Functional Aspects in Secondary Rhinoplasty

Abstract

Flexibility of the lower nasal framework permits both temporary changes in nasal shape and a reliable return to normal resting contour once the forces of deformation are withdrawn. This skeletal “memory” is fundamental to normal nasal physiology. Partial collapse of the nasal valve on deep inspiration—a phenomenon seen in all healthy noses—converts the normally (resting) laminar airflow into a more turbulent flow for better mixing of the inspired air with the highly vascular nasal mucosa during periods of increased ventilatory demand. In turn, the increased mucosal contact results in more effective filtration, humidification, and warming of the inspired air. Variations in mucosal congestion, coupled with variations in dilator muscle activity, function to further regulate the balance between the rate of airflow and the efficiency of air purification. However, this delicate equilibrium is often inadvertently disrupted by cosmetic nasal surgery. In many instances the newly reshaped and often smaller nose functions adequately at first, only to slowly deteriorate as the forces of healing begin to progressively distort the surgically weakened skeletal framework. Although symptoms of nasal obstruction may be present throughout the day, symptoms are most severe during sleep when the nose naturally congests owing to supine posture and reduced activity levels. The result is often severe nocturnal nasal dysfunction, typically manifested by obligate nocturnal mouth breathing, consistently dry throat, excessive thirst, and frequent sleep disruption.