The structure of the internal and external parts of the nose can have a profound impact on breathing. A deviated septum, for example, can make breathing through the nose difficult. In addition to deviations of the septum, there are other issues which may contribute to problems breathing through the nostrils, such as enlarged turbinates and cartilage or bone spurs.
The nasal septum is made of cartilage and is located in the very center of the nose. It is the structure that separates the right nostril airway from the left nostril airway. Deviations of the septum can block the flow of air in the nostrils and interfere with breathing.
A deviated septum can be corrected by removing the curved portions of the septum and by perfoming a septo-plasty (reshaping of the septum) at the same time. The exact areas that need to be removed, and the specific techniques used to re-shape the septum, will vary from person to person. These techniques may involve moving the septum to the midline and applying a combination of stitches to modify the curvature of the septum.
Normal internal anatomy of the nose showing the nasal septum, inferior (lower) nasal turbinates and the nasal sinuses.
Removal of curved portions of the septum combined with reshaping of the septum (septo-plasty).
Photo credit: https://oufer.myshopify.com/
Photo credit: https://www.dfwsinusselect.com/
The bone of the inferior turbinate can be removed or reduced in order to open the nostril airway.
INFERIOR NASAL TURBINATES
The inferior nasal turbinates are small growths of bone covered with a mucosa lining (the lining of the inside of the nose) located within the nostril airway. The purpose of the inferior nasal turbinates is to warm and humidify the air coming through the nostrils.
In some patients, the inferior nasal turbinates can be enlarged. This enlargement causes the tubinate to block the nostril airway, making breathing more difficult. In some severe cases, the septum and the turbinates may touch, completely blocking all air flow.
In order to correct this, the turbinates must be reduced in size. This can be done by removing or moving the small portion of bone inside the turbinate. (see the diagram to the right). Once this is done, the airway will become more open.
CARTILAGE AND BONE SPURS
Spurs are small outgrowths of cartilage or bone inside the nose. Spurs are often found along the bottom of the septum where they may interfere with breathing. They vary in size, but can become quite large.
When this occurs, it will be necessary to remove the spurs in combination with other techniques to improve nasal breathing.
Combination of Septal Deviation, Lower Turbinate Enlargement and Bony Spurs
More often than not, breathing difficulties through the nose are usually caused by a combination of multiple issues. These include septal deviation, enlarged lower turbinates and the presence of bony spurs.
In these cases, it will be necessary to surgically correct all problems. The combination of removal of portions of curved septum, septoplasty (septum reshaping), lower turbinate reduction and removal of bony spurs will be necessary. When this is done, the improvement in breathing can be dramatic.
This is a video which shows how Dr. John Diaz performs his technique for removing portions of the septum which are deviated. His technique is done using a "Closed" approach which means that all incisions are made inside the nostrils. There are no external or visible scars with this technique.
The picture above is of the inside of the left nostril. In this example, there is a spur from the nasal septum going into the left nostril airway. It is large enough to touch the lower (inferior) turbinate located across from it. This severely reduces airflow and needs to be corrected.
This is from an actual patient. The line points to the portion of the septum that was deviated and was removed. The surrounding fragments (circled) are composed of the inferior turbinate bones, cartilage spurs and bone spurs which were interfering with breathing. Some patients have a large amount of bone and cartilage blocking their airway, as you can see in this photo.