Augmenting the nasal airway: Beyond septoplasty

BACKGROUND Nasal airway obstruction is a common complaint of patients presenting to otolaryngology clinics and can be caused by a variety of anatomic factors. A number of advances in the surgical management of nasal airway obstruction have been made over the last century. The objective of this article is to provide descriptions of the surgical procedures used to augment specific anatomic deviations that lead to obstruction of the nasal airway. METHODS The descriptions of surgical procedures were derived from a literature review as well as the empiric knowledge of the senior author. Preoperative considerations of nasal anatomy, the nasal airway, and the L-strut are detailed. RESULTS Functional rhinoplasty techniques are reviewed including septoplasty, extracorporeal septoplasty, spreader grafts, batten grafts, alar rim grafts, and correction of caudal septal deviation. CONCLUSION The symptom, nasal obstruction, may arise from a number of different anatomic and physiological elements. The rhinoplasty surgeon must consider these contributing elements and manage accordingly, to achieve optimal results.