Rhinoplasty and submucous resection

Anatomy or system affected: Nose

Definition: Surgical procedures that correct cosmetic and health problems related to the nose

Indications and Procedures

The nose, in addition to being an important organ for breathing and smelling, is cosmetically significant because of its prominence on the face. Hence, surgery to improve the nose may be medically necessary, or an elective procedure to enhance facial appearance (cosmetic surgery). In modern society, the latter type of nasal surgery is very common. Nasal surgery, however, usually involves both. Before examining rhinoplasty and submucous resection, it is useful briefly to denote the function of the nose, its anatomy, and its interconnections with the body’s respiratory and olfactory systems.

Air breathed in enters the nose through the nostrils, which are separated by a wall of cartilage and bone called the nasal septum. In most cases, the septum produces two nostrils of similar size. In some cases, however, injury or heredity causes the septum to become thickened on one side or to exhibit ridges or bumps. In a minor case of deviated septum, the irregularity may make one nostril smaller than the other and can affect breathing and sinus drainage adversely during colds. In very severe cases, it can obstruct and irritate the nose enough so that relatively permanent nasal tissue swelling requires chronic, uncomfortable breathing through the mouth.

In most individuals, inspired air passes into two nasal passages, which lead into the upper part of the throat. They allow the air to pass through the pharynx and trachea (windpipe) to reach the lungs. Each nasal passage is lined with a soft, moist mucous membrane which is covered with fine cilia (hairs) that catch dust and other particles and keep them from reaching the lungs. The nose and the nasal passages also raise the temperature of inspired air before it enters the lungs. Furthermore, the nose plays a large part in the sense of taste, as shown by the inability of people with severe colds to taste food.

Submucous resection is performed when the nasal septum is so distorted that it causes discomfort to the patient, especially chronic nasal pain, the need for continuous and uncomfortable mouth breathing, or repeated and prolonged colds. In these cases, the septum is reshaped to cure the problem, allowing the patient to breathe normally again through the nose. Septum resection may be accomplished with fine scissors, a scalpel, and/or bone rasps.

Cosmetic nose alterations are collectively referred to as rhinoplasty. The most common procedures correct prominent bumps, bulbousness, drooping tip, and overly large or small size. Text on cosmetic surgery of the nose includes descriptive terms that graphically identify the surgical problems encountered in rhinoplasty, such as “saddle nose,” “short nose,” “pig nose,” and “hook nose.” Rhinoplasty is also used to repair damage caused by accidents and cancer. Furthermore, it is an essential part of repairing a deviated nasal septum, which can greatly impair the breathing of afflicted individuals if left untreated.

Most often, nasal surgery is performed by use of intranasal incisions. The nasal skin is temporarily freed and pulled back from underlying bone and cartilage. Then, this hard framework is altered by partial removal, rearrangement, augmentation with synthetic materials, or bone and cartilage grafts from various parts of the patient’s body. The site in the nose and the shape of the grafts used depend on the procedure to be carried out. Once all necessary procedures have been completed on cartilage and bone, the skin is redraped over them. In some cases, especially where nose size is to be reduced, portions of the soft tissues of the nose are removed.

After nasal surgery—whether rhinoplasty, submucous resection, or some combination of techniques is used—the nostrils are packed with sterile gauze to prevent bleeding and to support the nasal mucosa during its initial healing, as incisions are usually sutured only minimally and with resorbable suture materials. The packing is often removed after several days. A nasal splint is also used in many cases. It provides external support and aid in maintaining nasal recontouring. The splint also protects the altered nose from damage during the several weeks usually required for most swelling to subside. After the removal of the splint, it takes at least several months for normal feeling and final nose shape to be attained as postsurgical swelling subsides entirely.

Uses and Complications

Nasal surgery can be done under local or general anesthesia in a hospital or in a surgeon’s office. Hospitalization and general anesthesia are most often used, although frequently, they are not needed. Most reconstructive surgeons prefer these operative conditions for the patient’s sake and because they allow easier physical manipulation of the patient.

Most procedures attempted are quite safe and uncomplicated. Occasional problems include excessive bleeding, internal scarring of the nasal mucosa, recurring airway obstruction, and unexpected contour irregularities. Infections after nasal surgery are rare except in cases where cartilaginous nasal implants are used. The incidence of infection may increase, however, as surgeons add forehead and chin alteration to rhinoplasty to optimize the overall cosmetic results.

Overall, nasal surgery is straightforward and has few real risks. Patients should be aware, however, that the procedure can fail to yield a chosen cosmetic improvement and that airway obstruction can be generated by the process or can recur after repair.

Perspective and Prospects

Among the exciting advances being made in rhinoplasty and submucous resection are the replacement of deficient nostril parts and septa with cartilage from other body parts or with synthetic materials. It is projected by some doctors that implants obtained from other individuals will eventually be used to repair function and appearance in individuals whose noses are irreversibly damaged by accidents and cancer.

Another aspect of the importance of cosmetic nasal surgery is the growing realization that the chin, forehead, and other parts of the face are important to the appearance of the nose. This led some surgeons performing nose recontouring to expend much effort toward examining these features and designing complementary surgical procedures to achieve good results. It is essential that patients looking to have a cosmetic procedure on their nose, or any part of their bodies, locate a trained, board-certified cosmetic surgeon to ensure a safe and aesthetically-pleasing outcome. In the 2020s, rhinoplasty surpassed breast augmentation as the most popular cosmetic procedure performed in the United States.

Bibliography

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Elsahy, Nabil. Plastic and Reconstructive Surgery of the Nose. New York: Elsevier, 2000.

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Gruber, Ronald P., and George C. Peck, eds. Rhinoplasty: State of the Art. St. Louis, Mo.: Mosby Year Book, 1993.

Jewet, Brian, Shan R. Baker, and Sam Nacify, eds. Principles of Aesthetic Nasal Reconstruction. St. Louis, Mo.: Mosby, 2002.

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"Rhinoplasty." Mayo Clinic, March 1, 2011.

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