A common problem that causes many patients to go to the doctors is a nasal obstruction. A frequent cause of nasal obstruction is a deviated nasal septum. Septoplasty is a surgical procedure that fixes septal deviation and improves the patient's quality of life. In the U.S., it's the third leading neck and head procedure.
What is a Septoplasty?
Septoplasty, as mentioned, is a surgical procedure that fixes a deviated nasal septum. This condition is a movement of the cartilage and bone that separates your nostrils. Your ENT surgeon straightens and repositions your nasal septum in the center of your nose during septoplasty. Your surgeon may need to cut and remove some nasal septum parts before they can reinsert them in the correct position.
Indications for a Septoplasty
The primary indications for a septoplasty are:
Nasal airway obstruction.
Nasal septal deformity that exists with other intranasal surgeries.
Nasal airway obstruction resulting from a septal deformity causing mouth breathing, recurrent nasal infections responding slowly to antibiotics and sleep apnea.
Other intranasal surgeries that indicate septoplasty include:
You may get a septal spur headache, which is a headache that comes second to nasal septum pressure on your nose's inside linings. Doctors treat these headaches with topical septal impaction anesthesia the doctor applies to your skin in a localized area.
Reasons for a Septoplasty
It's common to have some septum deviation. But, when it becomes severe, it may cause blockage in one nostril, reducing airflow and making it difficult for you to breathe on either side of your nose or both.
When your deviated septum is exposed to airflow’s drying effect through your nose, it could result in bleeding or crusting. During a septoplasty, your surgeon straightens your nasal septum. They trim, reposition and replace bone, cartilage or both.
You may consider septoplasty to correct your deviated nasal septum if you're having problems breathing through your nose or experiencing other symptoms that impact your quality of life significantly.
Other reasons for a septoplasty include:
You may consider septoplasty if you have a visual septal deformity, but you can't identify any other causes of your nasal obstruction such as:
Chronic lung disease
Septoplasty is also an option if you've tried nasal steroid spray and other types of conservative management with no results.
If you have a closed nasal injury, a frequent occurrence is telescoping septum dislocation and tearing. Dislocations tend to occur at the ethmoid bone perpendicular plate and the quadrangular cartilage junction. Nasal obstruction can occur if a malpositioned septum wasn't addressed in nasal fracture reduction.
Turbinates are structures inside your nose on the side wall. They extend as ridges of tissue into your nasal passages. They keep air moisturized and warm while flowing through your nose. When enlarged, inferior turbinates may cause blockage of nasal airflow. Turbinates are made of soft tissue and bone and either one of these can become enlarged. With enlarged turbinate soft tissue, most patients experience big problems with swollen turbinates.
Nasal obstruction can occur due to rhinoplasty alterations made to your nasal structure unless the surgeon straightens your septum during the procedure.
What to Expect During a Septoplasty Procedure
Before you schedule your septoplasty, you need to set up a consultation with the surgeon to sit down and talk about the risks and benefits of this procedure. Typically, during the meeting, the surgeon will:
Perform a physical exam: Your doctor will give you a complete physical exam and take any necessary and relevant tests. They will inspect your nose both inside and out as well as your skin.
Discuss your medical history: Your doctor will likely ask about any conditions you’ve had in the past, any medications you’re on currently and several other questions regarding your medical history.
Take photographs: A staff member will come into the room and take pictures of the different angles of your nose. The doctor uses these pictures as a reference during surgery and after.
Discuss your expectations: You’ll both sit down and discuss what you expect out of your septoplasty procedure. Your doctor will explain the procedure to you and let you know what it can and can’t do. They may even give you an idea of the outcome.
A septoplasty procedure can be 30 to 90 minutes long, depending on how complex your condition is. You'll receive either general or local anesthesia, depending on your preference and what your doctor thinks is better suited for you.
During the procedure, your surgeon will access your septum through an incision they make on one side of your nose. They then lift up your septum protective covering (mucous membrane) and move the deviated septum into its proper position. They remove any obstructions like extra pieces of cartilage or bone. Once this is complete, the surgeon repositions your mucous membrane.
To hold the membrane and septum in place, you may require stitches. But, usually, it’s enough just to pack your nose with cotton.
Septoplasty for Children
With children, the surgeon also performs the surgery through the child's nostrils. They may either remove the septum or reshape a part of it. The surgeon may perform septoplasty along with other nose or sinus surgeries. Usually, surgeons don’t perform septoplasty on children since they still have developing cartilage.
But, in some cases, children may need a septoplasty.
Children may require the procedure done if they have:
Frequent sinus infections
Headaches or pain in their face
Children may present a deviated septum at birth or damage from past medical treatments or an injury can cause it.
The Septoplasty Recovery Process
Your surgeon typically performs septoplasty as an outpatient surgery if no major complications occur. Outpatient procedures allow you to go home the same day you have the surgery done after your anesthesia wears off.
Your surgeon might insert soft splints or plastic sheets inside your nose which reduces your risk of forming scar tissue and helps your septum heal straight.
The doctor might instead pack your nose with cotton to keep bleeding under control. It will be painful and swollen. A couple of days after your surgery you can remove the packing. Your doctor will likely prescribe you painkillers.
They will also likely recommend you don't take any ibuprofen, aspirin or other medications that thin your blood out so your risk of bleeding following your surgery is low.
After your procedure, limit any physical activity for a few weeks to minimize swelling and help you to heal quicker. Examples of physical activity to avoid include lifting weights, running or playing contact sports. All these types of activities may cause your blood pressure to rise and result in heavy bleeding.
Some tips you can try to recover quicker include:
Waiting a minimum of three days after your surgery to blow your nose.
Keeping your head elevated at night to reduce swelling.
Wearing button up shirts to avoid having to pull your clothes over your head.
Although results are generally stable, there is a risk of tissue and cartilage gradually reshaping or moving over time. Around three to six months following your surgery, your nasal tissues should be relatively stable.
Many people experience an improvement in their symptoms after septoplasty like deviated septum-related breathing problems.
In some cases, individuals have their symptoms continue after they receive surgery and decide to undergo another septoplasty to refine their septum and nose further.
Call Houston ENT & Allergy Services
Book an appointment with Houston ENT to get evaluated for a deviated nasal septum. Learn more about the septoplasty procedure and see if it's the right option for you.