The nasal septum is the partition of bone and cartilage that separates the right and left nasal cavities. Most people have a septum that is at least slightly off-center. If your wall is way off, you have a deviated septum. Some people were born that way while others might have had it because of trauma. The nasal septum functions, includes separation of the nasal two nasal cavities, support of the nasal framework including the nasal tip and forms part of the nasal valves.
Septoplasty may be required to correct a deviated nasal septum for the following:
- Irreversible symptomatic nasal obstruction.
- Improving access for endoscopic sinus or skull base surgery
- Epistaxis (Nasal bleeding)
In preparing for the surgery you might need to do the following:
- Laboratory testing (blood tests) and possible medical assessment to be done before surgery.
- You need to be assessed by anesthesiologist.
- You may need to adjust your current medications if you are taking any. (like blood thinners…)
- Stop smoking.
- Avoid taking aspirin, anti-inflammatory drugs and some herbal supplements as they can increase the possibility of bleeding
Septoplasty can be done either as inpatient setting (stay overnight) or on an outpatient setting (to go home the same day). If your septoplasty surgery is performed on an outpatient basis, you need to arrange for someone to drive you from surgery and to stay with you for at least the first night following the surgery.
Surgical steps:
- Anesthesia: can be performed under both local and general anesthesia but preferably under general anesthesia.
- Incision and elevation of the mucosal lining of the septum: The incision will be inside the nose not externally, then the mucosa will be lifted from the septal cartilage and bone to expose the deviated part of the septum.
- Removal of the deviated part will be done and the taken cartilage can be replaced back in a way ensuring a patent nasal cavity.
- Examination of the nasal cavities bilaterally will be done after adjusting the deviation to ensure completely patent nasal cavities.
- Closure of the wound with absorbable surgical threads (dissolves by it self).
- Silicone sheets will be applied in order to ensure avoiding nasal septal hematoma, stabilize the cartilage and helps to avoid adhesions especially if turbinoplasty is done at the same time.
- In some cases, nasal packing might be applied if there is a risk of bleeding.
Recovery:
- If packing applied, then it will be removed within 24 hours (in some cases longer if the is a risk of bleeding).
- The silicone sheets will be removed in the first follow up after 1 week.
- You will be given local medications to aid in healing and reduce the risk of infection, irrigations to clear the debris and analgesics (usually over the counter analgesics).
- The first period of time nasal blockage, discomfort and discharge will be experienced by the patients until the swelling subsides.
- The first follow up will be after one week to remove the silicone sheets and the patient will be seen 1 week after removal of the sheets then the surgeon will decide for future follow ups (which needs to be attended by the patient strictly).
- The initial swelling subsides within a few weeks, but it may take a few months for you to expect the full benefits of septoplasty. The overall healing process will be slow as cartilage and nasal tissue can take 3-6 months to fully settle. However, changes in the septum, cartilage and nasal tissue may occur for up to a year or more after surgery.
- During the recovery period a normal life style like bathing or eating the regular food can be carried, but the patient should avoid nasal manipulation (especially the sutures) and should avoid nasal blowing.
Complications:
- Septal hematoma
- Epistaxis from raw mucosal edges
- Septal perforation: because of Bilateral opposing mucosal tears, Excessive packing and septal hematoma.
- Nasal obstruction can be caused due to inadequate correction of septal deformity and synechiae from opposing, traumatized septal and inferior turbinate mucosal surfaces. Which might require revision procedure.
- Nasal deformity occurs from excessive removal of cartilage and preserving too little dorsal or caudal cartilage struts.
- All these complications and other less frequent complications will be mentioned and explained thoroughly in the pre surgical consent by the surgeon.
For detailed videos and images of this procedure,
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