Nasal Septoplasty - Indications, Diagnosis, Procedure, and Complications

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.