What causes nasal pinching after rhinoplasty? | causes, treatment, concerns

A pinched nasal tip occurs due to weakening of the nasal wing, which narrows the airway in the nose and causes problems such as difficulty breathing. The wings are the narrowest path in the nose for airflow and are located in the middle to the bottom of the nose.

 The main function of this part of the nose is to control the amount of air flow. Because the structure of wing is narrow, if another factor, such as nose surgery, makes the nostrils narrower, the amount of air flow through the nose will be reduced and in more severe cases it might be completely cut off. In this article, we will discuss the cause of nasal pinching and offer solutions for treating it after surgery.

What is the structure of ala nasi?

The alae nasi are made up of two parts; External and internal

• The inner part of the alae nasi

Most people only know the inner part of the nostrils. The consistency of the nose is due to this part and it is located between the skin and the respiratory tissue of the nose.

• The outer part of the alae nasi

The outer part of alae nasi consists of three parts; The bone between your nostrils, the bottom of your nose, and the walls of your nose.

When does the outer part of the ala nasi cause the nose to pinch inward?

It should be noted that weakness or upward form of the nasal tip bone can cause the outer part of the nose pinch inward. During rhinoplasty, the lower part of your nasal walls may be removed, which weakens the outer part of alae nasi and causes them to pinch inward.

When does the inner part of the ala nasi cause the nose to pinch inward?

If the upper part of your nasal walls is weak or too narrow, the inner part of alae of your nose may become pinched when you breathe. If a part of the inside of the nose is removed during rhinoplasty, it is possible that the walls of the nose at the top of it will come close to each other, and thus, the nasal pinching will occur in the inner part of the alae.

Symptoms of having pinched nasal tip

• Difficulty breathing
• Nasal congestion
• Blockage of the nasal passage
• Nose bleeding
• Scaling around the nostrils
• Snoring

Steps to diagnose pinched nasal tip

To correctly diagnose nasal pinching until we reach the next steps, which is the treatment of postoperative nasal pinching, the following actions should be taken:

The patient's medical history and signs of nasal congestion should be carefully examined first. The patient should then be examined for other problems associated with nasal pinching using endoscopy. Finally, to determine the cause of the nasal pinching, the cattell’s maneuver must be performed to determine whether the nasal pinching is more in the outer part of the alae or in the inner part of them.

Treatment of pinched nasal tip which happens after rhinoplasty

To treat a pinched nasal tip after surgery, you need to see which parts of your nasal wings have become narrower. Nasal pinching may have occurred in both inner and outer parts of nasal wings. If both the inside and outside of your nasal passages have been pinched inward, it is probable that your nasal airway would be completely blocked; But if only a part of it is abnormal, nasal breathing would be possible.

Use of medicines or some tools to treat pinched nasal tip

In the treatment of nasal pinching after surgery, using medications can be somewhat effective, and we will discuss some of them in the following.

Steroids such as Fluticasone can open the nasal airway a little, and this much opening is also helpful for patients with severe pinched nasal tip.

Gargling in the nose is also a common and safe solution that can rinse your nose and open your airways. It can make you feel better.

If you have allergies, you can use medications such as Loratadine and Cetirizine, which are anti-allergic and relieve nasal congestion to some extent.

In addition to the medications after rhinoplasty we mentioned, there are some tools, and if people do not want perform surgery, they might be able to solve some of their problems by using a nasal dilator. Some of these nasal dilators are placed outside the nose and open the nasal fins slightly; Others, made of silicone, are placed inside the nose. Both categories are commonly used at night and at bedtime. Of course, not enough studies have been done on the effectiveness of these tools.

If the use of such drugs and tools to treat pinched nasal tip after rhinoplasty does not work, you will probably need to do a revision operation.

Rhinoplasty to treat pinched nasal tip

There are a variety of ways to treat pinched nasal tip through surgery. You should see your doctor to choose the right method of surgery based on your condition and the structure of your nose.

• Surgery of the outer part of alae of nose

In rhinoplasty, the cartilage of your nose and the flesh attached to it must be strengthened. The surgeon may pick some cartilage from the other parts of your body, such as the ribs and ears, or another person’s body as donor, to treat pinched nasal tip. By doing this, your nasal cartilage will have the power to keep the outer part of alae in a normal position.

• Surgery of the inner part of alae of nose

Rhinoplasty can be done open or closed to place the cartilage between the middle bone of the nose and the upper walls of the nose, preventing the inner part of alae nasi from pinching inward.

• Other methods of surgery for treating pinched nasal tip

In addition to cartilage transplantation, another method of treating a nasal pinching after rhinoplasty is that the surgeon can operate on the outer part of the nasal septum to open the nasal passages to create more space for the patient to breathe.

• Using sutures to treat pinched nasal tip

Another way to treat a pinched nasal tip after rhinoplasty is to use sutures, which can push the structure of the alae nasi up and out to open the nasal passage for easier breathing. For this purpose, "polyglycolic acid" sutures are mostly used, which are absorbent. Once the sutures are absorbed, the wings of nose will remain the same. Depending on the patient's condition, both absorbable and non-absorbable sutures can be used; Of course, both cases have similar usages.

Possible sequelae of treating pinched nasal tip with surgery

Anesthesia: Depending on the type of anesthesia for rhinoplasty that your doctor prescribes for you, your body may have a specific reaction. Although this is unlikely to happen, you may want to consult an anesthesiologist.

Infection: In a few cases, it has been observed that patients become infected after surgery on the alae nasi. Surgeons should ask the patients to have a blood test to ensure that they are healthy enough for performing surgery. Surgeons should also take medications and supplements to ensure that patients do not bleed after surgery.

Need for revision procedure: Depending on the condition of the patient's nose and the complexity of the operation, it might be necessary to repeat the surgery to restore the beauty of the nose and its function.

Delay in surgical wound healing: In some patients who do not have a healthy physical condition, the course of treatment may be longer. Such people should take the necessary precautions before having surgery.

Reaction to dressings: Your body may react to materials used in rhinoplasty and postoperative dressings. Although these types of surgical complications are rare, you need to talk to your doctor about issues such as allergies to some of the adhesives used in dressings.

Changes in the patient's feeling about their nose: Some patients may have a different feeling about their nose after revision rhinoplasty; Like pain or numbness. This is a very rare complication of surgery, and if it does occur, it will be temporary and will go away.

Respiratory obstruction: The main purpose of surgery to treat postoperative nasal pinching is to improve the patient's respiratory status; However, sometimes in some patients, the nasal airway becomes permanently blocked or the blockage is intermittent but frequently happens. This is probably due to poor performance in postoperative care and may require another revision procedure.

Permanent need for medications: In some patients who do not have complete relief due to problems such as allergies, it is necessary to continue using medications such as steroids and sprays.

Perforation of the nasal septum: Occasionally, a hole may appear in the nasal septum after nasal pinching surgery. This complication does not cause a problem in some cases; But sometimes it causes nosebleeds and breathing problems, in such cases the patient needs another revision procedure.

Recovery after revision rhinoplasty

It usually takes about a week for you to return to normal situation after revision rhinoplasty. Follow these tips during this one-week treatment period:

* After surgery, see your doctor for few times to make sure you are recovering.

* Follow your doctor's recommendations during the recovery period; For example, sleeping with your head held high.

* Tell your doctor if you think your nosebleed is not normal.

* Do not expose your nose to strong winds and do not do Heavy exercises.

* Do not use painkillers such as aspirin to soothe your pain; This is because it prevents blood from clotting and causes your nose to bleed. Your doctor will prescribe the right medication to reduce your pain.

source : daneshyari.com