Sunday, October 31, 2010

Non surgical, non-medical treatment for collapsed nostrils (nasal valve collapse)

Nostrils by David ShankboneImage via Wikipedia
One, if not the most difficult thing to do is find a non medical device that will help you breath, especially when you have a nostril that is collapsed or weakened (nasal valve collapse-internal or external), or septum which deviates to one of the sides. It for me, especially has become a challenge when i become congested on my worse side which is often, and probably a secondary condition to my nasal collapse. My collapsed side is very narrow more so in middle section with a septum that already deviates towards it, which then doesn't allow enough space to breath properly especially when the turbinates start to swell creating blocked up congestion leading to post nasal drip. One factor that I realize that aggravates this problem is salt. After eating a meal high in salt, my collapsed side gets worse. Another factor is humidity. I've noticed after a shower, i can become congested as well, but not as bad now since my turbinates were partially removed. Cold weather can be another factor. Over the nearly 30 years of suffering with my nose, i have tried different treatments and have had surgery's along the way, which changes the way your nose will respond to treatments as well. Other factors could be allergic reaction to dust, strong scents, a pet, etc etc... I have been on non steroidal sprays which don't work for me as effectively as it once did since my last surgery but still works at times. I also use to take anti inflammatory medication which seemed to give a little relief. When all else fails i would take my over the counter (otc) decongestant nose spray. Problem with that spray however is after taking it for few days straight it causes rebound congestion, making my problem much worse for days. I also use a ocean spray nasal mist every day to hydrate my nose, which is important if you've had nose surgery and experience some degree of dryness. Problem again is all these liquid sprays can and for me does cause post nasal drip. Occasionally instead of the otc decongestant spray i will take otc decongestant pill in its place. This can be better option at times, however the pill form can still cause rebound congestion if taken too often and has other side effects which affect your blood pressure, and even you heart rate.

The options for non medicated relief is limiting for those suffering with collapse&/or blocked nostril(s). Some find salt water or baking soda mixes or drops of solutions in water using a neti pot helpful for sinus issue's. Some will do steam treatments by draping a towel over their heads above a hot steaming bowl of water or mix. You may even try menthol or other topical ointment products. However if you have a collapsed nostril or over enlarged turbinate issues then those treatments won't be of much use. The only other non medicated treatment that may be of help are the nasal breath strips you place over the middle area of your outer nose, like a bandaid. For me this may work well for the first hour, but after that my nose becomes itchy from the adhesive and the strip starts to weaken over a few hours as well. It also may not open the area as much as you need or would like. So whats left??? Well there is one other option i discovered after seeing a well known nose surgeon named Dr.Dean Toriumi in Chicago a year ago. After one of my visits with him, he mentioned that i could try a plastic nose splint (plastic internal dilator) which he helped design. They go inside the nostrils and are much stronger then the otc nasal strips. Because only one side of my nose is very  hard to breath with i only use one splint . It takes time to notice its effect, but after a couple hours i find that it does help my congestion problem which then helps me breath better. I usually will try to sleep with it over night. It's not a cure, but it's the best non medicated treatment i have available, which  helps reduce the use of otc medications and therefore I strongly recommend it.

For more information contact Dr. Dean Toriumi's office.

***Update:  Dec.27 , 2010***

Here are some more new non-medicated options for nasal valve collapse utilizing internal nasal dilators such as: unseen nasal dilator, breathe with eez, nozovent & sinus cones. I will be doing another post soon on  minor surgical techniques for correcting nasal valve collapsing. But in the meantime do yourself a favor and check out the links down below. They discuss all kinds of breathing issue's with the nose and the many different options available to improve it.

Unusual but somewhat effective treatment for Nasal Valve Collapse
Muscle-building therapy in treatment of nasal valve collapse.
M Vaiman, E Eviatar, S Segal
 The present study was performed to investigate the best way to combine transcutaneous and intranasal surface electromyography (sEMG) biofeedback training of muscles involved in nasal valve function with a home exercise program and electric stimulation of nasal muscles. 

CONCLUSION: Relieve of nasal valve stenosis and collapse can be achieved with a complex muscle-building therapy as described. It helps a significant cohort of patients with symptoms of obstructed nasal breathing to avoid surgical intervention. Electric stimulation of the muscles does not contribute significantly in achieving of good results.

