Septoplasty and Deviated Septum: A Comprehensive Guide

Are you struggling to breathe through your nose? Do you often find yourself breathing through your mouth, especially at night? You might be one of the millions of Americans suffering from a deviated septum. In this comprehensive guide, Dr. Pavlina Suchanova, a leading Otolaryngologist at Houston ENT & Allergy, explains everything you need to know about deviated septums and the life-changing procedure known as septoplasty.

What is a Deviated Septum?

A deviated septum is a condition where the wall (septum) between your nasal passages is displaced to one side. This wall would be straight in an ideal world, allowing for easy breathing through both nostrils. However, many patients have septums that deviate from the midline, sometimes in multiple places.

The nasal septum is composed of both bone and cartilage. The front part of the septum is made of cartilage, which gives it flexibility, while the back part is made of bone, providing structure and support. When either of these components is misaligned or damaged, it can result in a deviated septum.

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Causes of Deviated Septums

The causes of deviated septums can vary:

1. Congenital: Some people are born with a deviated septum. This can occur due to fetal development factors or complications during childbirth.

2. Childhood injuries: Accidents during childhood, such as falls or impact to the face, can lead to septum deviation. Children's noses are still developing, making them more susceptible to long-term damage from injuries.

3. Sports injuries: Contact sports or accidents during athletic activities can cause septum displacement. Sports like boxing, rugby, or even basketball can potentially result in nasal injuries leading to septum deviation.

4. Car accidents: The impact from a car accident can cause significant facial trauma, potentially resulting in a deviated septum.

5. Normal aging process: As we age, the structural support in our nose can weaken, potentially leading to or exacerbating septum deviation.

6. Unknown causes: Patients are often unaware of the incident that caused their deviated septum. The deviation might have occurred gradually over time without a noticeable triggering event.

It's important to note that you can have a perfectly straight nose externally while having a significantly deviated septum internally. This is why proper diagnosis is crucial.

Symptoms of a Deviated Septum

While some people with deviated septums may not experience any symptoms, others might face a range of issues:

1. Difficulty breathing through one or both sides of the nose
2. Nasal congestion, especially on one side
3. Frequent nosebleeds
4. Facial pain or pressure
5. Headaches
6. Postnasal drip
7. Loud breathing or snoring during sleep
8. Recurrent sinus infections
9. Sleep apnea or other sleep disturbances

The severity of these symptoms can vary greatly from person to person, depending on the degree of septum deviation.

## Diagnosing a Deviated Septum

If you suspect you have a deviated septum, the first step is to schedule an appointment with an ENT specialist. Dr. Suchanova recommends two primary diagnostic procedures:

1. Nasal Endoscopy

This is a quick, painless procedure performed in the office. Using a small, flexible camera called an endoscope, your ENT specialist can thoroughly examine the inside of your nose. Both you and your doctor can view the images on a monitor, allowing for a clear assessment of your septum's condition.

The nasal endoscopy provides several benefits:

- It allows for a detailed view of the nasal passages and surrounding structures
- It can identify other potential issues such as nasal polyps or chronic sinusitis
- It's a minimally invasive procedure with no downtime
- It provides immediate results, allowing for prompt treatment planning

2. CT Scan of the Nose

A CT (Computed Tomography) scan provides a detailed map of the nasal structures for patients with severely deviated septums. This imaging technique helps identify:

- The extent and location of septum deviation
- Other potentially affected structures, such as the turbinates
- Additional issues like chronic sinus blockages or polyps
- Any anatomical abnormalities that might complicate treatment

CT scans are particularly useful because they provide:

- Cross-sectional images of the nasal cavity and sinuses
- A clear picture of both bone and soft tissue
- The ability to measure the degree of septum deviation
- Valuable information for surgical planning if septoplasty is required

Dr. Suchanova emphasizes the importance of these diagnostic tools in developing a personalized treatment plan for each patient.

Understanding Septoplasty: The Solution to Deviated Septums

 What is Septoplasty?

Septoplasty is a surgical procedure designed to correct a deviated septum. It involves realigning the nasal septum to improve breathing and address related issues. This procedure is not to be confused with rhinoplasty, which alters the external appearance of the nose. While septoplasty focuses on function, rhinoplasty is primarily cosmetic.

The Septoplasty Procedure

Dr. Suchanova performs endoscopic septoplasty, an advanced technique that offers several advantages:

1. Minimally invasive: The entire procedure is performed through the nostrils, eliminating the need for external incisions.

2. Highly precise: Using an endoscope and monitor allows for better visibility and more accurate corrections. This precision is particularly beneficial when dealing with complex deviations.

3. Comprehensive correction: This technique allows for fixing the septum from front to back, ensuring optimal results. Traditional methods might struggle to address deviations in the posterior part of the septum.

