Septoplasty or alternatively submucous
septal resection and septal reconstruction, is a corrective surgical procedure done to straighten a deviated
nasal septum – the nasal septum being the partition
between the two nasal cavities. Ideally, the septum should run down
the center of the nose. When it deviates into one of the
cavities, it narrows that cavity and impedes airflow. Deviated nasal septum or
“crooked” internal nose can occur at childbirth or as the result of an injury
or other trauma. If the wall that functions as a separator of both sides of the
nose is tilted towards one side at a degree greater than 50%, it might cause
difficulty breathing. Often the inferior turbinate on the opposite
side enlarges, which is termed compensatory
hypertrophy. Deviations of the septum can lead to
nasal obstruction. Most surgeries are completed in 60 minutes or less, while
the recovery time could be up to several weeks. Put simply, septoplasty is a
surgery that helps repair the passageways in the nose making it easier to
breathe. This surgery is usually performed on patients with a deviated septum,
recurrent rhinitis, or sinus issues.
septoplasty
The
procedure usually involves a judicious
excision/realignment of a portion of the bone and/or cartilage in the nasal
cavity. Under general or local anesthesia, the surgeon works
through the nostrils, making an incision in the lining of the septum to reach
the cartilage/bone targeted in the operation. This may be performed using an
endoscope or with open techniques. Sufficient cartilage and bone is preserved
for structural support. After the septum is straightened, it may then be
stabilized temporarily with small plastic tubes, splints, or sutures
internally. Skin grafts can be placed
internally to support the internal structures.
Indications
Apart
from in patients with deviated nasal septum causing airway obstruction leading
to difficulty with breathing, recurrent rhinitis, or sinusitis, septoplasty is
done as an approach to hypophysectomy.It is sometimes done as
well to cure recurrent nosebleed (epistaxis) due to septal
spur.
Contraindications
Septoplasty
should not be done in acute nasal or sinus infection. It should also be avoided
if the person has untreated diabetes, severe hypertension or bleeding
diathesis
Post-operation
Unless
there are unusual complications, there is no swelling or discoloration of the
external nose or face with septoplasty alone. Packing is rare with modern surgical
techniques, but splinting the inside of the nose for a few days
is common; the splints are not visible externally. One percent of patients can
experience excessive bleeding afterwards — the risk period lasts up to two
weeks. This could require packing or cautery, but is generally
handled safely and without compromise of the ultimate surgical result. Septal
perforation and septal hematoma are possible, as is a decrease in the sense of
smell. Temporary numbness of the front upper
teeth after surgery is common. Sometimes the numbness extends to the
upper jaw and the tip of the nose. This almost always resolves within several
months.
The
nasal tissues should mostly stabilize within 3-6 months post-surgery, although
shifting is still possible for up to and over a year afterwards.
Complications of
septoplasty
·
Nasal
septum perforation due to the bilateral trauma of the
mucoperichondrial flaps opposite each other.
·
Septal hematoma and septal abscess.
·
Adhesions and synechiae
between septal mucosa and lateral nasal wall.
·
Saddle nose due to
over-resection of the dorsal wall of the septal cartilage.
·
Dropped nasal tip due to
resection of the caudal margin.