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In the first few weeks after surgery most patients find that they cannot breath well through the nose. Over the next six months breathing usually improves. A small number of patients may continue to have difficulty.
There are many reasons for difficulty breathing after rhinoplasty. The most obvious is the decreased size of the nose. A more serious problem arises when the valve function of the nose is impaired. This may be a factor when the amount of airflow through the nose improves by pulling the cheek away from the nose. This is called a "Cottle test."
There are two main reasons for this.
- scar contraction inside the nose. The scar, used for surgery, shortens and disturbs the internal anatomy.
- change in the angle between the upper nasal cartilages and the septum. In the caucasian patient this is normally about 10-15 degrees
In this situation, surgery may be needed to improve breathing. The most common techniques used are to either release the scar or insert a cartilage graft, called a spreader graft to open the angle inside the nose.
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