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Monday, October 18, 2010

The mystery of all the different types of nose grafts: Updated July 11, 2012

Spreader grafts are rectangular sculpted pieces of cartilage placed between the upper lateral cartilages and septum. They serve to widen the internal nasal valve, widen the middle vault, and prevent collapse of flail upper lateral cartilages. Also, they can provide additional support to the dorsum.

Do you get confused by all the different types of  nose grafts that are mentioned? Wonder where do they go, and how do they work? I'm not referring to where the source of origin for harvesting  are, like ear, septal, costal, calvarial, in cases of autologous grafts,  but referring to the actual names of the grafts relative to its location in the nose. For example: Columellar strut is a hidden graft within the columella that strengthens and supports the nasal tip. Spreader graft is another hidden graft, which is used to correct internal nasal valve collapse. A graft is simply a piece of  bone, cartilage, or soft tissue that is used for some purpose (i.e. structural support) in rhinoplasty. Each graft has a specific purpose. There are  tip grafts, batten grafts, strut grafts, dorsal augmentation grafts, rim grafts, lateral crural grafts, plumping grafts, caudal extension grafts, radix grafts, onlay grafts, shield grafts, etc.  Enough to get anyone confused and left scratching their head. Well here are some links that will help unravel this mystery. Grafts go by many names relating to their shape, size &/or locality in the nose.  A shield graft relates to the shape of the graft in the nasal tip lobule.. An "alar" batten graft relates more specifically to locality, but Alar batten grafts can be placed at slightly different degree's and angles.

If any of the above links are broken, please don't hesitate to let me know. 

The Butterfly Graft
The "Butterfly Graft" is a functional nasal procedure that Dr. J. Madison Clark has helped to develop and refine. Dr. Clark teaches the procedure to other nasal surgeons locally, regionally, and nationally. 

The simplest way to describe the procedure is as an internal "Breathe-Right" strip. The graft is taken from the ear but doesn't change the shape of the ear appreciably. It is usually intended that the graft not change the appearance of the nose, but it can be performed along with procedures that improve the aesthetic appearance of the nose (rhinoplasty).

The procedure is usually done under general anesthesia and takes about an hour to an hour and a half.

"Seagull Wing Graft

* This is specifically used for more serious cases to create  new lower lateral cartilages.  

A technique for the replacement of the lower lateral cartilages

Fernando Pedroza, MD; Gustavo Coelho Anjos, MD; Lucas Gomes Patrocinio, MD; Jose M.Barreto, MD; Jorge Cortes, MD; Suad H. Quessep, MD

The seagull wing technique is indicated in cases in which there are severe signs of overresection of the lower lateral cartilages. 

We describe our 20-year experience with the seagull wing technique, which is designed to replace the lower lateral cartilages and to reconstruct the nasal tip. This technique has the advantages of almost completely rebuilding the structure of the nasal tip, restoring the function of the external nasal valve, and effectively correcting a great variety of aesthetic deformities. 

Structural Approach to Endonasal Rhinoplasty
Anil R. Shah, M.D. and Philip J. Miller, M.D.
Includes Information on Extended Tip graft and Columellar strut
The marriage of endonasal rhinoplasty with structural grafting has resulted in more consistent rhinoplasty results. The nasal base can be stabilized by tongue-in-groove techniques, a columellar strut, or extended columellar strut. The middle vault can be addressed with spreader grafts or butterfly grafts. Lower lateral cartilage weakness can be supported with alar batten grafts or repositioning of the lower lateral cartilages.

Grafts used in closed (endonasal) nasal surgery

What's the difference between Lateral crural strut grafts and Alar strut grafts?  
Alar strut grafts and Lateral crural strut grafts are same thing. “Lateral Crural Strut Grafts” is the more precise terminology  to describe this underlay graft. A lateral crural strut graft  goes beneath the lateral crus to flatten it and/or to support it, preventing or correcting external valve collapse. Conchal cartilage is not strong enough to effectively support the lateral crus and is best not used for this.
Here's some other diagrams displaying nasal grafts. Click for larger view

Lateral crura strut grafts
Alar batten grafts

Rim grafts