Septoplasty

General Info about Septoplasty
Septoplasty is the procedure for correcting a deviated septum.

It is sometimes referred to as

Submucous resection of the septum (SMR)
Septal reconstruction.

The nasal septum is a structure in the middle of the nose that is designed to separate the two sides of the nose to allow airflow. Many people have what is known as a deviated nasal septum. What it means is that the septum is crooked on one side and allows less space for the air to flow through that side. However this may or may not cause any problems. Sometimes, following a trauma, the septum becomes crooked. When the deviated septum does cause problems, it can lead to obstruction or blockage in breathing and at times cause recurrent infection of the sinuses (these are the empty spaces around he nose that gives the voice resonance). Age can also cause deviation of the septum.

Septoplasty - Anatomy And Physiology
The nasal septum is the wall dividing the nasal cavity into halves.

The septum usually lies directly in the centre of the nose.

It separates the left and right sides of the nose into passageways of equal size and rests on a bony ridge called the maxillary crest

It is made up of a central supporting skeleton covered on each side by mucous membrane.

The front portion of this natural partition is a firm structure made mostly of cartilage and is covered by skin that has plenty of blood vessels

A "deviated septum" occurs when the septum is severely shifted away from the midline.

There are three pairs of sinuses (called maxillary, frontal & ethamoid) that open into the nasal passage. These sinuses secrete mucus fluid that usually drains into the nose. However a deviated septum, along with the swollen soft tissue structures hanging next to the septum (turbinates) may cause a blockage of the normal breathing passageway, and it could lead to inflammation of sinuses that is known as sinusitis.

septoplasty - Indications For Surgery
A Septoplasty is done in the following situations,

The most common symptom of badly deviated septum is difficulty breathing through the nose causing

  1· Mouth breathing,
  2· Snoring,
  3· Drooling during sleep,
  4· Change in voice,
  5· Decrease sense of smell and taste
  6· Sometimes sleep disturbances.
  7· The symptoms are usually worse on one side, and sometimes occur on the side opposite the bend.

In some cases the crooked septum can interfere with the drainage of the sinuses,

resulting in repeated sinus infections.

The septum may also need to be straightened in individuals undergoing sinus

surgery just so that the instruments needed for this operation can be fit into the nasal cavity.

Septoplasty - Pre-Operative Procedures
The patient should not eat or drink for 6-8 hours before the surgery.

It is advisable to inform and check with the doctor about any regular medication being taken, if necessary they should be taken with a minimal sip of water. (No Juice or other liquids).

Patient has to make sure that they do not take any medications containing Aspirin at least 5-7 days before the surgery.

If the patient is a smoker then he should stop smoking from the time the surgery has been decided. Smoke irritates the nasal passages and causes coughing that might result in bleeding for several days after the operation. It is also a contraindication for undergoing the surgery with General Anaesthesia.

Routine tests done before the surgeries are

1. Blood tests
2. X-Ray Chest (very important if patient over 45 yrs, smoker, or history of heart/lung disease)
3. ECG

The patient is given a consent form, which would explain the procedure, the medication given and the risks involved.

Dentures, rings, chains, or any metal objects on the body should be removed and given to the relative or attendants.

If an over night stay is required in the hospital then the patient should take clothes for changing and toilet items.

If there are any allergies to drugs like penicillin, sulpha or any other drugs it must be informed to the doctor.

Septoplasty - Surgery
The basic principle in a Septoplasty is to straighten the crooked portions of the septum.

The surgery can be done under a local or a general anaesthetic.

It is usually done on an outpatient basis.

The operation is almost always done through the nose, without an external incision, a small incision is made inside the nose.

Before surgery, the doctor may use a thin, lighted instrument (endoscope) to look at the nasal passage behind the deviated septum.

To repair the septum, the surgeon works through the nostrils, making an incision to separate the mucosa from the underlying cartilage and bone.

Badly deviated portions of the septum may be removed entirely, or they may be removed, readjusted, and reinserted into the nose.

The mucosa is then replaced over the cartilage and bone.

There is almost never any bruising on the skin of the nose after Septoplasty.

Post Operative Period - Do's & Don'ts
As this is usually performed as an outpatient procedure, there is no hospital stay.

But sometimes stay might be required if the operation is conducted in the afternoon or if full recovery from the general anaesthesia does not take place an overnight stay might be required.

Splints or packs are placed in the nose for a few days, this Helps prevent bleeding from the nostrils.

Has a small straw that allows the patient to breathe from the nose Makes swallowing much easier.

Keeps the septum straight while it heals.

