Nose Surgery & the Sinuses

"A lovely woman holds her blocked nose"

Why is my nose so blocked?

They are often blamed for continuing human misery, but scientists have revealed the sinuses are responsible for the shape of your nose.

But first, more about that sinus misery. While a vast sea of sinus “cure” potions, pills, drops, elixirs, tonics and assorted concoctions are offered in drug stores everywhere, the real bugbear is often not the sinuses at all.

Other nasal conditions often masquerade as sinus misery. Those conditions result in blocked breathing in the nasal channels preventing healthy draining. Not to put too fine a point on it, but when that drainage backs up, germs multiply creating stuffiness, headaches and the infamous “sinus pressure.”

Often, the conditions are a deviated septum or the need for turbinate reduction surgery.

Only an experienced nasal surgeon can tell for sure after a thorough nasal exam.

But what about the sinuses being responsible for the shape of your nose and the possible need for rhinoplasty, often including ethnic nasal surgery?

A just-released study from the University of Iowa and printed in the professional journal, The Anatomical Record reveals that nose shapes are determinded by the type of climate where your ancestors lived.

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The woman below and left from the Middle East requested the bump to be taken off her nose and for more nasal narrowing from the top to the tip. The healed changes, right, shows her more balanced face. (Photo, Robert Kotler, MD.) 

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The purpose of the much-maligned sinuses and the nose is to pass air to the lungs as rapidly as possible. The sinuses’ job is to warm the air you breathe and moisten it before delivery to the lungs.

In warmer places – like Africa – noses tend to be broad and short because the air is naturally warm and moist. But in a colder place – like Norway – the sinuses “ask” the nose to become longer and more narrow to trap your breaths of air for better moistening and warming.

Researchers discovered that by studying two groups of 20 people each; one group was of African origin while the second group came from Northern European. Results? The sinuses of  the European group were an average 36 percent larger in faces about the same size.

(Read the University of Iowa nose shape article.)

Said the lead researcher: “..These sinuses allow the nose to change its shape..in terms of width and independently from other parts of the face.

Previously, scientists thought that sinuses were just evolutionary leftovers, serving no useful purpose in modern people.

Rhinoplasty & Mouth Breathing

"A breathless man tries to catch his breathing via mouth breathing"

Mouth Breathing

The darnest things happen when patients inquire about rhinoplasty. Not only do they often complain about the appearance of their noses, but an ensuing nasal exam may reveal their noses are not performing their basic function: breathing.

A healthy person mostly breathes though the nose while resting, sleeping or moving around. During heavy exercise, you breathe through the nose and mouth to get extra oxygen.

But mouth breathing alone is bad news. In children, it can even lead to abnormal facial growth. In adults, mouth breathing can wreak havoc on:

  • Oral health
  • The gums
  • Irritate the tonsils and adenoids

Other possible causes of mouth breathing include allergies, a thick tongue or neck and obesity.

One dead bang giveaway of mouth breathing is a patient who has sleep apnea, snores at night and perhaps uses a CPAP machine, a mask-based device to force air into the lungs past any nasal blockages. He or she may also report “three to five” sinus infections yearly. Actually, true sinusitis is fairly rare while nasal congestion is often mistaken for sinusitis.

Mouth breathers often feel tired during the day and suffer reductions in smell and taste.  Some large uvulas dangling in the back of the throat are also  breathing bugbears.

Among anatomy checked by a nasal surgeon during a rhinoplasty exam is the septum, that thin, vertical wall of cartilage separating the two nostrils. If the septum is twisted or leans it into either nostril, it could block the air way and cause mouth breathing.

The surgical procedure, septoplasty, returns the septum to its proper position and unblocks the breathing channel. When septoplasty and rhinoplasty are done at once, the procedure is known as septorhinoplasty.

Located in the upper nose are three sets of bony shelves, the turbinates, which are covered with a unique skin, topped by a mucus membrane. The turbinates filter, warm and humidify air on the way to the lungs. (See illlustration, below)

When the sinuses drain and the turbinates are swollen, the patient suffers nasal congestion and again breathes through the mouth.

The skin of the turbinates is unique, found nowhere else in the human body. That particular skin has the ability to swell many times above its normal thickness and reacts to irritants.

To reduce turbinate swelling into the breathing channel, the nasal surgeon removes some of that skin and very slightly reduces some of the turbinate bone.

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"A drawing shows the location of the turbinates in the upper nose."

Turbinates Location