Septoplasty

Septoplasty (Deviated Septum Surgery)

A septal deviation is colloquially recognized as the nasal bone turning aside. Before answering the question what the deviation is, I think I must address what the healthy nose structure is.

The nasal septum consists of cartilage and bone in the anterior and posterior halves respectively. It extends from the midline between the two separate nostrils to the pharynx, separating the nasal cavity into two airway passages.

In a healthy nose, the anterior entrance to the airway passage enlarges while extending posteriorly. The air taken into is warmed up, humidified, and directed to the smelling regions in the roof of the nose.  Furthermore, the particles, with a size of over 5 microns taken in from the air, are filtered through the mucous secretions on the intranasal mucosa. This means that it always directs the air to the lungs in constant quality and cleanliness. The health states of the lower airways and lungs depend largely on the proper functioning of our nose.

In a deviated nose, this cartilage, which should be positioned exactly on the midline, is more or less moved on the other side.  The intranasal septal deviation, which occurs either in the entrance to or at the exit from the nose, causes an obstruction and prevents air passage. The patient cannot breathe healthily from either one side or both sides of the nose.

What are the causes of deviation?

A deviation may be congenital due to pronounced facial asymmetries developing from hereditary causes, or it may occur as a result of often external trauma subjected in childhood. The nonsignificant deviations with 1 mm shifts as the result of childhood trauma to the nose leads to significant deviations in adolescence as the development of the nose progresses with increasing age. The nose usually continues to develop until 18 years of age.

What are the problems which can be caused by the septal deviation?

The nasal obstruction caused by the septal deviation leads to a loss primarily in the quality of life of the individuals. The incessantly warmed up and humidified air is always sent to the lungs at a constant quality. When the nose is obstructed, the patient starts breathing from the nose causing the airways and lungs to be exposed to dry, cold, and polluted air directly. In this situation; the throat, larynx, lower airways, and the lungs try to climatize the air with failing attempts leading to severe irritation, reactions, and diseases.  The patient with severe nasal obstruction will have an increased tendency to snore at night and will develop disturbances in her or his sleeping pattern and sleep quality due to lack of full oxygenation of the body, leading to the development of headaches in the mornings and low mental and physical performance during the day. These may cause the individual to become more susceptible to weight gain, diabetes, and cardiovascular diseases.

The negative aspects of breathing from the mouth:

  • Dry mouth
  • A foul smell of breath
  • Gingival and dental health problems
  • Snoring
  • Low quality sleep, inability to rest
  • Irritability
  • Loss of appetite
  • Sneezing spells
  • A poor sense of smell
  • Getting up tired
  • Frequent infections and diseases of the lower respiratory tract and lungs

The uncomfortable condition due to nasal obstruction costs decreases in performance to the individual. The productivity of the individual is reduced because of the irregular sleeping patterns. A general fatigue will cause the patient to start failing to enjoy life sufficiently.

The following may occur due to a septal deviation:

  • A general sense of fatigue
  • Excessive weight gain and all diseases associated with excessive body weight (Diabetes, cardiovascular disorders, hypertension, etc.).
  • Loss of capacity to enjoy life
  • Attention deficits
  • A tendency to fall asleep during the day
  • Career failures

Furthermore,

sinusitis, sleep apnea, and diseases of the middle ear can occur as well.

What are the symptoms of the septal deviation?

A septal deviation can be observed from outside by the unaided eye roughly as the nasal bone moving aside or it may develop as a hidden structure within the nasal cavity. There are several general symptoms associated with the disease. If the patient experiences one or more of the following symptoms, the patients must see an Ear Nose Throat specialist (otorhinolaryngologist):

Nasal obstruction (on one side or on both sides)

Breathing from the mouth or sleeping as the mouth is open (causes a continuous inflammation in the pharynx, chronic pharyngitis, dryness in the throat).

Snoring and sleep apnea

Always getting up tired and poor performance during the day

Repeating sinus infections with increasing frequency

Pain in the nose, in the middle region of the face, and in the sinuses (sometimes misdiagnosed as migraine spells).

The decision-making process for the septal deviation surgery

The nose is composed of bone, cartilage, and soft tissues. As I always refer, inside and outside of the nose is a whole and cannot be handled separately. A patient with a septal deviation should have a careful examination of his or her nose both inside and outside before the surgery as it is critically important to determine whether the intranasal deviation causes a deformation visible outside as it will require performing both aesthetic surgery and a septal deviation surgery simultaneously.

In most cases, it is not possible to resolve an intranasal septal deviation visible outside by only performing an intranasal septal deviation surgery. Furthermore, in cases of only intranasal septal deviation surgery in patients with extranasal cosmetic disturbances, the intranasal cartilaginous structures, which constitute an important part for the extranasal aesthetic surgery of the nose, are either lost or injured in the nasal surgery. When the patient demands an extranasal aesthetic surgery in the coming years, these missing or injured non-existent intranasal cartilaginous structures cause remarkable troubles for the aesthetic nasal surgery.  Similar to the revision surgeries, cartilaginous tissue should be taken from the ear or from the ribs in order to restore the nose.  This increases the cost, duration, and the complexity of the surgery. After intra and extranasal structures are thoroughly evaluated before the septoplasty, it should be thoroughly discussed whether the patient would like to undergo a nasal aesthetic surgery along with the septal deviation operation in the same session. The patient's opinions about this issue should be carefully noted.  

How is a septal deviation surgery (septoplasty) performed?

Surgery to treat a deviated septum can be performed under either local or general anesthesia. I prefer performing all kind of surgeries under general anesthesia to maintain my patients' comfort.

First, the nasal cartilage is accessed via an incision performed on the nose of the patient under general anesthesia. Then, the nasal cartilage membrane is elevated and the deviated parts are excised. During these steps, utmost care should be attended to protect the cartilages strutting and bracing the nose. It is extremely important not to harm the connection points between the nasal septum and the nasal bone. Above, the image on the left demonstrates a narrow nasal airway passage. The image on the right shows that this airway passage has become patent.

A deviated septum surgery lasts for 1.5 to 2 hours in my hands. If the surgery includes a rhinoplasty, the duration will vary from 4 to 5 hours. The important point is not the duration of completing the surgery but allowing the patient to finally have a healthy and breathing nose.

The period after the septoplasty

After the surgery, breathing difficulties may occur due to the intranasal silicon plaques, intranasal edema, accumulated blood or clots. The patients must consume liquid and soft diets in the first days following the surgery. Drinking lukewarm water and moisturizing the lips will help during this period.

In the recovery period, the patients should use only the medications which I will recommend. Blood-thinning medications should not be used although they were received in the period before deciding the surgery.

The patients' heads must be supported by at least two pillows to keep the head elevated. Although it is normal to have a mild bloody discharge at the tip of the nose for a few days, the doctor should definitely be contacted in the case of an increased bleeding.

Silicone plaques are usually removed in the postoperative 5-7 days. The patients can breathe from their noses comfortably after this step.

During this period, it is very important to prevent the nose from blows. One should definitely not poke with and around the insides of the nose. Wearing glasses should be avoided as they will exert some force on the nose. A toothbrush with soft bristles should be preferred.  Moisture should be added inside the nose to avoid any intranasal crusting or dryness which can occur later in the process.

Blood pressure increasing activities should be avoided approximately for a duration of 2 weeks. During this period exposure to sun should be avoided, too. The nose should be protected from direct sunlight and sunscreen creams should be used if required.

It is normal to experience some degree of numbness in the nose and in the upper lip.  This numbness is temporary. It will be useful to avoid rubbing the nose strongly, blowing through the nose or sneezing as much as possible during this period.

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