Functional nasal surgery has evolved quite a bit over the last few decades. Technological advancements have allowed procedures, such as the septoplasty, to be done with far more precision and accuracy, yielding better results and an easier recovery.
A septoplasty is the surgical procedure used to correct a deviated septum. A deviated septum is defined as the displacement of the bone and cartilage that divides the nasal cavity into the right and left side. Some people who suffer from a deviated septum have one nostril that is noticeably smaller than the other. Surgery is the only way to correct this issue.
During a septoplasty, the nasal septum is straightened and repositioned so that it lies in the middle of the nose. Parts of the septum may need to be cut or removed then reinserted into their proper position. Dr. Hall routinely performs a procedure to address the most anterior aspect of the nasal septum (caudal septum) with a cartilage strut, which often improves the most critical area of nasal breathing, the internal nasal valve. The most common techniques for septoplasty do not address this area, yielding a much higher rate of inadequate results and need for revision surgery. If you have had a prior septoplasty and still suffer from nasal breathing issues, this is likely the area which needs to be addressed.
Breathing difficulties can arise as a result of the physical structure of the nose. A severely deviated septum can block an entire side of the nose, causing airway obstruction. Another effect is that the drying effect from improper airflow can lead to crusting and bleeding. These issues not only impact quality of life but may also pose real danger to respiratory health.
Before undergoing a septoplasty, patients should meet with their surgeon to discuss the risks, benefits, and alternatives, as well as expectations. During this consultation, medical history will be reviewed and a physical examination administered. Photographs may also be taken at this time.
In order to best prepare, certain medications, specifically aspirin and blood thinners, may need to be halted prior to the operation to prevent excessive bleeding. Smokers should abstain during the time leading up to and following the procedure.
Arrangements must be made for the day of the surgery. Patients will be unable to drive immediately following surgery due to anesthesia, which can cause delayed reaction time and impaired judgment. If possible, have a friend or family member who can help with everyday tasks for the next 24 hours.
During the Procedure
Patients may receive one of three types of anesthesia.
a. Limited to the nose area only, patients remain fully conscious after the pain-numbing medication is injected directly into the nasal tissues. This is done by Dr. Hall in limited cases.
2. Twilight Sedation
a. Delivered intravenously, this type of anesthesia leaves patients feeling groggy and a bit out of it but still awake and conscious.
a. Referred to as being put under, with general anesthesia, patients are temporarily unconscious.
Small incisions are made inside of the nose from which the surgeon will work to trim, reposition and replace cartilage and bone as needed. Lifting the mucus membrane grants access to this area. The procedure itself routinely takes Dr. Hall 20 minutes or less to complete.
The incisions are closed with an absorbable suture, thus eliminating the need for stitch removal. Nasal packing is sometimes required if bleeding persists or to provide support for the septum, however Dr. Hall finds that he almost never needs to do this, eliminating the need for removal in the recovery period.
Typically, a septoplasty is done as an outpatient procedure. Patients are watched for an hour or two and discharged and released to return home once the effects of anesthesia have fully worn off and no complications are detected.
Depending on the extent of the surgery, the surgeon may ask you to comply with some or all of the following post-op recommendations in order to minimize swelling and promote healing.
• Avoid strenuous activities or situations that increase blood pressure.
• Refrain from blowing the nose.
• Keep the head elevated at night when sleeping or if napping during the day.
No surgery is without risks. Infections, excessive bleeding, or an unexpected adverse reaction to anesthesia are all possible risk factors. Other include:
• Blood pooling in the nasal space (septal hematoma)
• Change in the shape of the nose
• Decreased sense of smell
• Discoloration of the nose
• Opening in the septum (septal perforation)
• Ongoing symptoms despite surgical corrections
• Temporary numbness along the upper gum line
Results are intended to be lasting, but over time, the cartilage and bone may shift. Nasal tissue can take up to a year to fully settle into place. Most people are extremely satisfied with their results and note a significant improvement in breathing ability right away. Some people, however, continue to experience symptoms and may require a revision septoplasty to further correct any remaining issues. Before and after photos can serve as an excellent marker of change.