DEVIATION SURGERY
(BREATHING
SURGERY)

“I don’t care how my nose looks, I can’t breathe.”
“Do you have patients like me?”
We hear these sentences very often. As an ENT specialist, we perform many nose
surgeries.
Because we share before-and-after photos, it can often be perceived that we only
perform aesthetic surgeries.
However, the surgeries I enjoy the most are breathing surgeries.

Nose Anatomy and Breathing

When air enters our nose, it first passes through the nostril and encounters a
structure called the septum in the middle.
The septum consists of cartilage and bone structures.
On the sides are the nasal turbinates (conchae), and further forward are the nasal
wings. These nasal wings form the structure we call the nasal valve. So you can
think of it as if there is a valve at the entrance of the nose. Problems that can occur
in these structures from front to back can lead to difficulty breathing through the
nose.

Causes of Breathing Problems

There are four main reasons that make breathing through the nose difficult:
1. Septum deviation (curvature in the midline)
2. Nasal turbinate (concha) enlargement
3. Nasal wing collapse (nasal valve problem)
4. Drooping nasal tip
5. Polyps
6.
7. The most common are septum deviation and nasal turbinate enlargement.
Other causes may sometimes be overlooked.

Septum Deviation

There may be curvature in the cartilage and bone structures that make up the
septum. Often, these two structures are affected together.
If the septum is shifted from the midline, the air passage narrows and breathing
problems occur.
The solution is to reposition the septum back to the midline. The cause of these
curvatures may be:
Genetic
Trauma-related
Or caused by compression in the womb or a difficult birth.
Even minor, unnoticed traumas experienced in childhood can manifest as
deviations in later years.
The cause may not always be clear, but the solution is known.

Nasal Turbinate (Concha) Enlargement

Nasal turbinates can enlarge due to:
Allergies
The amount of airflow (due to septal deviation)
Chronic inflammation
It is often seen together with septal deviation.

Nasal Valve (Nose Wing Collapse)

The collapse of the nostrils inwards during breathing is also an important cause.
This condition can be overlooked if examined. Some of the situations where
people say, “I had surgery but it didn’t fully improve” or
“it recurred,” are related to this problem.
Normally, the nostrils move slightly inwards when breathing. However, when this
collapse is excessive, air passage becomes difficult.

Drooping Nose Tip

Low nasal temperature can also narrow the airway. It is possible to test this simply:
When you gently lift the tip of your nose with your finger, you may notice that
breathing is easier.

Treatment Approach

These four problems can occur individually or together. Most importantly,
The key is accurate diagnosis before surgery.
We correct the septal deviation with special instruments called micromotors.
We place the septum in the midline while preserving the cartilage and bone
structure.
Previously, incisions were made, but this method has now been abandoned.
We can usually reduce the size of the nasal turbinates with a laser. In this way:
The chance of recurrence is greatly reduced.
The lifespan of the nasal turbinates is preserved.

Surgery Time and Post-Surgery

If there is only a septum and turbinate problem, the surgery takes approximately
25-30 minutes.
Procedures related to the nasal valve or nasal tip can take up to 45-50 minutes.
Post-Surgery:
Bruising around the eyes
Significant swelling
is not expected.
There is a thin discharge inside the nose. After 4-6 days, the nasal passages
are significantly relieved in cases where they are cleaned.

Healing Process

Return to daily life is quite fast. Crusting may occur inside the nose, and it takes
time to heal. In approximately 6 weeks:
Crusting will decrease
Swelling will subside
Healing inside the nose will be largely complete.