The nasal septum is the partition between the left and right nasal passages. It is composed of cartilage in the front of the nose and bone in the back. The septum is important for the function and appearance of the nose because it directs airflow and supports the lower nose. A deviated nasal septum may block a portion of the airway and cause the nose or nostrils to appear crooked. You may be born with this problem, or it may develop from an injury to the nose. We often see patients who report childhood injuries that initially did not cause a problem, but became more apparent over time. This is a structural problem so nasal sprays and decongestants will only help to a limited degree. 

During surgery, we remove the affected cartilage, flatten it, and replace it in the septum. Sometimes we have to re-position an entire segment of the septum to the midline. For deviations present in the nasal valve area, we often use cartilage grafts to splint the septum and enlarge the valve area (see Nasal Valve Repair).

The turbinates are “mounds” of tissue in the nasal cavity that shrink and swell periodically to humidify, warm, and direct airflow. If we did not have turbinates, airflow would be dry, cool, and turbulent in a large nasal cavity. Allergies or infection can trigger persistent and excess swelling of the turbinates, thereby obstructing the airway. Steroid sprays, antihistamines, and decongestants are very helpful, but may not be enough over time. 

Because the turbinates play such an essential role in normal nasal health, yet can be a problem in certain situations, the best treatment is a conservative reduction. This may involve merely fracturing and pushing the turbinate out of the way or partially removing turbinate bone and tissue.

A through-and-through hole in the nasal septum may seem like it would help breathing. However, it makes it worse by creating turbulent airflow. Those who suffer from this problem may also experience a whistling noise when breathing, frequent crusting and nasal drainage, or severe bleeding from the nose. For some, it may even be painful, or a saddle nose deformity may develop. Septal perforations have a variety of possible causes including intranasal drug/medication use, chronic picking, autoimmune disease, and previous surgery or trauma.

Repairing a nasal septal perforation is an extremely complicated operation requiring transferring of internal nasal tissues and free tissue grafts. To learn more about this, see the section below on Septal Perforation Repair Technique.

A saddle nose deformity is a collapse of the nasal bridge and upturn of the nasal tip. The deformity is usually due to a very large perforation that has weakened the support structures of the nose and may have resulted from trauma, previous surgery, infection, or autoimmune disease. This can be socially and functionally debilitating for the unfortunate patients who suffer from this condition.

In order to reconstruct a collapsed saddle nose, we must harvest and carve a rib cartilage graft to replace the nasal bridge. It is preferable to use your rib cartilage, but Dr. Patel may also use donor rib cartilage for this purpose. A nasal valve repair may also be performed, and the nasal tip is often re-positioned it to a more natural position.