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Babak Larian, M.D.
9401 Wilshire Blvd #650
Beverly Hills, CA 90212
Phone: (310) 776-6913
Fax: (310) 461-0310

 


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Nasal Airway Obstructions

Nasal Airway Obstructions, Corrective Nose Surgery & Rhinoplasty in Beverly Hills, Los Angeles

A nasal airway obstruction can have a major impact on the lives of those involved. The ability to breath through the nasal passage is an important way for the body to filter pollutants from the atmosphere. The air in major cities such as Los Angeles, and in fact the entire Southern California has large quantities of pollutants compounding the problem. A reduction or cessation of the ability to breathe through the nose can affect a person's overall health. Nasal passage blockage can also result in snoring.

 

About the Nasal Cavity and Nasal Septum
Causes of Nasal Airway Obstruction
Treatments for Nasal Airway Obstruction — Surgery and More
Anti-Inflammatory Nasal Spray
Septoplasty
Turbinate Reduction Treatments
Submucous Resection
Radiofrequency Reduction
Turbinectomy
Complex Procedures
Rhinoplasty

About the Nasal Cavity and Nasal Septum

The nasal cavity is an air-filled space lying inside the nose that is lined with a mucous membrane that helps to keep the nose moist. Inside the nasal cavity are six curved bones covered by sponge-like expansile tissue called turbinates. (Fig 10) By warming or cooling incoming air to within one degree of body temperature, and humidifying it, these turbinates serve to condition the air for introduction to the respiratory tract. The cavity also contains fine hairs that help filter particulates from the air we breathe. A nasal airway obstruction, such as enlarged turbinates from allergic rhinitis, can reduce or eliminate ones ability to breathe through the nose, and thus expose the individual to increased particulates and compromise his or her overall health.


Fig. 10 - Turbinates

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The nasal cavity is divided by a wall made of cartilage and thin bone called the nasal septum, which ideally runs through the center of the nose to create the left and right nostrils. In approximately 80 percent of people, the septum is displaced, creating one nasal passage that is slightly larger than the other. However, this doesn't cause breathing problems. But in some people, the septum leans significantly either to the right or the left. This condition, called a deviated septum, results in an obstruction to the nasal airway, reducing the ability to breathe correctly.


Fig. 11 - Septum & Turbinates

Causes of Nasal Airway Obstruction

Nasal airway obstruction is a very common condition in the United States that can be either temporary or chronic. The condition can be caused by a number of anatomic and non-anatomic factors, including:


Fig. 12 - Deviated Septum
  • Deviated septum. A deviated septum causes breathing in one nostril to be worse than in the other. A deviated septum is caused by fractures or other trauma, a congenital disorder, or drug use. This can cause breathing problems and a predisposition to sinusitis. This condition can be fixed with nasal airway surgery.

 

 

Fig. 13 - Enlarged Turbinate
    • Turbinate hypertrophy. Enlargement of the turbinates (called turbinate hypertrophy) causes obstruction of the nasal cavity as well. Initially nasal sprays or nasal irrigation with salt water is used to see whether the turbinates respond and shrink. In not, surgery should be considered to shrink this tissue.




    • Inflammation and swelling due to allergies or sinus problems. Allergies and sinus problems can cause swelling of the nasal lining, leading to blockage and poor airflow in the nose. In addition to nasal congestion, those who suffer from allergic rhinitis and sinusitis can experience sneezing, thin nasal drainage, or recurrent sinus infections, which can add to the obstruction problem.




Fig. 14 - Nasal Polyp
    • Nasal polyps. Polyps are noncancerous, grape-like growths that can appear on the nasal lining, which can plug the nose, making breathing more difficult. Polyps usually occur in individuals with asthma or allergic rhinitis and can contribute to worsening sinus conditions.



  • Nasal tissue enlargement. Adenoid tissue in the back of the nose usually shrinks during the late teen years. However, if the tissue fails to shrink, the enlarged tissue can cause chronic sinus infections, resulting in airway obstruction. Enlarged adenoids can also be a sign of a potential tumor.
  • Foreign bodies. Foreign objects such as beads, buttons, raisins, crayons, peanuts, and pencil erasers can become stuck in the nostrils and obstruct the nasal airway.
  • Medications. Nasal decongestant sprays and drops can contribute to nasal stuffiness if they are overused. These over-the-counter medications may provide initial relief for congestion, but using these products for longer periods of time can have a rebound effect, resulting in nasal passageways that are more swollen than before the products were used. The hormones in certain birth control pills can also cause swelling of the nasal lining and promote obstruction of the airways. Other medications, including those used to treat high blood pressure, can have the same effect.

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Treatments for Nasal Airway Obstruction — Surgery and More

Nasal airway obstruction is a very common problem and Dr. Larian strives to provide each of his patients with the best possible chance to reverse the obstruction. Most patients do not need surgery, The problem must be carefully assessed, diagnosed and treated.

