Functional Rhinoplasty – Part One

[Functional Rhinoplasty – Part One] Is Breathing Difficult a Daily Issue? ENT Doctor Explains: The Fundamental Solution to "Structural Nasal Obstruction"

When Breathing Becomes a Luxury – Ah Kin's Struggles

For 35-year-old firefighter Ah Kin (pseudonym), "breathing freely" is not just a pursuit of quality of life; it is a necessary condition for occupational safety. He has suffered from severe nasal congestion for years, especially worsening when lying down, leading to poor sleep quality and daytime fatigue. More critically, wearing breathing equipment in high-pressure environments, such as at fire scenes, makes his already difficult nasal breathing feel even more strenuous and unsettling. He has tried various medications and nasal sprays, but their effectiveness has been inconsistent, never providing a permanent solution, and  he worries that long-term use could lead to dependency or even "medication-induced rhinitis."

Ah Kin's predicament reflects the voices of countless long-term nasal congestion sufferers: "Where is the root of the problem?"

To address this fundamental issue, A-Kin decided to seek help from a doctor. This article will follow his journey to seek medical assistance, gradually breaking down the causes of "structural nasal obstruction" from a professional medical perspective, and providing an in-depth understanding of the medical approach of "functional rhinoplasty."

The "Structural Triangle" of Nasal Congestion and the Limitations of Medication

Many attribute long-term nasal congestion to "nasal allergies." Dr. Lee Shui Kwong points out that in ENT treatment, we adopt a stepwise approach to diagnosis and treatment. Medication is the first-line solution for managing inflammation (such as nasal allergies), but if the feeling of blockage persists after treatment, the issue often lies in the nasal cavity's "hardware"—its physical structure.

Stubborn structural nasal obstruction is usually caused by one or more problems within the following "triangle":

• Deviated Septum: This is the core culprit. The septum is the central bone plate that separates the left and right nasal cavities, ideally straight. However, due to congenital development or acquired trauma, many people's septums may curve into a C or S shape, blocking one or both airways, leading to breathing difficulties, affecting sleep, and causing snoring or exacerbating sleep apnea.
• Hypertrophied Turbinates: The turbinates are mucosal tissues in the nasal cavity responsible for filtering and humidifying air. When a deviated septum makes one side of the nasal cavity too narrow, the other side, being wider, may become "compensatorily" enlarged, attempting to balance airflow, resulting in double obstruction.
• Nasal Valve Collapse: The nasal valve is the narrowest area at the entrance of the nasal cavity, akin to a "bottleneck" in the airway. If the cartilage support here is insufficient, it may collapse inward during inhalation, severely obstructing airflow.

The Roles of Medication and Surgery: Complementary Treatment Approaches

Medication and surgery are partners at opposite ends of the treatment spectrum. The doctor's treatment direction is to first address or rule out mucosal inflammation, allergic rhinitis, and other "soft tissue" problems with medications (such as steroid sprays or antihistamines). If there is significant improvement in nasal congestion with medication, then ongoing medication is the most suitable option.

However, for structural issues like a deviated septum involving "bone" and "cartilage," the effectiveness of medication is quite limited. Once it is confirmed that the root of the problem lies in unchangeable structures, it is advisable to consider functional rhinoplasty. It is important to note that this surgical procedure corrects the internal structure of the nose to improve both breathing and appearance, providing significant relief for symptoms caused by structural abnormalities (such as a deviated septum), including nasal obstruction and recurrent sinusitis. However, if the underlying cause of nasal obstruction is allergies or inflammation, medication treatment is also necessary. Both approaches complement each other to achieve the best therapeutic outcome.

Solution – Diagnosis and Surgery Focused on "Function"

Functional rhinoplasty surgery aims to restore normal breathing function. Dr. Lee Shui Kwong emphasizes that before formulating a plan, there must be thorough communication between doctor and patient to understand the achievable goals and potential limitations of the surgery, establishing consistent expectations—this is a crucial foundation.

Before deciding on surgery, a rigorous series of diagnostics is essential:

• Medical History and Coordination: In several follow-up visits, the doctor gathers detailed information about the history of the nasal congestion, its patterns (e.g., day vs. night), and its impact on life, as well as assessing responses to medication.
• Nasal Endoscopy: This is a key step. The doctor will use a high-definition endoscope, allowing the patient to see their own deviated septum and enlarged turbinates on a screen, providing a direct understanding of the issue.
• Imaging Tests (if necessary): In complex cases or to assess the condition of the sinuses, a CT scan may be arranged to accurately evaluate the extent of bone structure curvature from a 3D perspective.

Surgery Breakdown: Reconstructing Your Airway

The sole goal of functional rhinoplasty is to reconstruct an unobstructed airway. The surgery is performed under general anesthesia and takes about 1.5 to 3 hours.

Core Steps of the Surgery:

1. Septoplasty: Through a minimally invasive incision inside the nostrils, the crooked and deformed septal cartilage and bone are precisely removed or straightened to restore it to the central position.
2. Turbinate Reduction: For excessively enlarged turbinates, minimally invasive techniques such as radiofrequency or powered rotary knives are used to reduce their size while preserving their normal function, thereby widening the airway.
3. Nasal Valve Repair: If nasal valve collapse is diagnosed, the doctor will use a portion of autologous cartilage taken from the septum as a graft to reinforce the fragile nasal valve structure, preventing it from collapsing during inhalation.

About Incisions and Appearance:

Most functional rhinoplasty surgeries can be completed through a "closed" approach, meaning all incisions are hidden inside the nostrils, leaving no visible scars. However, in dealing with extremely complex trauma or secondary reconstructions, an "open" incision may be required, which could leave a fine incision on the skin between the nostrils or, in individual cases, on the philtrum.

To be continued…

Updated: 2025-10

Please note that all medical health articles featured on our website have been reviewed by Chiron Medical doctors. The articles are for general information only and are not medical opinions nor should the contents be used to replace the need for personal consultation with a qualified health professional on the reader's medical condition.