What is the role of the septum in nasal aerodynamics?

Updated: Nov 04, 2019
  • Author: Samuel J Lin, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Sachs writes that an important area of the septum to consider is the upper bony septum in the area of the perpendicular plate of the ethmoid. [30] Sachs states that this area may cause nasal obstruction and prevent inward displacement of the nasal bones during osteotomy. Correction of the inferior portion of the septum is also important. Rhinoplasty that includes alar base resection moves the sides of the nose medially, and the turbinates can be in contact with previous septal deflections.

Hypertrophic turbinates may also contribute to nasal obstruction after rhinoplasty; resection of the inferior turbinate may be necessary. [31, 34] While outfracture is a potential solution, submucosal turbinate resection with volume reduction is often favored. [34, 35] Septal deformities that affect the nasal valve and narrow the angle between the septum and upper lateral cartilage may cause nasal obstruction.

In addition to noted cosmetic benefits, septoplasty and septal surgery for the treatment of septal deviation are shown to produce objective benefits for nasal patency. [36] It should be noted, however, that otherwise asymptomatic septal deviations may become problematic for patients after rhinoplasty. [20] Kim and Papel note that separation of the upper lateral cartilage and septum during dorsal hump reduction may cause a destabilization of the upper lateral cartilages and increase obstruction at the internal nasal valve. [37]  Tardy suggests that the upper lateral cartilages (unless deformed or asymmetrical) should be left attached to the septum in the vast majority of patients and that damage to the internal valve commonly results from separating the upper lateral cartilages from the septum. [38]

Tardy states that manipulating the lateral-most extent of the alar cartilages is seldom necessary; removal of cartilage in this area may cause dimpling and varying amounts of nasal obstruction. [38] Inaccurate lateral osteotomy and infracture can cause significant narrowing of the nasal valve. [39] Webster describes a modified approach to lateral osteotomy that preserved a portion of bone at the frontal process of the maxilla at the piriform aperture. [40]


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