Why is Septoplasty Required?
According to some research studies, over 80% of people suffer from nasal septum deviation. However, not all of them require surgery. Normally, mild or minor deviations are easily bearable and do not lead to any significant issues regarding breathing. However, if the patient exhibits severe breathing issues, then it is a sign that they require septoplasty surgery. It is generally performed if the patient exhibits the following symptoms:
- Deformed nasal septum due to trauma or congenital defect
- Difficulty in breathing through the nose
- Mouth breathing
- Recurring sinusitis
- Obstructive sleep apnea
- Frequent episodes of nose bleeding (epistaxis)
- Frequent sinus-associated headaches
If necessary, in these cases, the patient can get septoplasty surgery combined with other surgical procedures like FESS, turbinectomy, tonsillectomy, myringotomy, etc.
Pre-operative Preparation for Septoplasty
Before getting the surgery, the patient should ensure they have undergone a thorough diagnosis and evaluation to make sure they need the surgery. While septoplasty is an elective procedure that patients can choose to get if they want, it is best to ensure it is medically necessary as well. Before the surgery, the patient should get the following diagnostic tests:
- Physical examination: A severely deviated nasal septum is easily distinguishable from the outside. However, your ENT doctor may use a small nasal speculum to widen the nostrils and check the complexity and severity of the deviation.
- Imaging Tests: Imaging tests like nasal endoscopy, X-rays, CT scan, etc., help assess the internal tissues of the nose and determine how much overall correction is needed to draft an accurate surgical plan.
Once the diagnosis has been successfully performed, the patient should follow the given instructions to prevent septoplasty complications:
- Inform your ENT specialist of your medical history, allergies, etc., so they can make necessary adjustments to their treatment plan.
- Discuss your post-surgery expectations with your surgeon. Some people do not realize that septoplasty does not make any aesthetic changes to the nose shape and hence are not satisfied with the surgery results.
- If you are taking any blood thinners or clotters, you should stop those for a couple of days before and after the surgery. Moreover, you should avoid painkillers like aspirin, ibuprofen, etc., as they increase the risk of bleeding during surgery.
- Smoking and tobacco consumption slow down the healing process and increase the risk of complications, so the patient should stop smoking a couple of weeks before the surgery if they cannot quit altogether.
Day Before Surgery
On the day before the surgery, you should make pre-surgery preparations such as:
- You may need to stay in the hospital overnight, so prepare an overnight bag. Make sure you pick out comfortable clothes that are easy to change into and out of.
- You may not be able to drive for a couple of days after the surgery, so arrange for someone to drive you home after the surgery.
Procedure Day
On the day of the surgery, you will be hospitalized, and your pre-surgery vitals will be taken to ensure you are in optimum condition for the surgery. Following this, you will be anesthetized and prepared for the surgery. Septoplasty can be performed under both general and local anesthesia based on the surgeon and patient preference. Septoplasty procedure steps are listed as follows:
- The septoplasty incision is placed inside the nose, so there is no aesthetic change on the patient’s face after the surgery.
- The nasal septum tissues are removed and repositioned wherever necessary to straighten them. Tissue grafts may also be used if needed.
- Finally, when the surgeon is satisfied, the incision is closed with absorbable sutures, and absorbent bandages will be used to pack the nose and limit bleeding. Then, the patient is moved back to their room for post-surgery observation.
Techniques of Septoplasty Surgery
Based on the surgical procedure and septoplasty steps, there are 3 surgical approaches for septoplasty, as described below:
- Open endonasal septoplasty : In this technique, the surgeon corrects the nasal septum deviation by removing parts of the nasal septum and the ethmoid bone. Since it causes aesthetic changes and can result in facial scarring, it is generally not preferred nowadays.
- Endoscopic septoplasty : Endoscopic septoplasty is a minimally invasive procedure that results in very little damage to the tissues surrounding the nasal septum. The endoscope is guided through the nasal passages to remove the deviated parts of the nasal septum only and re-align them properly.
- Open (external) septorhinoplasty : A septorhinoplasty approach is taken by the surgeon when the patient wants both - better breathing ability and a more aesthetic appearance of the nose. It is also performed when the septal deviation is the result of a severe facial trauma that has altered the appearance of the nose.
Post Procedure Septoplasty Recovery
Once you are moved to the recovery room, you will be kept under observation for a few hours to ensure there are no complications. In some cases, an overnight hospital stay may be required to ensure proper recovery. It can take about 3-6 months for the patient’s nasal tissues to settle into their new position. However, most patients can resume their normal day-to-day activities within a couple of weeks.
Based on the extent of correction you need and the surgery, your surgeon may advise you to follow all or some of the given tips to improve your recovery:
- Use a soft pillow to elevate your head while sleeping.
- Don’t blow your nose for at least the first 3 days after the surgery. Avoid sneezing as much as possible.
- Stay away from allergens like dust, smoke, pollen, etc., that can trigger your allergies and lead to sneezing or runny nose.
- Avoid strenuous activities such as heavy lifting, aerobics, running, etc., for up to 5 weeks to avoid nosebleeds.
- Massage the surgical area using an ice pack in the first couple of days after the surgery to reduce swelling and bruising.
- Avoid strenuous activities such as heavy lifting, aerobics, running, etc., for up to 5 weeks to avoid nosebleeds and displacement of nasal tissues.
Risks and Complications involved in Septoplasty Surgery
While septoplasty is incredibly safe and effective, it can also lead to some complications if not performed carefully. Some of these are listed below:
- Failure to resolve the symptoms, i.e., continued breathing issues
- Hemorrhage and scarring
- CSF leakage
- Change in the shape of the nose
- Septal perforation
- Decreased sense of smell
- Alteration of the voice quality
- Hematoma formation
- Temporary numbness of the gums, teeth, or nose.
- Anesthesia-related complications
In mild cases, these complications may wear off on their own in some time, but in severe cases, the patient may require additional treatment and surgery for successful recovery.
