Septoplasty

What is septoplasty?

A wall of cartilage and bone, called the septum, separates two distinct nostrils in the nose. In some people, the septum is on one side of the nose, disproportionately. Therefore, this means the size of each nasal passage is different, with one being smaller than the other. For some, this condition is present right from birth. It can also be a result of a physical injury to the nose.  

Patients with deviated nasal septum are unable to breathe with ease. Some of them complain of facial pain. Patients may also experience nosebleeds and dryness inside the nose.

Septoplasty refers to the surgery performed to rectify a deviated nasal septum. This surgery aims to correct the deviation by straightening the septum and help improve airflow through the nose.

 In some patients, the deviation is acute. This causes a huge problem with breathing.  Without much airflow in and out of the nose, it could become a breeding ground for bacteria that results in infection and inflammation.

Septoplasty trims the bone and straightens it. Then, the bone and cartilage is replaced .

When should you go for septoplasty?

Some of the overriding reasons patients go in for septoplasty are as follows:

• To set right the nasal septum deformed due to a birth defect or injury
• Trouble  breathing through nose
• Infection in the mouth due to breathing from the mouth
• Increased nasal dryness and nose bleed
• To remedy nasal drainage
• Relieve constant headaches because of sinus
• Inflammation in the nose

Septoplasty also helps doctors view the inside of the nose to clearly spot other medical problems in the nose.

Types

Septoplasty is performed using conventional method as well as with the use of laser called as laser assisted outpatient septoplasty. Patients benefit from this simple treatment for deviated nasal septum. This procedure can be performed on an outpatient basis for snoring and nasal obstruction.

Treatment options

Some of the forms of treatment that patients usually consider for relief are:

Use of nasal steroids

Nasal steroids do provide temporary relief for the people suffering from difficulty in breathing, due to a deviated nasal septum. Patients that suffer from infections and allergies are given nasal steroids.

The problem with this form of treatment is that it needs to be used for prolonged periods. These steroids can cause few side effects such as nosebleeds, dryness and throat soreness.

Medicine to treat allergies

• Antihistamines are prescribed both as a tablet or as a spray to alleviate allergy which may have caused inflammation. This can make the symptoms worse.
• Nasal strips can provide relief as they help opening up the nasal passages by lifting the sides of the nose away from the septum. All these provide some relief if the patient uses them at night.
• Nasal dilators, nasal valve support, use of vaporizers and humidifiers and use of neti-pot provide temporary relief.

Though these remedies may help for a short while without going through surgery, there is no guarantee that the symptoms will not worsen. Septoplasty or surgical option to correct the deviated nasal septum can offer a lasting solution.

Preparation

Your surgeon will perform a complete physical examination. Your breathing technique through the nose is of utmost importance and the surgeon makes a note of this.

• Usually, patients will receive advice from doctors about the medicines they will need to stop consuming few weeks prior to the procedure. This is especially so, if patients are on blood thinners such as aspirin. It is important to let your doctor know if you have a history of bleeding problems.
• The doctor also conducts a detailed medical history assessment to understand prevailing medical conditions, surgeries undergone in the past and overall highlights about health and genetic factors.
• If you are allergic to any medicine, then your doctor must be aware of it. A day before the surgery, you should stop eating after your dinner, so it will prevent vomiting or choking, if you are on general anaesthesia.
• Your surgeon will completely explain the septoplasty procedure to you. It is during this time the surgeon explains all possible outcomes of the surgery and evaluates the expectation from the patient.
• The surgeon will also take pictures of your nose which will be part of the medical documents. This will help make a comparative study before and after surgery.
• The whole process of surgery as well as risks will be thoroughly explained to the patients. 
• Advice to smokers will be to quit the habit, at least during the days preceding the surgery. This will help hasten the healing process.

Risks

As with any surgery, septoplasty can run into few complications post-surgery. 

