewed as an important feature to identify prior to a septorhinoplasty to prevent need for revision surgery .

On each lateral wall of the nasal cavity, there are three bony projections known as nasal turbinates. Disorders in the lateral wall can affect the function of the nose. In a condition known as concha bullosa, the turbinate has a double layer of bone instead of a single layer.

Inclusion criteria

• All sept rhinoplasty patients aged between 16-60 years

Exclusion criteria

• participants who had a history of major craniofacial trauma or surgeries
• conditions such as acromegaly or gigantism
• fungal infections in the paranasal sinuses
• craniofacial malignancies
• chronic rhinosinusitis
• congenital anomalies like cleft lip or cleft palate.