4. Reduced tissue trauma: The endoscopic approach minimizes damage to surrounding tissues, potentially leading to faster recovery times.

5. Ability to address concurrent issues: During the procedure, the surgeon can also treat other nasal problems like enlarged turbinates or sinus blockages if necessary.

The procedure typically takes about 45 minutes to an hour and is performed under general anesthesia in an outpatient surgery center. Here's a step-by-step breakdown of what happens during septoplasty:

1. Anesthesia administration: The patient is put under general anesthesia to ensure comfort throughout the procedure.

2. Accessing the septum: The surgeon makes small incisions inside the nose to access the septum.

3. Septal correction: The deviated portions of the septum are carefully reshaped, removed, or repositioned to achieve proper alignment.

4. Turbinate reduction (if necessary): If enlarged turbinates are contributing to nasal obstruction, they may be reduced during the same procedure.

5. Closing the incisions: The incisions are closed with dissolvable sutures.

6. Splint placement: Small, soft plastic splints may be placed in the nose to support the septum during healing.

Post-Operative Care and Recovery

After the surgery, patients can expect:

1. Minimal pain: Most patients manage post-operative discomfort with over-the-counter pain relievers like acetaminophen or ibuprofen. Dr. Suchanova may prescribe stronger pain medication, but it's rarely necessary beyond the first few days.

2. Short recovery time: Patients typically return home the same day. Most can resume normal activities within a week, although strenuous exercise should be avoided for 2-3 weeks.

3. Use of nasal splints: Small, hollow plastic tubes are placed in the nose for the first week to ensure proper healing. These splints help maintain the new shape of the septum and reduce the risk of adhesions (scar tissue formation).

4. Nasal irrigation: Patients are instructed to flush their nasal passages with saline solution 2-3 times daily for optimal healing and comfort. This helps keep the nasal passages clean and moist, promoting faster healing and reducing the risk of infection.

5. Follow-up appointments: Patients will have a follow-up visit about a week after surgery to remove the splints and assess initial healing. Additional follow-ups may be scheduled to monitor progress.

6. Gradual improvement: While some benefits may be noticeable immediately after splint removal, full results typically develop over several weeks as swelling subsides and tissues heal completely.

The Life-Changing Results of Septoplasty

Many patients experience significant improvements in their quality of life after septoplasty. Dr. Suchanova often witnesses emotional reactions from patients when they take their first unobstructed breath post-surgery. Some patients have reported such dramatic improvements that they describe "smelling colors" due to their enhanced breathing capacity.

Common benefits reported by patients include:

1. Improved nasal breathing: Patients often experience dramatically improved airflow through both nostrils.

2. Reduced snoring: Better nasal airflow can significantly reduce or eliminate snoring, improving sleep quality for both the patient and their partner.

3. Fewer sinus infections: Proper nasal drainage resulting from improved airflow can reduce the frequency of sinus infections.

4. Enhanced sleep quality: Many patients report better sleep due to improved breathing and reduced sleep disturbances.

5. Increased exercise tolerance: Improved nasal breathing can make physical activities more comfortable and enjoyable.

6. Reduced reliance on nasal sprays or strips: Many patients find they no longer need these aids to breathe comfortably.

7. Improved sense of smell and taste: Some patients notice an enhanced ability to smell and taste after surgery.

When to Consider Septoplasty

You might be a candidate for septoplasty if you experience:

1. Chronic nasal congestion or obstruction
2. Difficulty breathing through your nose, especially on one side
3. Frequent sinus infections
4. Nosebleeds
5. Facial pain or headaches related to nasal issues
6. Sleep disturbances or sleep apnea
7. Chronic mouth breathing

It's important to note that not all cases of deviated septum require surgery. Mild cases may be managed with conservative treatments like nasal sprays or strips. However, for significant deviations causing persistent symptoms, septoplasty can be a highly effective solution.

Risks and Considerations

While septoplasty is generally safe and effective, like all surgical procedures, it carries some risks. These may include:

1. Bleeding
2. Infection
3. Changes in sense of smell
4. Septal perforation (a hole in the septum)
5. Alteration in the external appearance of the nose (rare with septoplasty alone)

Dr. Suchanova thoroughly discusses these risks with each patient and takes all necessary precautions to minimize them.

Conclusion: Breathe Easy with Houston ENT & Allergy

Living with a deviated septum can significantly impact your quality of life. However, with modern surgical techniques like endoscopic septoplasty, relief is possible. Dr. Pavlina Suchanova and the team at Houston ENT & Allergy are committed to helping patients breathe easier and live better.

If you're struggling with nasal breathing issues, don't wait to seek help. Schedule a consultation with Houston ENT & Allergy today and take the first step towards better breathing and improved quality of life.

Remember, every breath counts – make sure yours are as easy and comfortable as possible!