• Alterations to the shape of the nose
• Blood clots in the nasal area
• Excessive and unrestrained nasal bleeding
• Punctures in the nasal septum
• Eye injury
• Compromised sense of smell
• Cerebral spinal fluid leak
• Teeth and upper maxilla feeling numb
• Scarring
• Heart problems although rare
• Blood clots in the nasal region called septal hematoma
• Allergy to medicines in the course of the surgery
• Blocked nose even after surgery needing a repeat procedure
• Problems with breathing post-surgery
• Uneven appearance of nose
• Blood transfusion as a critical measure

Maintaining proper hygiene in the nose as well as sanitising the hands will help offset some of the risks.

Procedure – septoplasty

You will be under general or local anaesthesia based on the earlier discussion between you and the surgeon. The procedure will take only 30 minutes to complete if there is no complication. Incase, the case is complex, the surgery time may get extended to about 90 minutes.

Although, most people undergo the surgery under general anaesthesia, in rare cases local anaesthesia is also used.

• During the procedure, the first step is to gain access to the septum. To do so, the surgeon makes an incision on one side of the nose.
• Next is to lift the protective covering on the septum, mucous membrane.
• Deviated septum is now shifted to the right side to reposition and rectify it.
• The surgeon does away with pieces of cartilage and bone which is extra.
• The mucous membrane is repositioned.
• The surgeon secures the membrane and septum with sutures. Sometimes, the use of cotton inside the nose may also be adequate to hold the septum in its position.

Laser-assisted outpatient septoplasty

Laser-assisted outpatient septoplasty is another successful technique to perform and rectify the deviated nasal septum under local anaesthesia. This surgery is a simple procedure that is completed in five minutes. This type of surgery best suits patients with moderate anterior septal deviation.

The benefits of laser-assisted outpatient septoplasty are that it is not as invasive as traditional septoplasty and involves much lesser cost of surgery. It is linked to lower morbidity and quicker recovery that helps patients resume complete activity.

LAOS is a relatively painless procedure, with reduced bleeding and faster process of healing.

Cost of septoplasty

The cost of septoplasty varies depending on the city, hospital, infrastructure, facilities, skill and experience of the surgeon performing the surgery.

If it is performed as an outpatient procedure, the price is much less. Depending upon the post operative experience, especially in the presence of complications or co morbidities, patients may or may not need hospital admission.

On an average the cost of nasal septum surgery falls in the Rs. 40,000 and Rs. 60,000 range. Laser assisted septoplasty costs much lesser than traditional septoplasty.

Post-op care and things to keep in mind

• In the absence of any major complications, usually septoplasty does not require hospital admission or stay. It is generally performed as an outpatient procedure.
• Patients will be able to go back home the same day after the effect of anaesthesia has worn off.
• After the surgery, the nose is packed with cotton to limit bleeding. The packing can remain for a day or two after surgery. Patients will need to take medication to reduce pain.
• Avoid intense physical activity for several weeks post septoplasty, because this will help the healing process and also minimise chances of complications. Playing contact sports, lifting weights and running should be avoided. With these activities there is a chance that the blood pressure may increase leading to excessive bleeding.
• It is good to keep the head at a higher position during recovery phase. This keeps the swelling down.
• Do not blow your nose for at least few days after the surgery.
• Avoid risk of any possible injury to the nose. So, do not wear clothes that are tight at the neck which might damage or injure the nose while pulling the cloth over the head. It is good to wear clothes that will allow you to button up in the front.
• Although the nose will heal soon and the breathing will show improvement after the procedure, the nasal tissues and cartilage will take nearly a year to completely adjust to the changed shape. The healing process inside can be a bit slow.
• In some patients the nasal tissues and cartilage continues to change and may block the flow of air through the nose. Such patients may need a repeat surgery to reshape the deviation. The complete healing may take place only after 3 to 6 months.

Best option

Septoplasty helps improve breathing and quality of life for patients. Fixing the shape of the nasal septum cures the blockage in the nose and remedies uncontrollable nosebleeds caused by increased drying of the nose. Further, patients experience relief from sinus drainage and inflammation inside the nose.

Septoplasty or surgical option to correct the deviated nasal septum can offer a lasting solution for unbearable symptoms.

Many hospitals in Bangalore offer septoplasty performed by qualified surgeons with years of experience. goficure, is a healthcare service that offers consultation with the best surgeon, support with surgery, post-op care and follow-up, all under one umbrella to make it easy and affordable to patients.

References