It’s springtime in St. Louis (at long last). The trees are budding, the grass is growing and the noses are running! In most cases, nasal congestion and drainage are minor inconveniences that can be treated with prescription or over-the-counter medications. However, it’s not always that easy.
“One problem we see is the excessive use of over-the-counter nasal sprays,” warns Dr. William Hart Jr., a plastic surgeon and board-certified ear, nose and throat specialist with Hart Cosmetic and Reconstructive Surgery Institute. “Patients can experience a rebound effect, which is marked by swelling of the tissues, making breathing even more difficult.” He advises limited use of nasal sprays for no more than four days.
“The sinuses normally drain about a quart of fluid per day,” he adds. However, if an individual suffers from excessive or foul-smelling drainage, fever or headaches, a visit to the primary-care physician is justified, he says. Sinus and nasal problems that don’t respond well to conservative treatments may need the attention of a specialist. Occasionally a more complex solution is needed to correct medical conditions that hinder breathing or contribute to repeated sinus infections. Nasal surgeries are usually performed under general anesthesia, but many are done on an outpatient basis.
One of the more common types of nasal surgery involves repair of the septum, which is the wall that divides the nose into halves. “Think of the inside of the nose as a highway that has two lanes, which are the nostrils, and a median, which is the septum,” says Dr. Mike Nayak of Nayak Plastic Surgery and Skin Enhancement Center. “If the median swerves one way or the other, it’s tough to get traffic, or airflow, through the blocked lane.”
Repairing a deviated septum can ease breathing and reduce sinus infections. It does not change the external appearance of the nose, although some patients opt to combine the corrective surgery with a cosmetic procedure. If this is the case, insurance will reimburse costs for the corrective portion of the procedure but not the costs associated with the cosmetic portion. Surgical methods used to open blocked sinus passages and clear infected mucus and fluids from the cavities vary depending on the portion of the sinuses that need attention. X-rays or CT scans help the surgeon pinpoint the treatment area.
While about 85 percent of Nayak’s practice is devoted to elective cosmetic procedures, he says the remainder of his work involves reconstruction needed to repair damage done by skin cancer treatment. Some skin cancers are so deep, their removal leaves a noticeable hole. “The problem with this type of procedure on the nose is that there’s no extra skin to work with,” he says. “The cheek or neck has some lax skin, but the nose is shrink-wrapped.” Additional challenges involve the fact that the surgical wound contracts during healing, and the skin itself tends to be thick and greasy, which makes it more prone to scarring. “Skin from other areas doesn’t look like nose skin, which has a different texture and visible pores,” Nayak says. “So we can’t do a graft from another area of the body without it appearing to be an obvious patch.”
Reconstruction of the nose requires a layered approach, starting with the innermost layers of tissue. The surgeon then recreates the cartilage layer or adds cartilage harvested from the back of the ear in order to prevent excessive contraction during healing. “The external covering of the nose is the trickiest part,” Nayak says. More than one surgery is usually needed to completely reconstruct the nose, and Nayak performs two or three such procedures each week.
Dr. Gregory Branham, who practices at Washington University Physician West County office, says trauma or previous surgery can lead to nasal obstruction that requires a surgical solution. “When the nasal structures are traumatized, the overall effect is for the nose to collapse inward, creating a more narrow nasal vault and worsening obstruction,” he says. “Consequently, one of the most common procedures I perform for improvement of nasal function is cartilage grafts to reconstruct the damaged nasal skeleton.” He adds that the nasal bones may need to be refractured in a controlled fashion to bring them back to midline.
Branham says that recovery varies between a week to two weeks, depending on the extent of surgery performed and individual variation in terms of bruising, swelling, etc. However, he says that most patients are ready to return to work and social activities within a week. “Nasal surgery can be very rewarding for the patient due to the fact that nasal obstruction can be a vexing problem for so many people,” Branham says. “Most patients are happy they did it once it is healed.”