Nasal Anatomy: Questions on Asymmetry and Surgery Options

Inquiry Consultation

Dear Dr.
Lu,
I have a question regarding a recommendation from my otolaryngologist to consult with a plastic surgeon for a more comprehensive and accurate answer.
My main concern is as follows: I have a slightly protruding area in the anterior part of my left nasal cavity, and there is a similar structure in my right nasal cavity, but the protrusion in my left nasal cavity feels more prominent 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 appear to be shaped like two pieces of cartilage resembling parentheses ( )( ) that can be palpated in the anterior part of both nasal cavities.
I would like to ask Dr.
Lu the following questions:
Q1.
Based on 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 prominent than that in my right nasal cavity? Additionally, what are the common causes of such a condition? (For example, could it be due to a deviated septum causing asymmetry in the cartilage, or could it be that the left and right cartilages are inherently 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 asymmetrical medial crura of the lower lateral cartilage? Is it the case that asymmetry is the norm, as most people have varying degrees of septal deviation, and that perfectly symmetrical medial crura are actually uncommon?
Q3.
When I inhale forcefully through my left nostril, I experience a phenomenon known as "external nasal valve collapse." Could the prominence of the medial crura of the lower lateral cartilage in my left nasal cavity be the reason for this collapse when I inhale, or are the two issues unrelated?
Q4.
Currently, aside from the "external nasal valve collapse" when I inhale forcefully through my left nostril, I do not experience any other discomfort (such as hypoxia, rhinitis, or nasal congestion), except for the noticeable protrusion of cartilage in the anterior part of my left nasal cavity; the right nasal cavity does not have a similar palpable cartilage.
In your opinion, do I need to undergo surgery to correct or remove the more prominent cartilage in my left nasal cavity? Furthermore, would such surgery pose any risks or potential complications for my nasal cavity?
Thank you, Dr.
Lu.

Axiang, 40~49 year old female. Ask Date: 2022/10/14

Dr. Lu Daokuan reply Plastic Surgery

You should consult with a plastic surgeon who specializes in rhinoplasty for your concerns.
Many people may not have seen the written descriptions and might not know where to start.

Reply Date: 2022/10/14

More Info

Hello! Thank you for your detailed questions regarding your nasal anatomy and potential surgical options. Understanding the complexities of nasal structures can be quite challenging, and it’s important to address your concerns thoroughly.

Q1: Asymmetry of the Nasal Cartilage
The asymmetry you are experiencing in the medial crura of the lower lateral cartilages (the "footplates") can arise from several factors. One common cause is a deviation of the nasal septum, which can lead to compensatory changes in the surrounding structures, including the cartilages. Additionally, congenital factors may play a role; some individuals may naturally have asymmetrical nasal structures due to genetic variations. Trauma or previous surgical interventions can also contribute to such asymmetries. It’s not uncommon for patients to have slight variations in their nasal anatomy, and these can be influenced by both developmental and environmental factors.

Q2: Prevalence of Asymmetry
In clinical practice, it is relatively common to observe asymmetry in the nasal cartilages. Many individuals have some degree of nasal septum deviation, which can lead to corresponding changes in the shape and position of the lower lateral cartilages. While perfectly symmetrical nasal structures are ideal, they are not the norm. Most people exhibit some level of asymmetry, which can be exacerbated by factors such as aging, trauma, or even habitual behaviors (like sleeping on one side).

Q3: External Nasal Valve Collapse
The phenomenon you describe as "external nasal valve collapse" during inhalation can indeed be related to the prominence of the medial crura. If one side of the lower lateral cartilage is more prominent, it can create a mechanical disadvantage during inhalation, leading to the collapse of the external nasal valve. This collapse can result in a feeling of obstruction or difficulty breathing through that nostril. However, it’s essential to conduct a thorough examination to determine if other factors, such as septal deviation or other structural issues, are contributing to this problem.

Q4: Surgical Considerations
Regarding the need for surgical intervention, it is crucial to weigh the benefits against the potential risks. If your only symptom is the prominence of the cartilage without significant functional impairment or discomfort, surgery may not be necessary. However, if the asymmetry is causing functional issues, such as the external nasal valve collapse or if you are concerned about the aesthetic aspect, then surgical correction could be considered.
Surgical options may include procedures to reshape or reposition the cartilages. However, as with any surgical intervention, there are risks involved, including infection, scarring, and potential changes in nasal function or appearance. It’s essential to have a detailed discussion with your surgeon about these risks and the expected outcomes of the procedure.

In conclusion, while asymmetries in nasal anatomy are common and often benign, they can sometimes lead to functional issues. If you are experiencing significant problems or have aesthetic concerns, consulting with an experienced otolaryngologist or facial plastic surgeon would be advisable. They can provide a comprehensive evaluation and help you make an informed decision regarding potential surgical options. Thank you for your questions, and I wish you the best in your journey toward better nasal health!

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