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Nasal Septoplasty - Indications, Diagnosis, Procedure, and Complications

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Nasal septoplasty is a procedure to correct bent or curved noses to make them straight to enhance the airflow through the nose and improve the facial appearance.

Written by

Dr. Ruchika Raj

Published At January 12, 2023
Reviewed AtJanuary 12, 2023

Introduction:

Everybody in the world has a different size and shape of nose. Some people have bent, curved, or angled appearance of the nose since birth because of curved underlying nasal bone or cartilage, and some may develop it due to nasal trauma or infections. Nasal septoplasty is a surgical procedure done by an ENT (ear, nose, and throat) specialist to correct the deformed nasal bone and make them straight to enhance the function (restores the free flow of air through the nose) as well as the physical appearance of the nose.

What Is a Deviated Nasal Septum?

The nasal septum is a cartilaginous structure (made of cartilage in the central portion) that is present between the two nasal cavities (separating them). It is normally straight. Any bent or curvature present in the nasal septum either since birth or due to nasal trauma is called deviated nasal septum.

What Are the Indications for Nasal Septoplasty Surgery?

Indications of nasal septoplasty surgery are:

  • Nasal Bone Deformity: Nasal bone or cartilage deformity obstructing the airflow through the nose should be corrected by a septoplasty.

  • Recurrent Epistaxis: Aperson complaining of frequent epistaxis (nose bleeds) are indicated for the surgery.

  • Cosmetic Purpose: A person having a bent or curved nose who wants to straighten it for improved physical appearance is the candidate for the surgery.

  • Nasal Trauma: Bent or curved bone due to trauma to the nose is corrected surgically.

  • Obstructive Sleep Apnea Syndrome: People having obstructive sleep apnea (breathing difficulties while sleeping) and snoring problems due to the presence of deviated nasal septum or abnormal tissue growth in the nose resulting in obstruction in the free flow of air through the nose.

  • Sinusitis: In patients who do not respond to the medicinal therapy for sinusitis (swelling of the nasal tissue due to bacterial or viral infections).

What Are the Conditions in Which Nasal Septoplasty Surgery Is Avoided?

Contraindications of Nasal septoplasty surgery are:

  • Rhinitis Medicamentosa: A person having swelling in the nasal mucosa due to overuse of nasal sprays or decongestants.

  • High Expectation: A person who has unrealistic expectations from the outcome of the surgery in terms of physical appearance. The risk factors of the surgery should be explained to the patient by counseling before the surgery.

  • Recurrent Sinus Infections: Patients with repetitive sinus infections like rhinosinusitis in whom the medical therapy has not yet been tried.

What Is the Diagnosis Done before the Nasal Septoplasty Surgery?

  • History and Clinical Examination: A detailed history of the symptoms faced due to nasal deformities with a history of recent trauma should be noted. Drug history for use of intranasal decongestant for underlying infections and history of past nasal surgery is recorded. A nasal endoscope (thin flexible tube) is used to examine the nasal mucosa completely to rule out the presence of any infections or swelling.

  • Computed Tomographic (CT) Scans: This scan is done to assess the extent of the nasal septum deformity and helps in treatment planning.

How Is the Nasal Septoplasty Procedure Done?

The nasal septoplasty procedure is performed under general or local anesthesia and usually takes two hours. A cut on a wall of the nose on one side is given by the surgical blade to expose the nasal cartilage and bone. Refining of the nasal bone and cartilage is done as per the requirement (depending on the extent of the deformity). The mucosa is then placed back to its original position, and dissolving stitches are given. Silastic nasal splints (a flexible or rigid device that maintains the fixed position of the movable part) is then inserted in the nose to maintain the septum in a position, avoid recurrence, and prevent nosebleeds. After the surgery, medications are prescribed to the patient. Splints are usually removed after two weeks of the surgery.

What Instructions Need to Be Followed after the Nasal Septoplasty Surgery?

