Thursday, June 3, 2010

One week post-op update of lateral wall implant

It is only one week post-op so I am still not in a position to judge the long-term benefit, but I do feel more and more confident each passing day that I made the right decision and will not need further implant surgery - to remove or add Alloderm. This does not mean that my right nostril is perfect or nearing 100% improvement. I have lost nerve cells in my right nostril from my 1997 turbinectomy, and having so much removed inferior turbinate means this nostril will always have some degree of dysfunction. But at least with more orderly airflow, thanks to the lateral wall implant, I can be overall more comfortable in my breathing - and that's the point where I can accept it for what it is and move on in my life.

I think I made a good decision with removing the lower septal implant. It feels much more natural when I breathe to have the lower septal implant removed, which convinces me this was the right decision for me. (I actually think I have been breathing better, too, in my sleep. I am not waking up tired despite not using the CPAP since the surgery, as I need to allow my nose to heal.) The lower septal implant was sort of like breathing against a large bump for me - and it was obstructive at times.

I do think the upper septal implant, which compensates for my middle turbinates, is fine now, and might be a good option for people missing their middle turbinates. Dr. Houser noted there is even air space in this location of my nose on both sides.

Re: the lateral wall implant, I also believe this was a good decision. There's still crusting and I am sure it is swollen and will resorb over time, but I am not sensing any of the obstruction I felt with the lower septal implant. It feels a bit like it has pushed all my breathing to the left, but then again, there is still some major crusting in my nose, so I expect this to go down as time passes. If anything, this lateral wall implant does seem to offer some airflow resistance as it is in the airway (but not too much like the septal implant) and it seems to direct airflow in a much more orderly and natural way than the septal implant does. In fact, there were times today when I felt like my nasal breathing was fairly normal in my right nostril. Now, Dr. Houser only put in 2/5 of a 2 x 4 cm sheet in my lateral wall, so this is a small implant. So I do think the lateral wall is best positioned for directing airflow in a natural way; I noted to Dr. Houser at the office visit prior to surgery that my right nasal breathing is more comfortable if I put my finger near the base of the right nasal vestibule toward the lateral wall where my nose would conceivably feel most empty (I say 'would' because I was saying this when I had my lower septal implant in, which made my nose feel pretty full), along the same line as the lateral the lateral wall implant made sense for me. The septal implant is more into the airway, so it is easy to see how that could help with issues of dryness, volume, and airflow resistance, but I think there is also a risk of a sense of obstruction in this location - at least there was for me and most people with whom I have corresponded. If you can accept some degree of obstruction, then its benefits may outweigh its risks for you. My initial thoughts are the lateral wall implant might not address the issues of dryness and volume as well as the septal implant can because the septal implant protrudes more into the airway, even if the septal implant isn't in the most natural location. But, for me, the sense of obstruction was too much of a trade off to gain from the moisture and volume it offered. Of course, a smaller, more conservative septal implant would lead to less obstruction. According to Dr. Houser, my lower septal implant was equivalent to 1.5 2 x 4 cm alloderm sheets.

But Dr. Houser indicated to me that his trend is to do the lateral wall more and the septal implant less, and perhaps this is because people find it a more natural location....I'll plan to post again in a week or sometime later to update on my progress with this implant.