Septoplasty Surgery Procedures

Septoplasty is surgery to correct a deviated septum. The septum is the common wall inside the nose that runs down the middle, dividing it into two nasal cavities. Nasal septal deviation is a common structural disorder of the nose, involving a displacement and/or twist of the nasal septum. It can occur naturally or as a result of trauma to the nose.

A septoplasty can straighten a deviated, twisted, bent, or crooked septum. This improves nasal breathing, can reduce the incidence of nasal and sinus infections, and increases comfort. Patients with a deviated septum also sometimes complain of headaches, nose bleeds, or sleep disorders such as snoring or sleep apnea. However the overwhelmingly commonest symptom is difficult nasal breathing. The degree of difficulty usually parallels the degree of deviation. There are exceptions. Occasionally a severely deviated septum is seen on examination of a patient without symptoms. This usually happens when the person has always had long standing blockage and therefore knows no better. The opposite situation, that of a mild to no deviation but significant symptoms, is also infrequently seen. The latter should always alert the surgeon to consider other causes of blockage.

Many people go through their entire lives never knowing that difficulty breathing through their nose could be corrected with septoplasty surgery. This is most commonly seen when the nasal blockage started at a very young age, so young that, never having known normal breathing, they consider their abnormal nasal resistance to be the norm. Occasionally someone who was interested only in cosmetic rhinoplasty is shocked at the unexpected improvement in their breathing post operatively.

Normally, the septum lies very close to the center, and thus the nasal passages are symmetrical. A deviated septum is an abnormal condition in which the cartilaginous septum narrows one of the nasal channels. Much less commonly a multiple fractured septum can narrow both sides. These septums are commonly called ‘an accordion septum’. There are many variations of septal deviations. Probably the commonest is a fracture which runs horizontally down the cartilaginous septum. This causes the septum to fold like an open book and the book’s spine protrude into the nasal channel and causes obstruction of the affected nasal passage. A fracture at the junction of the cartilaginous and bony septum is another common finding. Since this is beyond the nasal valve area, its effect is less. For similar reasons a twist of the septum called a caudal septal deflection at the beginning of the nasal passage and before the nasal valve area, although often visually dramatic, can have minor impact on nasal resistance.

The Procedure

When planning septoplasty, your surgeon considers your features, your symptoms — such as breathing difficulties — and the physical structure of your nose.

A septoplasty is internal nasal surgery only. During septoplasty, an incision is made in the mucous membrane lining of the nose. These linings are then raised off from the septum. Then the attachments of the septum to the floor of the nose and then the transitional area from cartilage to bony septum are disconnected, so that the septum is loose and mobile. The nasal septum can then be re-positioned. This may also require cutting and removing parts of your septum before it can be repositioned. Modern day techniques stress conservation of the cartilage if possible, so little excision is done. After the cartilage and/or bone are modified into a straight sheet, the mucosa is sutured back into place. Septoplasty is the least traumatic and invasive nose surgery. There is no external bruising and rarely any visible swelling. The exception is when there is work done on the caudal septum at the entrance of the nostrils, then there will be some external swelling of the columella and upper lip. The surgery usually takes about an hour. Complete healing takes from several days to several weeks. Very commonly plastic internal nasal stents are placed at the end of the procedure inside each nasal cavity to support and maintain the straight position of the septum during the critical first few days of healing.

Frequently, partial inferior turbinectomy is done along with septoplasty. This minor procedure trims the fleshy swellings of the inner sides of the nasal passages. It improves nasal breathing by increasing the cross-sectional area of the nasal channel.

Septoplasty and Rhinoplasty Together

If you have a deviated, crooked or twisted septum, you may find that you want cosmetic improvements to your nose as well. Septoplasty, alone, usually results in no or very little external change to the shape of the nose. Patients often find it difficult to understand that, even when a bend in the nose is successfully corrected on the inside, it remains visibly bent on the outside. The answer lies in the fact that the external twist of the septum is fixed in place by two plates of cartilage, called the upper lateral cartilages, that prevent movement of the external and visible art of the septum. These plates make up part of the side walls of the nose. The upper lateral cartilages need to be detached from the external edge of the septum to fix the external bend and this requires rhinoplasty. As it is the internal bend and not the external bend, that is responsible for the breathing problems, this is not done during a septoplasty. There can occasionally be improvement in the external twist of the nose with a septoplasty only, however when this occurs, it is a fortunate and lucky side effect of the internal work. Usually rhinoplasty is added to straighten the outside of the nose. The two surgeries can and should be performed together, so the patient only undergoes one procedure and maximizes the rate of success.

When septoplasty is performed in conjunction with rhinoplasty, the procedure will take longer, usually an additional one to two hours.

Recovery after Septoplasty

The recovery from septoplasty is less than rhinoplasty. First there is no visible bruising. The external swelling, if any, is markedly less and usually is only found in the upper lip and fleshy part between the nostrils. This swelling is the cause of the facial pressure and discomfort associated with rhinoplasty. With septoplasty the overall the amount of surgical is less, and hence the quantity of post operative symptoms and their length are reduced compared to rhinoplasty. Most people are back to work and resume their lives after two weeks. Physical exercise or anything causing elevated heart rate, increased blood pressure or sweating is to be avoided for a month. Also flying isn’t recommended for a week due to the higher risk of pressure changes causing a sinus headache. Similar to rhinoplasty, it is absolutely forbidden to move or bump the nose to reduce the risk of shifting the temporarily weakened structures during this critical early healing phase.

Touching or washing the nose is permitted, in fact encouraged. People heal better and more comfortably if the nostrils are kept clean and free of dry crusts and blood. Q-tips dipped in 2% hydrogen peroxide and gently rotated around the nostrils several times a day will clean the nose and remove the bloody mucous which forms for the first few days.

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