Why nasal obstruction worsens when the septum collapses to one side

Hello, I am Dr. Peter C. Kang.

Today, I would like to share a revision rhinoplasty case of a male patient who had concerns about severe left-sided nasal obstruction and a noticeably drooping tip.

In this case, the patient had undergone two prior nasal surgeries.

• Approximately 17 years ago: Reduction for a nasal bone fracture (at a university hospital)

• Approximately 10 years ago: Septal surgery and rhinoplasty with a silicone implant

However, from previous procedures, the septum had completely collapsed to the left, leaving almost no airway space in the left nasal cavity and causing severe nasal obstruction.

When the patient visited our clinic for consultation, the requests were as follows:

• Relief of left nasal obstruction (primary objective)

• Correction of crooked nose

• Improvement of a drooping tip

• Preference for autologous rib cartilage

• Improvement of scar tissue inside the nose

The left nasal obstruction in particular caused significant discomfort in daily life, so functional improvement was the patient's highest priority.

Preoperative examination revealed that the septum had completely collapsed to the left, leaving virtually no left nasal cavity space. In addition, the nasal tip was noticeably drooping, and the underlying cartilage and implant were visible through the skin.

1. Septal reconstruction using autologous rib cartilage

• Reconstruction of the completely collapsed septum using autologous rib cartilage

• Stable fixation by drilling holes in the maxilla for cartilage anchoring

• Structural restoration to secure space in the left nasal cavity

2. Septoplasty

• Straightening the deviated septum

• Root cause of nasal obstruction addressed

• Securing balanced airflow in both nasal passages

3. Septal extension

• Extending the nasal tip based on the reconstructed septum

• Naturally elevating the drooping tip

• Covering the cartilage and implant that showed through

4. Correction of nasolabial angle

• Adjustment of the angle between the nose and the lips

• Maximizing correction of the drooping tip

• Achieving a masculine yet refined profile line

5. Rhinitis surgery

• Reduction of hypertrophic inferior turbinates

• Resolution of nasal obstruction symptoms

• Restoring comfortable breathing function

1. Frontal changes

• The crooked nose was straightened

• Overall neat and refined impression

• Achieving bilateral symmetry

2. Profile changes

• The drooping tip was naturally elevated

• Cartilage and implant show-through were corrected

• A masculine and natural nasal bridge line

3. Functional changes

• Nasal obstruction relieved by securing left nasal cavity space

• Long-term functional maintenance supported by septal reconstruction

• Overall breathing improved through rhinitis surgery

When the septum has completely collapsed and the nasal cavity space is nearly gone, conventional septal correction alone has limitations. In such cases, the septum itself must be reconstructed using autologous rib cartilage.

In septal reconstruction, there is a process of drilling holes into the maxilla to secure the cartilage. In most cases, 1 to 3 or 4 fixation points are created. Bleeding can occur during this process, and particularly in patients who bleed more heavily, bleeding can sometimes arise from within the bone even after thorough hemostasis, occasionally leading to a septal hematoma. In this case, there was also a somewhat higher amount of bleeding during surgery, so I managed the recovery process with extra care, taking into account the potential for swelling, bruising, and hematoma formation.

Even in these circumstances, patients recover smoothly with appropriate postoperative management, so there is no need for excessive concern. The key is to closely monitor progress after surgery and take timely measures whenever needed.

I will continue to prioritize safety and recovery to provide the intended surgical outcomes. I hope this case provides helpful information to those with similar concerns. This has been Medical Director Dr. Peter C. Kang. Thank you.

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