Functional Rhinoplasty: Repairing Nasal Valve Obstruction

April 8, 2010

The first line of treatment for most patients with nasal obstruction symptoms is medical therapy, but

“Treatment of nasal valve obstructions begins with a complete evaluation and proper diagnosis,” says Tang Ho, MD, a fellowship-trained facial plastic and reconstructive surgeon in the Department of Otorhinolaryngology-Head and Neck Surgery at The University of Texas Medical School at Houston and Memorial Hermann-Texas Medical Center. “Obstructions can be caused by an inherent weakness in the structure of the internal nasal valve such that when the patient breathes in, full air flow is inhibited. In addition to inability to breathe through the nose, a common complaint is snoring at night. Many people who benefit from commercially available Breathe Right strips may find that functional septorhinoplasty offers a more permanent solution for improved nasal breathing.”

In patients who also have a deviated septum or turbinate hypertrophy, Dr. Ho corrects the disorders during the functional nasal reconstruction procedure. “The deviated portion of the septal cartilage is removed and carved into cartilage grafts such as spreader grafts, alar batten grafts, or butterfly grafts, which are implanted in the nasal valve area to widen the nasal valve angle,” he says. The typical reconstruction for relief of nasal obstruction can be done in a 3–4 hour procedure.

Thirty-nine-year-old Marya Davidson presented a more dramatic case to Dr. Ho, who is an assistant professor in the Department of Otorhinolaryngology-Head and Neck Surgery at The University of Texas Medical School at Houston. Diagnosed with severe rheumatoid arthritis at the age of 22, Davidson has undergone two total knee replacements, as well as replacement of all of the metacarpophalangeal joints in both of her hands. Davidson presented to Dr. Ho for nasal obstruction secondary to a severe saddle-nose deformity with near-complete resorption of her septal cartilage, likely secondary to the same disease process that destroyed her joints.

“The arthritis had destroyed virtually all the cartilage in my nose,” she says. “I had no septum at all and was in pain much of the time. I couldn’t wear sunglasses because of the pressure on my nose. My immune system is compromised by the medications I’m taking for arthritis, and I was getting one sinus infection after another, along with severe nosebleeds. When my colds and infections continued to worsen, my rheumatologist referred me to Dr. Fakhri, who then referred me to Dr. Ho.” Internationally recognized rhinologist Samer Fakhri, MD, is affiliated with UT Medical School’s Texas Sinus Institute and Texas Skull Base Physicians.

In a six-hour surgical procedure, Dr. Ho first made a small 3-centimeter incision within the inframammary crease and harvested a piece of rib cartilage measuring 5 centimeters in length, which he then carved and shaped into multiple pieces of cartilage graft for structural grafting to rebuild Davidson’s nose. The rib cartilage is needed because of her severe saddle-nose deformity secondary to near-complete resorption of her native septum. As a result, a significant amount of straight and durable cartilage grafts were necessary to reestablish nasal support for Davidson to achieve the desired functional and aesthetic outcome.

“Recovery was easier than I imagined it would be, and the difference is amazing,” Davidson says. “Dr. Ho was just wonderful. He explained every step of the procedure very thoroughly.”

To refer a patient to Dr. Ho, please call 713-486-5000 or visit

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