Nasal Deformities

What are nasal deformities?

Nasal deformities are all those anomalies that alter the aesthetics or nasal function. It is more common than we think and many patients do not go to an ENT specialist. However, they report problems with bad breathing and suffer an aesthetic deformity. Aesthetic alterations sometimes also need to be corrected to improve functionality. Function and esthetics are related and need to be addressed together.

If the deformities are aesthetic, they should be divided into whether there is a problem of excess or defect of the dorsum, whether it is the tip of the nose that is deformed or asymmetrical, or whether the nose is laterally deviated. In this way the aesthetic nasal alterations can be studied and explained. If there is an additional functional problem it should be addressed in the same procedure.

Thus, the most common categories of deformities are:

1. Excessive projection of the nasal dorsum (hump nose). These deformities are usually accompanied by a decrease in the valvular angle and do not always have functional repercussions. They are of congenital origin, due to an excess growth of the septum.
2. Dorsal projection defect (saddle nose). It can cause various problems in the patient, such as respiratory discomfort, as there is a decrease in resistance due to an overly widened valve. The origin can be traumatic, related to granulomatous diseases or congenital.
3. Lateralizations of the nasal pyramid. They are usually related to deformities due to excess of the nasal dorsum.
4. Lateralization of the nasal septum, with possible obstruction of one of the nostrils.

There may also be other nasal deformities of congenital origin that can lead to problems in the patient, such as having a large nose, which usually does not produce symptoms, or having a small or narrow nose, which can produce respiratory insufficiency.

Nasal deformities may be functional or cosmetic.

Prognosis of the disease

Although nasal deformities can cause respiratory problems, it is not a malformation that prevents daily chores or that is excessively serious. It is true that the fact that the patient continuously breathes badly can cause derived problems, such as a prolonged bad rest, possible sleep apneas… Nasal breathing problems usually worsen with time and age, at the same time that the tissues lose consistency. If the nasal deformity is aesthetic and is maintained over time, it will also be affected with the natural aging of the body and facial structures.

Symptoms of nasal deformities

Many nasal deformities have no symptoms, so the patient does not notice if he or she is suffering from them. However, other deformities cause symptoms such as:

• Obstruction of the nostrils, or only one nostril. This can make breathing difficult and is more evident when the patient has a cold or suffers from an allergy that can inflame and narrow the nostrils.
• Nosebleeds. If the surface of the nose dries out, the patient may suffer more nosebleeds. – Facial pain. Sometimes a nasal deformity or deviated nasal septum can cause facial pain.
• Audible or noisy breathing during sleep. Occurs if there is inflammation of the tissue inside the nose. It is also common in infants and children with deviated septum.
• Nasal cycling. The nose is usually blocked on one side and the other, alternately, which is called “nasal cycling”. This is normal, but if it is very frequent, it may mean an abnormal obstruction.
• Preference for sleeping on one side. Some people prefer to sleep on one side to improve nasal breathing at night, which may be due to a deviated nasal septum.

Medical tests for nasal deformities

It is important for the specialist to establish an accurate diagnosis and for this it is important to determine the problem that prevents the patient from breathing well, or which are the aesthetic deformities that need to be corrected. Therefore, an examination of the inside and outside of the nose is necessary. For the interior exploration a fiberscope will be used, that is to say, a camera coupled to a flexible optical fiber. This device allows to observe if there is a mechanical obstruction or if the nose collapses when the patient breathes.

With the internal and external exploration (performed by the specialist with his own hands) the diagnosis of the aesthetic and functional problems suffered by the patient will be established. From this point onwards, we will discuss with the patient which aspects should be treated, the surgical techniques to be applied and which pathway should be approached.

What are the causes of nasal deformities?

The causes of nasal deformities can be produced by:

• Conditions from birth, having occurred during fetal development and becoming apparent at birth.
• Injuries to the nose. Any deformity may be due to an injury to the nasal organ. In infants it may have occurred at birth. In children and adults there are multiple accidents that can cause such injury, and trauma in contact sports are very frequent.
• Congenital. Sometimes nasal deformities are part of the normal development of people, inheriting the nasal shape from their parents.

Treatments for nasal deformities

The only useful and definitive long-term treatment is surgery, i.e. rhinoplasty. Although some substances have been developed that can be infiltrated under the skin to modify the contour of the nose, the results are not very consistent and the results are not predictable over time. Hence, the best solution is rhinoplasty. Currently, these interventions are not very painful and traumatic.

To carry out the intervention, the specialist must plan and individualize the intervention completely, since no two noses are ever the same. Depending on the severity, various surgical maneuvers can be used to improve nasal appearance and function. However, the surgery should last between one and a half to two hours, if the functional and aesthetic defect is to be corrected. The patient is usually discharged the same day of surgery and the definitive results are seen after 3-4 months.

Which specialist treats it?

The specialist who treats nasal deformities is mainly the expert in Otolaryngology. He is the one who knows the nasal organ, its anatomy and functionality, as well as any other related pathology of nasal problems. Sometimes rhinoplasties are also performed by the specialist in Plastic, Aesthetic and Reconstructive Surgery and, specifically, by a surgeon highly specialized in this field.