Septoplasty
A septoplasty is an operation performed to straighten bends that may be present in the wall (nasal septum) that separates the nostrils.
What are the reasons that a septoplasty may be undertaken?
Nasal obstruction
Some individuals may have bends in the nasal septum which may block the passage of air such that they experience a sensation of nasal blockage. In certain cases, an additional procedure termed a turbinoplasty may also be required.
To help straighten the outside appearance of a nose
Certain bends within the nasal septum may cause the external appearance of a nose to be twisted. Correcting this external twist may require a septoplasty as part of the procedure of a rhinoplasty. Hence, this operation is then termed a septorhinoplasty.
To help with access for other operations on the sinuses
People undergoing operations upon their sinuses, endoscopic sinus surgery, have these operations performed using delicate instruments and cameras which pass through the nasal passageways. However, a bend in nasal septum may hinder access for the cameras and instruments that are used during the operation. A septoplasty may be performed in these instances to help sinus surgery to be completed.
What happens before the operation?
In your consultation with Dr. Michael, he will ask questions in relation to issues that you may be having with your nose. You will also have an endoscopy. This is a specialised examination where a fine camera (endoscope) is used to inspect the inside of the nasal passageways. Dependent upon what is found, Dr. Michael may consider medical treatments and other tests before advising upon surgery.
What does a septoplasty operation involve?
A septoplasty is mainly undertaken with general anaesthesia and performed through the nasal passageways without any external cuts. In certain, more complicated cases, an “open” approach may be needed which involves a small cut made underneath the nose. This typically heals very well.
The nasal septum is made of cartilage at the front and bone further back. Firstly, the lining over the cartilage and bone is lifted off. Dr. Michael typically uses an endoscope to then straighten the wall by removing very selective components that are bent or by shaping the wall in order to straighten it.
Dissolvable stitches are placed inside the nasal passages to keep the wall in its new position and prevent the collection of blood.
Splints (temporary stabilising supports) are sometimes placed inside the nasal cavity.
You may require temporary nasal packs. These are required in approximately 1 in 20 of the operations that Dr. Michael performs.
Are there any risks to having a septoplasty?
There are general risks associated with having an operation. These include nausea and vomiting, bleeding, infection and allergies to medicines or dressings used. When having an operation under general anaesthesia, other risks include blood clots in the legs or lungs, a stroke or a heart attack. However, the risk of these serious complications is extremely low. Your anaesthetist will discuss these with you prior to the operation.
With regards to septoplasty, there are a number of specific risks. These are listed below.
A septal haematoma occurs when blood collects between the lining and cartilage making up the nasal septum. This is a rare complication and Dr. Michael uses acknowledged techniques to minimise this occurring. However, if a subsequent infection ensues, a septal abscess may form. People may notice increasing pain and nasal blockage. There may also be feverish symptoms. You may require admission or a minor operation to drain any collections formed.
A saddle nose is the descriptive term given to the appearance of a nose when there is loss of support from the nasal septum. This can occur from too great a removal of the septum or as a consequence of a septal haematoma or abscess. Dr. Michael minimises this risk through preserving as much of the nasal septum as possible and preventing the chance of a septal haematoma forming
A septal perforation (hole in the nasal septum) occurs when the nasal septum fails to heal. Often, this is not noticed as it causes no difficulties. However, when present, they may cause issues with crusting, bleeding or whistling when air passes through the hole. If appropriate, an operation can be undertaken to repair the hole.
Scarring (adhesions) may occur between the nasal septum and the side wall of the nasal passageways. These adhesions do not usually cause any problems but Dr. Michael may divide them when you are seen at your follow up appointments.
A revision operation may be required. Although the septum may be straight at the end of the operation, it may return to its bent state much in the same way that a spring is straight when it is stretched but returns to its original shape when let go. Techniques are used the prevent this from happening in order to minimise the risk of revision surgery.
What happens after the operation?
There is usually no pain or external bruising involved and people typically go home the same day. If you required nasal packing, Dr. Michael may arrange for an overnight stay for observation. The nasal packs are then removed the day following the operation. If splints have been placed, these are removed one week after the operation. While healing occurs, the inside of the nose can become dry and crusts may form. Hence, you will be asked to wash your nose with a salt water solution to help clear these crusts.
Although, the operation is designed to improve breathing through the nose, you may feel congested (similar to a heavy cold) for a period of 4-6 weeks.
You will be seen at regular intervals to assess for complications and assess your progress.
Are there any precautions that I should undertake?
If you have a septoplasty alone, return to work would be possible in a few days if you undertake desk duties. Else, 1-2 weeks leave should be considered. You should refrain from exercise for 4-6 weeks.