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Treating Nasal Obstruction

Septoplasty, Inferior Turbinate Reduction, and Spreader Grafts

The nasal septum divides the nasal airway into two sides. It consists of cartilage and bone and helps support the structure of the nose. If the septum is not straight or if it is crooked, it is described by the condition called the deviated nasal septum. In normal conditions, the nasal septum is usually a straight partition, though in some conditions, it may be deviated to one side or both sides. A deviated nasal septum can be a cause for various health issues such as difficulty breathing through the nose, snoring, sleep apnea, restricted breathing during exercise. The severity of the health issues associated depends on the severity of the deviation of the septum. Scroll down to know more about the symptoms associated and about the corrective surgery called septoplasty.

Symptoms of deviated nasal septum:

The deviated nasal septum can be marked by any of these following symptoms.

  • Frequent bleeding of nose
  • Nasal blockage
  • Nasal congestion that is sometimes one sided
  • Frequent sinus infections
  • Noisy breathing while sleeping
  • Restricted breathing during exercise

Septal deviation can exist since birth or can be a result of trauma. The symptoms are worsened with colds and allergies.


The surgery that is used to correct the deviated nasal septum is called the septoplasty. In the first visit for a corrective treatment of the nasal septum, the surgeon examines the septum by looking inside the nostrils. Based on the severity of the condition, treatment options will be discussed. In some cases, inferior turbinate reduction and spreader graft placement is needed to improve the airway. In these cases, septoplasty alone may not be sufficient.

The surgery can last up to 1 ½ hours and can be done either on local or general anesthesia. It is a simple surgery and can be done at the outpatient surgery center. In the case of septoplasty, there is no bruising of the external tissues, as the physician works through the nasal mucosa and trims of the deviated cartilage and bone to make it straight. Nasal packing is not typically used. The recovery is typically 1 week and discomfort is minimal.

Inferior Turbinate Reduction

The inferior turbinates are structures within the outer sides of the nasal airway that modulate airflow and help humidify the nasal air. In some cases, the turbinates become enlarged and as a result begin to block the nasal airway. The treatment is to reduce the size of the turbinates, by performing an Inferior Turbinate Reduction. This is often done in conjunction with the septoplasty or can be done alone. It depends on the circumstances involved in each case. This is a minimally invasive procedure with a short down-time. The recovery is minimal and generally takes 1 week.

Spreader Graft Placement

The internal nasal passage is made up of three components, the septum, the inferior turbinate, and the upper lateral cartilages (which forms the roof of the nasal passage). Together these form the internal nasal valve. The nasal valve is the most narrow aspect of the nasal airway and is considered the bottle neck. Small changes in the angle of the valve make major changes in the function of the nose. In some cases, a technique called placement of spreader grafts or repair of internal valve is used to open this angle and make a major impact in breathing. In cases where a person would benefit from this type of airway repair, septoplasty and inferior turbinate reduction alone will not be adequate. This is considered an advanced maneuver but an important one. We often see patients who have had septoplasty yet continue to have difficulty breathing. In these cases, following an examination with the cottle maneuver, in which the sides of the nose are pulled outward during inspiration and expiration, it can be easily determined if valve repair will be required.

The procedure can be done at the same time as the septoplasty. Cartilage is used to open the angle at the roof of the valve, which in turn opens the airway. Tape and a small splint is placed over the bridge of the nose for 1 week. Recovery takes about the same amount of time as septoplasty and inferior turbinate reduction.

These conditions are often covered by most insurance plans. Our practice accepts PPO plans that have out-of-network coverage. Click here to see if your plan would cover you to have the procedure at our facility.

Dr. Karam, who is board certified by the American Board of Facial Plastic and Reconstructive Surgery and American Board of Otolaryngology, offers services in San Diego County including San Diego, Del Mar, Carlsbad, Carmel Valley, Encinitas, Rancho Bernardo and La Jolla in Southern California.

If you are ready to schedule an appointment with Dr. Karam, contact us today.

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