|
Septoplasty Patient Information
What is a septoplasty?
The septum is a wall of bone and cartilage that divides the left nasal cavity from the right. Ideally it should run down the middle of the nasal cavity but often it is crooked, protruding into one side or the other. This condition is called a “septal deviation” and can make breathing through the nose difficult, either because of actual obstruction of flow, or because of the creation of turbulent airflow, which slows the air movement. In these cases, a septal repair, or “septoplasty,” is indicated.
The procedure is typically performed through the nose. An incision is made within the nose and the lining is lifted off of the crooked cartilage and bone. These structural elements are then straightened in a variety of ways and the lining is then returned to its original place. Dissolvable stitches are used to keep the lining in place during healing. Occasionally sponges or plastic splints may need to be placed temporarily within the nose following surgery to help with the healing.
In some severe deviations, or when other surgery is to be performed on the nose at the same time, a small incision may be necessary. If an external incision is to be made, your surgeon will specifically discuss this issue with you.
In some patients, other structures in the nose may contribute to the blockage of airflow and your surgeon may advise that these be addressed as well. Occasionally, shelf-like structures known as “turbinates” can be enlarged and block normal air movement through the nose. The function of the turbinates is to increase the surface area of the nose and to act like battens to direct air through the nose. Surface area within the nose is important because the nose warms and humidifies air and removes small particles before the air reaches the lungs. When the turbinates are too large, however, they can disrupt air movement through the nose and may therefore need to be reduced in size. Your surgeon will discuss with you whether this is the case in your nose.
What are the benefits of surgery?
The goal of the surgery is to restore normal airflow through the nose. Deviated portions of the nasal septum will be straightened or removed to improve airflow. Trimming or reduction of enlarged turbinates may also play a role in achieving this goal.
What are the risks of surgery?
While the risks involved in this surgery are relatively minor and uncommon, it is important to remember that risks do exist, as they do in all activities in life. You should be aware of the risks of the surgery in order for you to make an informed decision.
All surgeries carry with them the risks of bleeding, infection, and pain. The risk of bleeding is increased by certain medications so you should review all medications (prescription, over-the-counter, and herbal) with your physician prior to surgery. Aspirin must be stopped at least 10 days prior to surgery and other anti-inflammatory medications such as ibuprofen (Motrin®, Advil®, etc.) must be stopped at least 4 days prior to surgery. You may have small sponges placed at the conclusion of the procedure if your nose is oozing excessively. The sponges are usually removed within 1-2 days.
Taking antibiotics after the procedure will minimize the risk of infection. Most patients pain is relieved by Extra Strength Tylenol® or a mild narcotic and Tylenol® combination. You will receive a prescription for sufficient pain medicine after your surgery.
Rarely, septal surgery can lead to an unexpected change in the appearance of the nose or can lead to a permanent loss of the sense of smell. Another rare risk is creation of a hole in the septum, connecting the right side of the nose to the left. This condition, called a septal perforation, can cause accumulation of dry mucus (“crusting”), bleeding, or a whistling sound in the nose. Because the nose is close to the eyes and brain, it is conceivable that these structures could be injured during nasal surgery as well. Such an event is extremely rare.
Turbinate surgery carries the additional risks of increased crusting and a condition called atrophic rhinitis or ozena, in which the interior of the nose is excessively dry. Atrophic rhinitis is caused by the loss of moisturizing surface area in the nose and can be difficult to treat.
Lack of improvement or even worsening of the underlying condition and the need for re-operation are other risks inherent with any surgery. Surgery also carries with it the risks of anesthesia. Septoplasty can be performed under local or general anesthesia; general anesthesia is more commonly chosen. You should discuss your anesthesia preferences with your surgeon in order to determine what is best for you. You will also have an opportunity to discuss the risks and benefits of each form of anesthesia with an anesthesiologist.
What should I expect after surgery?
You should expect to have some nasal congestion from swelling within your nose. This will last for 4-7 days. You may also have some bloody fluid or oozing from the incisions within your nose for 1-2 days following surgery. Scabbing or “crusting” may form along the incisions in your nose and may last for a week or two. Pain is usually mild but you will want to be careful not to bump your nose, as it will be a little tender. You may want to take 4-7 days off from work/school following the surgery but may go back sooner if you feel up to it. There are no travel restrictions after the surgery but you will not want to swim until healing of the incisions is completed, about 2-3 weeks. You will receive a complete list of instructions following surgery.
What are the alternatives?
Medications to diminish the swelling of the lining of the nose may promote airflow but have drawbacks that you should discuss with your physician. If turbinate surgery is recommended, there are a number of methods to perform this portion of the procedure and you may wish to discuss these with your surgeon. The surgery is, of course, elective so that no surgery is also an option. As with any surgery, you should feel comfortable seeking a second opinion from another surgeon if you desire.
|
