The nasal septum is the wall between the nostrils that separates the two nasal passages. It is made of a thin sheet of cartilage and bone, within an envelope of tissue (mucosa).

• A deviated septum occurs when the cartilage or bone is not straight.

• A crooked septum can make breathing difficult. Increased effort to breathe through the nose also can lead to snoring and sleep apnea.

• Surgery to straighten the septum is called septoplasty. This procedure may be done along with other procedures to treat recurrent or lingering sinus infections or to address the airway obstruction that causes sleep apnea. Septoplasty also may be done to allow access into the sinuses to remove nasal polyps.

• To repair the septum, a small incision is made inside the nose, opening the envelope of the septum to access the underlying cartilage and bone. The cartilage may be trimmed or scored to straighten the bent cartilage and remove any crooked pieces of bone. The envelope is then closed and plastic splints are temporarily placed inside the nose to hold the cartilage and bone in a straight position.

• These splints are typically removed after 2-3 days.

Facial trauma can cause significant injury to the thin bones of the nose, resulting in both cosmetic deformity and impaired breathing.

• The extent of injury can be difficult to assess without an imaging study.

• Non-displaced or minimally displaced fractures usually heal without intervention.

• Comminuted or displaced fractures require surgical reduction.

• If the fracture can be addressed within two weeks of the injury, when the bones are still mobile, the reduction can be performed by simply manipulating the bones back into position (“closed reduction”). A plastic splint is placed across the bridge of the nose to hold the bones in place as they heal.

• If the fracture is more than two weeks old, and the bones have healed, they must be re-broken to position them correctly (“open reduction”), and this is often performed by a plastic surgeon.

The nasal valve is the narrowest area of the nose, located just inside the nostril. Nasal valve collapse may impair nasal airflow.

• Static nasal valve collapse often develops as a result of trauma or prior surgery which changes the shape of the valve area, restricting airflow through this narrow passage.

• Dynamic nasal valve collapse occurs when the cartilage support of the valve is weakened and the nostrils collapse inward when taking a deep breath.

• Opening the nasal valves may require placement of supporting struts of cartilage beneath the skin of the nose, elevating the walls of the nasal valve. This procedure can be done independently, or in conjunction with surgery to straighten the septum.

The sinuses are air-filled cavities in the forehead, between and behind the eyes and within the cheeks. These spaces produce small amounts of mucus throughout the day, and this mucus drains into the nasal passages.

• If airflow into the sinuses is restricted, or drainage of the sinuses is impaired, then sinusitis can develop.

• Weather-related sinus pain, pressure behind the eyes, thick nasal mucus production, post-nasal drainage, decreased sense of smell, and recurrent or lingering sinus infections can all result from impaired sinus aeration and drainage.

• If medical therapy is not sufficient to relieve these symptoms, surgery may be necessary.

• A small telescope (“endoscope”) and camera is inserted into the nostril to visualize the sinus spaces.

• Using various instruments, inflamed or diseased tissue can be removed to open these spaces and restore airflow and drainage.

Sleep apnea occurs when increased effort to breathe through the nose results in collapse of the airway in the back of the throat.

• Septal deviation, turbinate swelling, enlarged tonsils and other anatomic features can contribute to breathing problems.

• Surgery can relieve airway obstruction and improve airflow through the nose and throat, either elimination apnea or making other treatments (e.g., CPAP) more effective.

Laryngoscopy is a visual examination of the lower throat, where the voice box (“larynx”) containing the vocal cords is located.

• It is an effective procedure for discovering the causes of voice and breathing problems, throat pain, and difficulty in swallowing.

• This procedure also allows for treatment of vocal cord lesions which may affect voice quality.