Nasal Obstruction and Snoring Treatment – NYC Facial Surgeon
Nasal Valve Collapse Treatment in New York
We just looked at potential causes for snoring due to nasal obstruction and examined how a malfunction of the nasal valve can cause snoring and other breathing problems. In this part, we will take an in-depth look at the nasal valve area, its anatomy and function, and Dr. Slupchynskyj’s surgical techniques that address snoring symptoms due to structural issues in and around the nasal valve region.
What Is the Nasal Valve Area?
As we reviewed earlier, the nasal valve is the narrowest part of the nasal passage. Located near the top to the nostril, the nasal valve regulates the air flow from the nose to the lungs. Several of the surrounding structures, both inside and outside the nose, can affect the functionality of the nasal valve. Defects in these structures can lead to a collapse of the nasal valve, which can hinder or obstruct breathing and also cause snoring.
Nasal Valve Anatomy
Although the nasal valve sits at the narrowest point in the nostril, the nasal valve area encompasses much of the upper nose. The nasal valve area starts at the upper lateral cartilage near the bridge of the nose. The head of the inferior turbinate bone inside the nose marks the top side of the area, and the floor of the nose forms the bottom. The anterior nasal aperture (also called the “piriform aperture”) outlines the edge of the area.
The nasal septum (the cartilage that divides the nostrils) forms a line that bisects the nasal valve area. In a typical nose, the angle between the nasal valve and the septum is between 10 and 15 degrees. When an obstruction occurs in the nasal valve area, the angle between the nasal valve and the septum is often narrowed. In some instances, the narrowing of the angle occurs in both nostrils. In others, one side is narrowed while the other has either a normal or a wider than normal angle.
Nasal Valve Physiology
Scientists have speculated about the full functionality of the nasal valve for nearly a century. One prevailing theory is that the valve works to control airflow as a “Starling resistor.” In a Starling resistor, a semi-rigid tube (in this case, the nostril) has a collapsible segment (the nasal valve) that restricts the flow of liquid or gas. As the pressure becomes unequal on either side of the valve, the walls of the nostril oscillate, thus producing the noises and breathing interruptions that come with snoring.
Another part of the nose that affects the function of the nose is the nasalis muscle, which flexes and compresses the nasal cartilage on either side. The nasalis muscle, especially the lower portion that attaches to the greater alar cartilage near the tip of the nose, is believed to prevent the collapse of the nasal valve during times of high airflow. However, if the surrounding cartilage is too rigid or damaged, the nasalis muscle may not be able to provide adequate protection to insure full nasal valve functionality.
What are the Causes of Nasal Valve Obstruction?
Mucous Membranes and Skin
Obstruction of the nasal valve can come from a wide range of sources. One of the most prevalent causes is irritation in the mucous membranes and skin that line the interior of the nostrils. These areas can become swollen, often due to allergies or “common cold” viruses, and inhibit the function of the nasal valve. Internal infections or external forces can also cause adhesions to form on the membranes, as well as strictures that can pinch off the air flow through the nostrils.
Another major cause of nasal valve obstruction is damage to the septum. If the septum is too thick, either from cartilage growth or from external trauma, it can reduce the angle between itself and the nasal valve. A deviated septum, often found in Dr. Slupchynskyj’s patients who are professional athletes and participate in contact or combat sports, can divert the angle and redirect air flow in the nostrils. In rare instances, the septum becomes warped and curved, which can cause major problems.
Upper Lateral Cartilage
The upper lateral cartilage supports the structure and forms the bridge of the nose. Along with the septum, the upper lateral cartilage gives the nose its shape along the upper and middle thirds. When this cartilage is damaged or deformed, it can also affect the functioning of the nasal valve. When one side or the other of the upper lateral cartilage becomes thickened, bent or curved, it affects the entire upper structure of the nose. Since the nasal valve rests in this area, the conditions can also affect the nasal valve itself.
Nasal Valve Issues and Snoring
For such a small part of the anatomy of the nose (estimated between 55 and 64 square millimeters), the nasal valve carries out a vital function. Almost any condition that affects the nasal valve can lead to snoring, up to and including Nasal Valve Collapse. If the valve does not function at its best, the interruptions in airflow can cause vibrations in the nose, sinuses and throat. These vibrations lead to snoring, which has been proven to be a serious health problem, both during sleep and in waking hours.
Non-Surgical Snoring Treatments
Many clinical studies showed the positive effects of mechanical devices and other non-surgical methods that prevented snoring due to Nasal Valve Collapse. Another popular avenue to open nasal passages are plastic nasal dilators that go across the upper lateral cartilage, commonly known as “Breathe-Right Strips.” These strips serve to open the upper areas of the nose and increase the angle between the nasal valve and the septum, but the extent of their effectiveness is still under clinical review.
Other non-surgical treatments that affect the nasal valve range from over-the-counter remedies to expensive machinery. The plastic dilators used in one study are effective, but are also reported to be uncomfortable and require replacement up to six times per year. Nasal sprays and medications open up nasal passages closed due to congestion, but they also carry some serious side effects. Patients with severe sleep apnea may invest in adjustable beds and constant positive airway pressure (CPAP) machines, each of which are highly expensive.
New York Nasal Valve Collapse Surgery
For a permanent solution to snoring, Dr. Slupchynskyj may recommend Nasal Valve Collapse Surgery. The main goals of the surgical procedure are to return the nasal valve to full functionality, while maintaining the consistency of the cartilage that makes up the valve itself. Dr. Slupchynskyj takes extra care in these scenarios to insure that the nasal valve does not become too rigid with scar tissue or too flexible and prone to collapse.
Dr. Slupchynskyj also takes precautions to preserve the mucous membranes and skin that line the inside of the nostril. The addition of scar tissue to these sensitive areas can affect both the function of the nasal valve and the sensation inside the nose as air passes through it. Also, the lower lateral cartilage (found at the outside and tip of the nose) is just as vital to nasal valve function.
The delicate nature of procedures such as rhinoplasty (reshaping the nose) and septoplasty (repairing the septum) require that a surgeon pay attention to how the results will affect nasal valve function. Not just any plastic surgeon can accomplish this goal. He or she must be formally and properly trained and experienced as only a Facial Plastic Surgeon is. Dr. Slupchynskyj, a NYC Facial Plastic Surgeon knows how to take into account the various regions of the nasal valve area, where the issues with the nasal valve lie, and how these regions work together to give the nose both its shape and function.
Butterfly Graft Surgery
Studies at the Oregon Health and Science University explored how a different surgical technique can improve nasal valve function and decrease snoring. The technique involved the use of external cartilage (often from the nose or ear) to create a “butterfly graft” that would dilate the nostrils and increase the nasal valve angle. The cartilage could then be grafted onto the patient’s nose, either internally or externally.
Out of the 37 patients who received the surgery, 35 had improvement in their breathing. In addition, 16 patients reported reduction in snoring, while 11 stated that their snoring had stopped completely. Malfunctions of the nasal valve are often a major contributor to snoring problems. After receiving treatment for these problems, Dr. Slupchynskyj’s patients and their partners can rest well, knowing that they will enjoy a quiet, restorative sleep.