Precautions that need to be followed after surgery are:

  • Head end elevation while sleeping by keeping two pillows.

  • Avoid blowing your nose for three weeks.

  • Avoid strenuous activities like weight lifting or jogging for a minimum of five weeks.

  • Take all the medications as prescribed by the doctor.

  • Regular follow-up with the doctor as scheduled.

  • Any complications noted should be reported to the doctor.

  • Avoid smoking, as it can delay the healing process.

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What Are the Complications Associated with Nasal Septoplasty Surgery?

Risk factors associated with nasal septoplasty surgery are:

  • Bleeding: Some amount of bleeding can occur during the surgery, which is managed by giving a nasal pack.

  • Septal Hematoma: Nasal septal hematoma (pooling of blood and forming a clot) under the nasal septal cartilage can occur. It needs to be drained to avoid septal perforation.

  • Nasal Septal Perforation: A hole or perforation can occur in the nasal septum (Bony-cartilaginous wall dividing the nasal cavities) during the surgery.

  • Nasal Blockage: Swelling in the nose or nasal congestion can occur after the surgery causing nasal obstruction.

  • Numbness in the Upper Teeth and Lip: Numbness in the upper teeth and lip can occur after the surgery due to damage to the nerve (nasopalatine nerve) supplying them.

  • CSF (Cerebrospinal Fluid) Rhinorrhea: Damage to the vital structures located close to the nose, like the brain, while performing the surgery, can result in leakage of CSF (cerebrospinal fluid) from the nose.

  • Change in Smell: After the surgery, temporary loss of smell can occur due to damage to the olfactory (the first cranial nerve) nerve fibers. It gets resolved after six months.

  • Change in Taste: Change in taste can occur due to repetitive nasal blockage leading to loss of smell. It gets resolved after the nasal blockage subsides.

  • Pain and Discomfort: Pain and discomfort at the surgical site may occur due to the presence of a splint.

Conclusion:

Nasal septoplasty is one of the most common surgeries performed by the surgeon that shows 60 to 100 percent of satisfactory treatment outcomes for both the patient and the doctor, except for a few cases where the recurrence of the nasal septum back to its original place can occur. Septoplasty improves the airflow through the nose, the physical appearance of the nose, and snoring problems (due to obstructive sleep apnea). Treatment outcomes may vary from person to person. Any complications noticed after the surgery should be reported to the doctor immediately for further needful treatment.

Frequently Asked Questions

1.

Is Septoplasty Considered a Significant Surgical Procedure?

Septoplasty is generally considered a minor surgical procedure. It involves straightening or repairing the nasal septum, the wall of tissue separating the nostrils. While it is a surgical intervention, it is typically performed as an outpatient procedure and does not involve extensive incisions or major alterations to the external appearance of the nose.

2.

Does Septoplasty Recovery Involve a Lot of Pain?

Pain during septoplasty recovery can vary from person to person, but it is typically not very painful. Patients may experience some discomfort, congestion, and a sensation of stuffiness in the nose, which is more like pressure rather than severe pain. Pain can be easily managed with over-the-counter pain medications, and any discomfort usually subsides within a few days to a week after the surgery.

3.

How Long Does It Take To Recover From Nasal Septoplasty?

The recovery time for nasal septoplasty can vary. However, most patients can expect to resume normal activities within one to two weeks. However, complete healing of the nasal tissues may take several weeks to a few months. Following the surgeon's post-operative instructions is essential to ensure a smooth and timely recovery.

4.

What Is the Typical Cost of Septoplasty in India?

The cost of septoplasty in India can vary depending on various factors. Factors commonly influencing the cost of septoplasty include the location of the surgical facility, the surgeon's experience, and whether it is performed in a private or public hospital. It is advisable to consult with a healthcare provider or surgeon to get an accurate cost estimate based on specific needs and location.

5.

Will the Nose Be Blocked After Septoplasty?

