Septoplasty

Septoplasty, also known as nasal airway surgery, is performed to straighten and reposition the bent (crooked or deviated) nasal septum to alleviate breathing difficulties.

Nasal septum is a wall separating the left and the right nostrils. It is made up of bone and cartilage (strong, flexible tissue that contains 65% to 80% of water). The sides of the nasal cavities include special structures called turbinates. They are made of bones covered with mucous membrane and help the nose to act as a filter and air-conditioner, providing clean, warm, and moist air to the lungs.

A deviated or crooked nasal septum usually occurs after a direct injury to the face or due to birth defects related to diseases of the cartilage. It causes the septum to bend either towards the left or right nostril, thus blocking the nasal airway. Although many individuals with the condition do not have any symptoms, some complain of problems like breathing difficulty and snoring. Septoplasty is performed to correct a deviated nasal septum and provide relief from the symptoms associated with the condition. It is also done along with other medical procedures such as nose-shaping surgery. During the surgery, the surgeon may cut and remove the septum to reinsert it into the middle of the nose.

Septoplasty is recommended in individuals with deviated nasal septum who show the following symptoms:

• Difficulty breathing due to obstruction in the nasal passage
• Excessive snoring that causes trouble sleeping
• Headaches

The surgery is also performed to treat sinusitis caused by a deviated nasal septum. Symptoms of sinusitis are:

• Cough
• Stuffy nose
• Fever
• Tiredness
• Pain in ears
• Toothache

A septoplasty may be performed as a standalone procedure or along with some other surgeries such as:

• Septorhinoplasty
• Endoscopic sinus surgery
• Endoscopic dacryocystorhinostomy (correcting obstruction in tear ducts or lacrymal sacs)
• Transseptal transsphenoidal approach to pituitary fossa (treatment of pituary ademonas)

Septoplasty is generally contraindicated in individuals with:

• Untreated diabetes
• Bleeding diathesis (tendency to bleed or bruise easily)
• Acute sinus or nasal infection
• High blood pressure

You will be asked to visit the hospital a few days prior to the surgery for a preoperative assessment. During the assessment the surgeon will conduct a few tests to ensure that you are physically healthy and eligible for the surgery. The tests include:

• Blood tests
• Urine tests
• Pregnancy test
• Physical examination
• Nasal endoscopy (inserting a flexible tube with a camera in the nose to examine the nasal cavity and the surrounding structures)

In addition, the surgeon will study your medical history and ask you whether you are pregnant or have any other allergy. You will be provided with the following instructions:

• Share a list of all the medications that you take, including over-the-counter medicines and herbs with your doctor. If your list includes blood thinners (aspirin, warfarin, ibuprofen, etc.), you will be asked to discontinue them a week before the surgery.
• If you smoke, the surgeon will ask you to stop smoking. This will help reduce the risk of complications and promote recovery after the surgery.
• You will need to shower and remove all the body piercings, make-up, and nail polish before arriving at the hospital on the scheduled day of the surgery.
• Arrange a friend, family member, or responsible adult to drive you home after the procedure.
• Inform the surgeon if you have flu, cold, or fever on the days leading to the surgery. In such a case, the surgery will be postponed.
• Your doctor will give you a list of medicines that you can take on the day of the surgery.
• You will be asked to fast from midnight prior to the surgery. Fasting is required to prevent vomiting, which is a risk of general anaesthesia, during the surgery.
• The surgeon will explain the procedure to you along with the risks associated with the surgery. If you agree to the surgery, you will be asked to sign a consent form.

After you arrive at the hospital, the hospital staff will provide you with a hospital gown to change into. Subsequently, they will insert an intravenous line in your arm to supply you with essential fluids and medications during the surgery. The surgery usually involves the following steps:

• An anaesthesiologist will administer general anaesthesia to you so you will be asleep during the procedure. In some cases, medicine is administered to only numb the nose and the surrounding area (local anaesthesia).
• The surgeon will make a cut on one side of your nasal septum.
• He/she will lift off the mucosal lining, the thin tissue that covers your nasal septum, to expose the bone and cartilage underneath. The same procedure will be conducted on the other nostril.
• Next, the surgeon will remove the deviated bone and the cartilage, reshape it, and reposition it.
• When the septum is straightened and fixed in the required position, the surgeon will reposition your mucosal lining over the septum and stitch it together with dissolvable stitches.
• After the surgery, a splint (supporting structure for the septum) or nasal packing (materials like gauze) will be packed into your nose. The packing will absorb any discharge coming out through your nose. Togather with the splint, it will keep your nasal tissue in position, prevent the formation of scar tissue, and avoid bleeding.

The surgery may last for about an hour. You will be required to keep the splint in for one to two weeks and the packing for about 24 to 36 hours after the surgery. When you regain consciousness, you may feel tired, groggy, and restless. These are side effects of general anaesthesia and usually subside within a few hours. The surgeon will discharge you shortly after the effects of the anaesthesia fade away.

Once at home,you will need to take care of yourself in the following manner:

• You may experience some pain, swelling, and breathing difficulty for a few days after the surgery. The swelling will go away within a few weeks. The surgeon will prescribe medications to provide you relief from the pain.
• You will be provided with nasal spray or drops to help you breathe along with an antibiotic cream to prevent infections.
• Your doctor may advise you to rinse your nose with salt water to remove any surgical debris.
• Avoid exposure to smoke or dust for a while.
• You may have blood-stained liquid discharge from your nose for about a week.
• When you sneeze, keep your mouth open to prevent injury in the nose.
• Avoid blowing your nose or sniffing for at least a week as it may increase the swelling.
• You should avoid strenuous exercises and lifting heavy objects as these activities can increase the swelling and bleeding.
• The surgeon will advise you to not drive for at least 24 hours after the surgery and rest at home for two weeks before restarting work.

Although the healing process may complete in three to six months, changes in your nasal septum may continue for over a year. A majority of the individuals who undergo this surgery experience improved breathing, reduced snoring, and improved sleep.

When to see the doctor?

Contact the surgeon if you experience any of the following after the surgery:

• Body temperature greater than 101^°F (38^°C)
• Nausea or vomiting
• Increased pain, swelling, warmth, tenderness, and numbness in the operated area
• Increased tiredness
• Severe diarrhoea or constipation
• Pain that persists even after taking medications

The potential risks and complications associated with septoplasty are:

• Infection in the nose
• Excessive bleeding
• Reduced sense of smell
• Hole in the nasal septum
• Temporary loss of sensation in the upper teeth or gums
• Change in the shape of nose
• Septal haematoma (collection of blood in the septum)
• Risks of general anaesthesia such as confusion, lung infection, and stroke

You will need to revisit the hospital one to two days after the procedure to get the packing inside your nose removed.

Additionally, you will also be asked to visit the surgeon four to eight weeks after the procedure so the surgeon can check for improvement in your symptoms.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.