Rhinology

What is Septoplasty?

Septoplasty is a surgical procedure to straighten the bone and cartilage dividing the space between your two nostrils (septum). When the septum is crooked, it's known as a deviated septum. A deviated septum can make it harder to breathe through your nose and can increase the risk of sinus infections due to poor drainage.

During septoplasty, your nasal septum is repositioned to the middle of your nose. This may require your surgeon to cut and remove parts of your nasal septum before reinserting them in the proper position.

Once a septoplasty is healed, you'll likely find it's easier to breathe. Your surgeon can discuss what septoplasty can achieve for you.

What are the indications for Septoplasty?

A crooked septum is common. But when it's severe, a deviated septum can block one side of your nose and reduce airflow, causing difficulty breathing through one or both sides of your nose.

Septoplasty straightens the nasal septum by trimming, repositioning and replacing cartilage, bone or both.

If you experience symptoms — such as difficulty breathing through your nose — that affect your quality of life, you may consider surgery to fix a deviated septum.

What are the risks of Septoplasty?

As with any major surgery, septoplasty carries risks, such as bleeding, infection and an adverse reaction to the anaesthetic. Other possible risks specific to septoplasty include:

• Continued symptoms, such as nasal obstruction

• Excessive bleeding

• A change in the shape of your nose

• A hole in the septum

• Decreased sense of smell

• Clotted blood in the nasal space that has to be drained

• Temporary numbness in the upper gum, teeth or nose

You may need additional surgery to treat some of these complications. You may also need additional surgery if the outcome of septoplasty doesn't match your expectations. Talk to your doctor about your specific risks before surgery.

How to prepare for surgery

Before scheduling septoplasty, you'll meet with your surgeon to discuss benefits and risks of the surgery. This meeting generally includes:

• Your medical history. Your doctor will ask about conditions you have or have had, as well as any current medications or supplements that you're taking.

• A physical examination. You'll have a physical exam, including any relevant tests. The doctor will inspect your skin and the inside and outside of your nose.

• Photographs. Someone from your doctor's office may take photographs of your nose from different angles. Your doctor can use these photos for discussion before septoplasty or for reference during and after surgery.

• A discussion of your expectations. You and your doctor should talk about your expectations. He or she will explain what septoplasty can and can't do for you and what your results might be.

What you can expect from the surgery

Septoplasty straightens the nasal septum by trimming, repositioning and replacing cartilage or bone. The surgeon works through incisions inside the nose. Occasionally it is necessary to make a small incision between the nostrils.

If the nasal bones are crooked and pushing the septum off to one side, it may be necessary to make cuts in the bones of the nose to reposition them. Spreader grafts are small, reinforcing strips of cartilage that can be used to help correct a deviated septum when the problem is along the bridge of the nose.

After the procedure

To further decrease the chances of bleeding and swelling, your doctor may ask that you follow these precautions for several weeks after surgery. Depending on the extent of your surgery, you may not need to do all of these:

• Elevate your head when you're sleeping.

• Don't blow your nose for several weeks.

• Avoid strenuous activities, such as aerobics and jogging, for up to five weeks to avoid potentially causing a nosebleed.

Results

By three to six months after surgery, your nasal tissues will be relatively stable. It's still possible that cartilage and tissue may gradually move or reshape over time. Some changes can still occur for up to a year or more after surgery.

Most people find that septoplasty improves their symptoms, such as difficulty breathing, that were caused by a deviated septum. The level of improvement you can expect with septoplasty varies by person.

Some people find that their symptoms continue even after surgery and opt to undergo a second septoplasty to further refine the nose and septum.

What is Endoscopic Sinus Surgery?

Endoscopic sinus surgery is a procedure designed to open the natural drainage pathways of the sinuses to restore their function and health. In chronic sinusitis, the sinuses are unable to drain adequately due to inflammation of the narrow drainage pathways. As a result, nasal secretions can become trapped in the sinuses and become chronically infected.

The goal of surgery is to carefully remove the thin, delicate bone and mucous membranes that block the drainage pathways of the sinuses. The term “endoscopic” refers to the use of small fibreoptic telescopes that allow all of the surgery to be performed through the nostrils, without the need for any skin incisions. Endoscopic sinus surgery is generally performed on an outpatient basis.

What to expect before, during, and after surgery?

Before Surgery: In preparation for your surgery, your physician may prescribe preoperative medications to optimize the condition of your sinuses for surgery. The medications may include antibiotics and/or oral steroids. Please be sure to start any preoperative medications on the appropriate day and adhere closely to the prescription. In addition, you should avoid taking the following medications for at least seven days prior to surgery: aspirin, ibuprofen, naproxen, other non-steroidal anti-inflammatories (NSAIDS). These medications can thin the blood and create excessive bleeding. If you take a blood thinner, please discuss discontinuation of this medication with your surgeon.

During Surgery: In most cases, you will receive general anesthesia for your surgery, which means you will be asleep for the entire procedure.  After your surgery has been completed, you will spend about one hour in the recovery room, followed by an additional recovery period of 1-2 hours in the second stage recovery unit. Most patients feel well enough to go home the day of surgery. You will most likely go home without nasal packing.

After Surgery: You can expect mild bleeding for 1-2 days after surgery and a general sense of fatigue for 1-2 weeks after surgery. In general, pain can be successfully controlled with narcotic or non-narcotic medications. Your visit schedule will usually consist of 2-3 visits over the first 3-4 months. Thereafter, your visits will be spaced a few months apart, depending on how well your sinuses are healing.

Risks of Surgery

As with any surgical procedure, endoscopic sinus surgery has associated risks. Although the chance of a complication occurring are very small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.

• Bleeding: Most sinus surgery involves some degree of blood loss, which is generally well tolerated by the patient. However, on occasion, significant bleeding may require termination of the procedure. Although most patients do not require nasal packing, a few patients will require a small nasal pack or tissue spacer to be removed after one week. Blood transfusion is rarely necessary and is given only in an emergency.

• Recurrence of disease: Although endoscopic sinus surgery provides significant symptomatic benefits for the vast majority of patients, surgery is not a cure for sinusitis. Therefore, you can expect to continue with your sinus medications even after successful sinus surgery, although in general your requirements for such medications should be lessened. In some instances, additional revision surgery may be necessary to optimize your surgical outcome.

• Spinal fluid leak: Because the sinuses are located near the brain, there is a rare chance of creating a leak of spinal fluid (the fluid lining the brain) or injuring the brain. Should the rare complication of a spinal fluid leak occur, it may create a potential pathway for infection, which could result in meningitis. If a spinal fluid leak were to occur, it would require surgical closure and hospitalization.

• Visual problems: Visual loss has been reported after sinus surgery due to injury to the eye or optic nerve. The potential for recovery in such cases is not good. Fortunately, such a complication is extremely rare. Injury to the eye muscles may result in double vision. Persistent tearing of the eye is another possible complication. Tearing problems usually resolve on their own but occasionally require additional surgery.

• Other risks: Other uncommon risks of surgery include alteration of sense of smell or taste; persistence and/or worsening of sinus symptoms and facial pain; change in the resonance or quality of the voice; and swelling or bruising of the area around the eye. 

Restrictions during postoperative recovery period

For the first week following surgery you should not blow your nose. In addition, you should not bend, strain, or lift more than 2kg during the first week. Light walking and regular household activities are acceptable anytime after surgery. You may resume exercise at 50% intensity after one week and at full intensity after two weeks. You should plan on taking one week off from work and ideally have a half-day planned for your first day back.