Elevation of the head and resting in a recliner or using two or three pillows while sleeping helps in reducing bleeding & swelling.

Taking a shower with lukewarm (not hot) water and an attendant should always be at hand as sudden feeling of drowsiness and fainting can occur.

Some bleeding can be expected for two to three days after surgery.

Keep changing the drip pad as needed

Keep the nostril clean.

Cleaning the dried blood and secretions from the nostrils can be done usually with 3% hydrogen peroxide.

Do not blow the nose for at least 10days after surgery.

Do not sneeze through the nose, to avoid risk of bleeding.

After the removal of splints or packs the patient will be advised to Keep nostrils moist for first five days with Oxymetazoline hydrochloride 2-3 times daily for first five days Subsequently the patient will be asked to use saline sprays 6-8 times a day to keep the mucosa moist and free of crust.

Complications & Risks of the procedure
Septoplasty can occasionally lead to a few minor complications like

Bleeding
Infection
Chills

Sometimes a small risk of a hole (perforation) in the septum, but this rarely requires treatment.

Additional surgery is done if the perforation causes discomfort or an infection such as "Toxic Shock Syndrome" develops.

Bacteria such as Streptococcus and staphylococcus are found usually in the nose of some people, if nasal packing is done there are some chances of them developing toxic shock syndrome.

The doctor should be consulted immediately if any of these symptoms are experienced,

1. Fever of 101 °F (38.3 °C) or more
2. Headache
3. Vomiting
4. Diarrhoea
5. Sun burn like rash
6. Chills
7. Signs of very low blood pressure, such as dizziness and fainting.

Septoplasty - FAQs
1. What is Septoplasty? Septoplasty is the surgical procedure to straighten a deviated, twisted, bent or crooked septum to improve breathing, function, sinus infections, comfort and possibly, cosmetic.

2. How succesful is the surgery? Septoplasty is a common nasal surgery, and most people recover well.

3. How do I know if I need a septoplasty? It is best to have a good nasal exam by an Otolaryngologist. There are some medical treatments that can reduce nasal swelling.

4. When and why is a septoplasty done? A septoplasty is done if the septum is so crooked that it interferes with breathing or causes other problems. Few people actually have a perfectly straight septum, but in most cases the amount of bending is not large enough to be noticed.

5. Will I be able to breathe better after surgery? The surgery improves the patient's ability to breathe through their nose.

6. How long will I have swelling and bruising after nasal surgery? With current techniques used there can be minimal swelling and bruising after the surgery. If the patients do have a small amount of bruising after surgery it is usually for a period of 1-2 days.

7. Will the structure of my nose be altered after surgery? No if Septoplasty is the only procedure that was performed then it would not alter the basic structure of the nose.

8. What is the medication that would be prescribed? Antibiotics, Codeine or hydrocodone, Phenergan suppositories are some of the common medications used.

Septoplasty - Glossary
Septum: A wall dividing two cavities or compartments.

Cartilage: A type of connective tissue that contains cells (chondrocytes) surrounded by a tough but flexible matrix. The cartilage matrix is made of several types of the protein collagen and several types of proteoglycans, which are combinations of protein and long sugar molecules called glycosaminoglycans. Chondroitin sulfate is the major glycosaminoglycan in cartilage. Sinuses: Empty spaces or cavities usually within a bony structure.

Sinusitis: Sinusitis is inflammation of the lining membrane of any of the hollow areas (sinuses) of the bone of the skull around the nose. The sinuses are directly connected to the nasal cavities.

Mucus: A thick, slippery fluid produced by the membranes that line certain organs of the body, including the nose, mouth, throat, and vagina.

Aspirin: A drug that reduces pain, fever, inflammation, and blood clotting. Aspirin belongs to the family of drugs called nonsteroidal anti-inflammatory agents. It is also being studied in cancer prevention.

ECG: A procedure that uses ultrasonic waves directed over the chest wall to obtain a graphic record of the heart's position, motion of the walls, or internal parts such as the valves.

Anaesthesia: Loss of feeling or sensation resulting from the administration of certain drugs or gases.

Incision: A cut made in the body during surgery.

Perforation: Process of making a hole, or the hole itself.

Bacteria: A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium. (Des: Common medical terminology used)

Septoplasty - References
1. A Short Practise Of Otolaryngology 2nd edition. By- KK.Ramamlingam, B.Sreeramamurthy, Ravi Ramalingum.

2. Oxford handbook Of ClinicalSpecialities.

Author by
      Dr. B.Vivek

Edited by 
    Dr. Ramya & Dr. Shroff

    

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