Repair of Nasal Obstruction with Functional Septorhinoplasty

November 28, 2010

For nearly 20 years, 45-year-old Susan Haase lived her life exhausted.  “I couldn’t understand why I was so tired,” Haase says.  “At first I thought it was a normal part of aging but I was only in my early 30s at the time.  When it got to the point that I was too tired to do anything at all, I decided to seek medical help.”

Haase saw her primary care physician, who referred her to a rheumatologist for testing.  Laboratory results revealed some of the physical conditions associated with systemic lupus, but produced insufficient evidence for a positive diagnosis.  Her rheumatologist suggested she schedule a sleep study, which she underwent at a center near her home in The Woodlands, Texas.  When the study showed that she stopped breathing 10 to 12 times per hour during sleep, she was diagnosed with obstructive sleep apnea and fitted with a continuous positive airway pressure (CPAP) machine.

“I hated the CPAP,” she says.  “It was extremely uncomfortable so I didn’t use it for long.  Eventually, I got a dental device that pulled my lower jaw forward, and that was easier to tolerate.” But when Haase began experiencing jaw pain and headaches after a few months, she stopped using the device.  “For a while I just didn’t do anything,” she says.

In 2006, she underwent uvulopalatopharyngoplasty (UPPP) during which her tonsils were removed and the back of her throat was shaved to enlarge the airway.  “The surgery seemed to help for about six weeks and then I was tired again,” she says.

In early 2010, a colleague with connections in the Texas Medical Center suggested she schedule an appointment with Richard Castriotta, MD, professor and division director of Pulmonary, Critical Care and Sleep Medicine at The University of Texas Medical School at Houston and medical director of the Sleep Disorders Center at Memorial Hermann-Texas Medical Center.

“By then I was tired of being tired, so after the sleep study I started wearing a CPAP regularly.  Technology had advanced, and Dr. Castriotta gave me a new mask that fit well enough that I was able to sleep with it,” says Haase, who is an assistant principal at Carl Wunsche Sr.  High School in Spring, Texas.  “But I was still feeling desperate.  I couldn’t breathe at night without the mask and didn’t want to sleep with it for the rest of my life.”

Recognizing that an underlying nasal obstruction issue was associated with her sleep apnea, Dr. Castriotta referred Haase to Tang Ho, MD, an assistant professor of facial plastic and reconstructive surgery in the Department of Otorhinolaryngology-Head and Neck Surgery at the UT Medical School.  “As otolaryngologists and facial plastic surgeons, we are often consulted by our sleep specialist colleagues to evaluate a patient’s upper airway for potential contributions to sleep apnea,” Dr. Ho says.  “Patients who have problems tolerating CPAP machines often have nasal obstruction issues that interfere with the effectiveness of the device.  Susan had a very crooked nose—the result of trauma she suffered as a child—as well as a severely deviated septum and nasal valve collapse.”

Dr. Ho performed a septorhinoplasty procedure to correct the nasal obstruction and reshape her nose.  A follow-up sleep study by Dr. Castriotta showed complete resolution of her obstructive sleep apnea.

“Susan is one of our dramatic successes,” Dr. Ho says.  “Many times a functional septorhinoplasty procedure relieves the underlying nasal obstruction problem sufficiently to allow the patient to decrease the CPAP settings so that the device more comfortable to wear.”

“When Dr. Castriotta called me at home to give me the results of my sleep study, I couldn’t believe it,” Haase says.  “After years of surgery and living with CPAP machines, I fully expected that the procedure wouldn’t make a difference.  When he told me I breathe normally during sleep, I was ecstatic.  For me this was a life-changing event.  I’ve had headaches nearly every day of my adult life, and I had reached the point that I was so tired I was afraid to drive.  It’s a wonderful thing to be free of that machine.”

Dr. Tang Ho’s clinical interests include both aesthetic and reconstructive surgeries of the face, including facial rejuvenation procedures (facelift, browlift, Botox® injections and injectable fillers), rhinoplasty, facial reanimation procedures for patients with facial paralysis and reconstructive surgery of skin cancer defects.

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