Anti-Inflammatory Nasal Sprays

In a great majority of cases, nasal airway obstructions can be corrected without surgery. Anti-inflammatory nasal sprays can help improve airflow for individuals who experience impaired breathing from allergic rhinitis, sinusitis or other inflammatory causes. Nasal sprays are made of corticosteroids, which mimic an anti-inflammatory substance found naturally in the body called cortisol. Corticosteroids effectively work to reduce congestion and swelling in the nose as well as open up nasal airways by constricting blood vessels. Patients who use anti-inflammatory nasal sprays can find immediate relief from their allergy and sinus symptoms. Improvements usually start after a one-week delay, as such patients must be warned and encouraged to continue using the medications, and not to give up too quickly.

Septoplasty

A septoplasty is a nasal airway surgery procedure that aims to correct a deviated nasal septum to help improve an individual's nasal airflow. During the procedure, an endoscope is used to view the size and shape of the septum. Next, the surgeon creates hidden incisions within the nose. Then, the mucosal lining of the septum is detached and the crooked septum cartilage and bone is straightened. Once the septum is corrected, it is held in place with sutures and at times soft nose splints while it heals. Dr. Larian doesn not use nasal packing. The entire procedure takes approximately 30 minutes, depending on the complexity of the deviation. To learn more about this effective operation, please contact Dr. Larian today.

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Turbinate Reduction Treatments

Turbinate reduction surgery aims to decrease the size and thickness of the turbinates and the mucous membranes surrounding them to correct obstruction in the nasal passages. There are three kinds of turbinate reduction surgery offered at our practice: submucous resection, radiofrequency reduction, and turbinectomy. These three treatment options have helped many of our patients find the relief they need and improve their breathing. The choice of turbinate procedure is individualized to each patient's particular problem and need.

Submucous Resection

Submucous resection, or SMR, is a nasal airway surgery procedure that corrects obstruction caused by enlarged turbinates. The procedure involves making a small incision on the mucousal lining and removing the excess tissue and bone under the surface.

Radiofrequency Reduction

Temperature controlled radiofrequency is a state-of-the-art non-surgical approach to reduce the size of the turbinates. This fairly new minimally-invasive procedure uses a small electrode that is placed within the nasal passageways to heat and shrink turbinate tissue. The procedure is temperature-controlled, which allows for a safe, effective, and precise delivery of energy to the treated areas while preserving the normal function of the turbinates. Patients who undergo radiofrequency reduction experience a shorter recovery time than those who undergo submucous resection. Please contact Dr. Babak Larian for more information on this effective treatment option.

Turbinectomy

In addition to submucous resection and radiofrequency reduction, Dr. Larian also provides turbinectomy to treat nasal airway obstruction. Turbinectomy surgery involves removing large portions of tissue from the enlarged turbinates to resolve nasal obstruction. When done correctly this can be a very effective way to treat nasal obstruction.

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Complex Procedures

In certain patients, the problem can be more complicated and the patient may need additional complex procedures. External valve reconstruction is a procedure to reshape and reinforce the cartilages on the side of the nose that keep the nostril open from the side. This is especially and important procedure for patients that have had previous rhinoplasty procedure, which included removal of a portion of the cartilage, that now is too weak to maintain the nostril opening. Maxillary recontouring is done when the boney anatomy of the nasal aperture is too narrow thus obstructing breathing.

Rhinoplasty

Rhinoplasty is a surgical procedure on the nose to change the structure and form of the nose. It can be for cosmetic reasons, reconstruction of a deformed or traumatized nose, or functional reasons.

Careful analysis of the nose internally and externally is done to diagnose all problems. At times, a CT scan is obtained to view the deeper structures. Pictures are taken for further analysis and an appropriate approach is planned: open vs. closed rhinoplasty.Dr. Larian performs both open and closed rhinoplasty, customized to the unique needs of each patient. Closed rhinoplasty involves creating internal incisions that cannot be seen after surgery. During open rhinoplasty, an external incision across the columella is created to help the surgeon gain access to the internal structures of the nose. The incision usually heals well and remains unnoticeable. Once the primary incisions have been made, any obstructive tissues, including deviated parts of the septum, are corrected. After creating an open nasal passage the cosmetic and reconstructive portions of the surgery is begun. Often grafts are obtained to create natural lines and nasal anatomy.

From purely an aesthetic and artistic perspective a perfect nose is not necessarily a small one, but rather one that looks natural and fits the person[s face, and most importantly is not the center of attention. The attention should always be directed towards the more dynamic portions of the face including the expressions and the beauty of the eyes, lips and the smile. A small nose that is not appropriate to a face will bring the focus back to the nose, this is truly a failed result and all measures should be taken to avoid it.

Another very important consequence of a poorly planned rhinoplasty is nasal obstruction; when the nose is altered and is made smaller the air passage maybe disturbed. Appropriate steps must be planned, and taken during the operation to correct airway issues. All these possibilities are carefully considered and planned for before the operation.

Schedule a Nasal Airway Surgery Consultation at our Southern California Practice

Please contact our practice to schedule a comprehensive rhinoplasty consultation with Dr. Babak Larian.

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