It is common to experience nasal congestion and blockage immediately after septoplasty due to swelling and post-operative changes. However, septoplasty aims to improve nasal airflow and alleviate blockages in the long run. Most patients experience improved breathing and reduced nasal congestion as the healing progresses.

6.

Is There an Age Limit for Septoplasty?

There is no specific age limit for septoplasty. The suitability for septoplasty is determined on a case-by-case basis, depending on the individual's medical condition and the severity of their nasal septum deviation. Both younger and older individuals can undergo septoplasty if it is medically indicated and recommended by an ENT specialist.

7.

Are Stitches Used in Septoplasty?

In most cases, septoplasty does not involve external stitches. The surgery primarily focuses on internal adjustments to the nasal septum. Any incisions made are typically inside the nose and do not require external sutures. Dissolvable sutures, if needed, are usually placed inside the nose and are not visible after the procedure.

8.

Would an ENT Specialist Recommend Septoplasty?

An ear, nose, and throat (ENT) specialist will recommend septoplasty when correcting a deviated or damaged nasal septum is medically necessary. The recommendation for septoplasty is based on the patient's symptoms, clinical evaluation, and the impact of the nasal septum deviation on their breathing and overall health. It is not typically recommended unless there is a valid medical reason to do so.

9.

Is It Possible for a Septoplasty to Be Unsuccessful?

While septoplasty generally improves nasal airflow and addresses septum deviations, it may not achieve the desired results in some cases. Factors such as the surgeon's skill, the severity of the septum deviation, and post-operative care can influence the outcome. In such cases, revision septoplasty or additional procedures may be considered to address any residual issues.

10.

Is It Possible to Smile After Having Septoplasty?

Yes, the patient can smile after septoplasty. Septoplasty primarily focuses on the nose's internal structure (the septum) and does not affect the muscles responsible for facial expressions, such as smiling. The surgery should not impair the ability to smile or make facial expressions.

11.

What Guidelines Should the Patient Follow After Septoplasty?

After septoplasty, it is important to follow the surgeon's post-operative instructions, which may include:


- Avoiding strenuous activities for a few weeks.


- Keeping the head elevated, especially when sleeping.


- Taking prescribed medications and pain relievers as directed.


- Avoid blowing the nose forcefully.


- Using saline nasal sprays or rinses as recommended.


- Attending follow-up appointments with the surgeon for evaluation and care.

12.

Will the Patient Be Able to Breathe Properly After Septoplasty?

The primary goal of septoplasty is to improve nasal airflow and alleviate breathing difficulties caused by a deviated or obstructed septum. While there may be temporary congestion and discomfort immediately after surgery, most patients experience improved nasal breathing and better airflow once the healing process is complete.

13.

Does Septoplasty Improve One’s Quality of Life?

Septoplasty can significantly improve the quality of life for individuals suffering from breathing problems or nasal congestion due to a deviated or obstructed septum. By enhancing nasal airflow and reducing symptoms like snoring, sleep apnea, and chronic sinus issues, septoplasty can lead to a better quality of life for many patients.

14.

Does Septoplasty Alter the Shape of the Nose?

Septoplasty primarily focuses on correcting the internal structure of the nose, specifically the nasal septum. It is not intended to change the external shape or appearance of the nose. However, in some cases, septoplasty may be combined with rhinoplasty (cosmetic nose surgery) if the patient desires both functional and esthetic improvements.

15.

What Dietary Restrictions Are Recommended for Septoplasty?

There are usually no strict dietary restrictions after septoplasty. Staying hydrated and maintaining a balanced diet is essential to support the healing process. However, the person is advised to avoid extremely hot or spicy foods that could irritate the nasal passages while they are healing. Moreover, it is best to consult with the surgeon for dietary recommendations and any post-operative instructions they provide.

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Dr. Syed Peerzada Tehmid Ul Haque
Dr. Syed Peerzada Tehmid Ul Haque

Otolaryngology (E.N.T)

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