Nasal Cartilage Asymmetry: Insights from ENT Experts

Inquiry Consultation

Dear Dr.
Cheng,
Hello.
Last month on September 14th, I asked you a question.
One of my inquiries was: "I observed a slightly protruding area in the anterior part of my left nasal cavity, which I just discovered today (September 14th) and am unsure how long it has been there.
When I pressed it with a cotton swab, it felt somewhat hard and bled." Currently, the protrusion in my left nasal cavity has not bled again; there is a similar structure in my right nasal cavity, but the protrusion in my left nasal cavity feels more pronounced than that in my right.
After researching relevant medical information, I found that the protrusions in both nasal cavities are likely the medial crura of the lower lateral cartilage (which seems to be referred to as the footplates of the medial crura in English), resembling two pieces of cartilage shaped like )( that can be palpated in the anterior part of both nasal cavities.
I would like to ask you the following questions:
Q1.
From my research, I understand that the two pieces of cartilage should generally be symmetrical and of the same size.
Why does the medial crura of the lower lateral cartilage in my left nasal cavity feel more pronounced than that in my right nasal cavity? Additionally, what are the common causes of this condition? (For example, could it be due to a deviated septum causing asymmetry in the cartilage, or could the left and right cartilages have been "congenitally" different in size or orientation, or are there other factors involved?)
Q2.
In your clinical experience (or knowledge), is it common or rare for individuals to have asymmetry in the medial crura of the lower lateral cartilage? Or is it more typical for there to be some degree of asymmetry due to nasal septum deviation, making perfectly symmetrical medial crura relatively uncommon?
Q3.
Is the pronounced medial crura in my left nasal cavity the reason why my left nostril collapses when I inhale forcefully? Or is there no correlation between the two?
Q4.
Currently, aside from the collapse of my left nostril during forceful inhalation, I do not experience any other discomfort (such as hypoxia, rhinitis, or nasal congestion), and I can only feel the more pronounced cartilage in the anterior part of my left nasal cavity; I cannot palpate that cartilage in my right nasal cavity.
In your opinion, do I need to undergo surgery to correct or remove the more prominent cartilage in my left nasal cavity? Would such surgery cause any harm or lead to complications in the nasal cavity?
Thank you, Dr.
Cheng.

Axiang, 40~49 year old female. Ask Date: 2022/10/13

Dr. Zheng Jueyi reply Otolaryngology

For detailed information regarding the specific structures and surgical techniques, it is recommended to consult with an otolaryngologist or a plastic surgeon who specializes in rhinoplasty for examination and advice.

Reply Date: 2022/10/13

More Info

Understanding nasal cartilage asymmetry can be complex, especially when it comes to the anatomical variations and their implications for nasal function. Based on your observations and questions regarding the asymmetry of the medial crura of the lower nasal cartilage, let's delve into your inquiries.

Q1: Why is the left nasal cartilage more prominent than the right?
The asymmetry you are noticing in the medial crura of the lower nasal cartilage can arise from several factors. One common reason is the presence of a deviated nasal septum, which can lead to compensatory changes in the surrounding structures, including the nasal cartilages. If the septum is deviated to one side, it can cause the cartilage on that side to appear more prominent due to altered pressure dynamics and airflow patterns.
Additionally, congenital factors may play a role; some individuals may have naturally asymmetrical nasal structures. This can include variations in the growth patterns of the cartilage or even differences in the surrounding soft tissue. Trauma or previous surgical interventions can also contribute to asymmetry, as they may alter the normal anatomical relationships.

Q2: Is asymmetry of the lower nasal cartilage common?
In clinical practice, it is not uncommon to encounter asymmetry in the lower nasal cartilages. Many individuals have some degree of nasal septal deviation, which can lead to variations in the size and shape of the medial crura. While complete symmetry is ideal, anatomical variations are part of human diversity. It is generally accepted that some degree of asymmetry is normal, and it is often the case that individuals may not even be aware of these variations unless they are specifically examined.

Q3: Is the prominence of the left nasal cartilage causing the "external nasal valve collapse"?
The prominence of the left medial crura could indeed contribute to the sensation of external nasal valve collapse during forceful inhalation. The external nasal valve is a critical area for airflow regulation, and any structural abnormalities, such as prominent cartilage, can affect its function. If the cartilage is pushing inward or if there is insufficient support from the surrounding structures, it may lead to a collapse during strong inhalation efforts.
However, it is essential to consider that other factors, such as the overall nasal structure and the presence of any soft tissue swelling or inflammation, can also contribute to this phenomenon.

Q4: Should you consider surgery to correct the prominent cartilage?
The decision to pursue surgical intervention should be based on a thorough evaluation of your symptoms and the functional impact of the asymmetry. If you are not experiencing significant discomfort, nasal obstruction, or other related symptoms, surgery may not be necessary. Surgical procedures, such as cartilage reduction or correction, can be performed, but they carry risks, including potential changes in nasal airflow, scarring, and the possibility of requiring further surgery if the outcome is not satisfactory.

It is crucial to have a detailed discussion with an ENT specialist who can assess your specific situation, including any functional impairments caused by the asymmetry. They can provide guidance on whether surgical correction is warranted and what the potential risks and benefits are.

Conclusion
In summary, nasal cartilage asymmetry is a common anatomical variation that can arise from various factors, including septal deviation and congenital differences. While some degree of asymmetry is normal, it is essential to evaluate whether it is contributing to any functional issues, such as external nasal valve collapse. Surgical intervention should be considered carefully, weighing the potential benefits against the risks. Consulting with an experienced ENT specialist will provide you with the best course of action tailored to your specific needs.

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