A septoplasty is a surgery for treating nasal blockage.
A deviated septum is a displacement of the wall between the nostrils and often causes these blockages. Enlarged bone structures called turbinates might also block parts of the nose.
A surgeon will also perform a septoplasty to treat long-term sinusitis, remove nasal polyps, and treat other conditions that block the nasal airway. Occasionally, surgeons will recommend a septoplasty to stop recurrent nosebleeds.
A septoplasty is one of the most common ear, nose, and throat (ENT) procedures in the United States. However, doctors will often only recommend septoplasty after ruling out other treatments for nasal blockages.
In this article, we look at what to expect during a septoplasty, including the risks of the procedure and the reasons for having one.
Before the surgery, a nurse and doctor will review the details of the surgery and answer any questions.
They may ask the individual undergoing surgery to complete some routine tests, such as a blood test, X-ray, or electrical heart tracing.
The physicians and nurses will also ask some questions about general health, current medications, or possible allergies.
On entering the hospital, the anesthetist will meet with the person who is having surgery to explain all elements of anesthesia.
Septoplasty often involves general anesthesia. An anesthetist puts an individual to sleep during the surgery. Sometimes, surgeons will choose to use local anesthesia and intravenous sedation instead, but they will discuss this with the patient first.
As with other surgeries that use general anesthesia, people should not eat, drink, or even chew gum after a certain time on the night before the procedure.
If necessary, a doctor or nurse will provide further instructions on when and how to take medications.
To reduce the risk of bleeding, the doctor will probably ask the person to stop using any oral blood-thinning medications up to a week before surgery. Anyone taking blood thinners or other drugs should discuss these with the surgeon.
During a septoplasty, the surgeon will attempt to straighten bent cartilage and bone in the septum. Firstly, they lift the mucosa lining covering the cartilage and bone.
The surgeon then reshapes the cartilage and bone, sometimes removing portions. After that, they will then put the lining back in place.
If enlarged turbinates are causing a blockage, the surgeon might attempt to shrink them with radiofrequency reduction. In some other cases, the surgeon will remove a portion of the turbinate.
Results and recovery
People will commonly feel drowsy for a few hours following surgery. Some will feel nausea, due to the anesthesia. They might also feel pain from the procedure. People should report any after-effects to the nurse. They can offer medications to soothe symptoms.
The medical team will likely place packing in both nostrils. This packing means that the individual needs to breathe through their mouth straight after the procedure. The packing is in place to help stop any bleeding that occurs immediately after surgery.
The nurse will remove the packing once the doctor discharges the individual from the hospital.
Rarely, the healthcare professional places splints in the nose. If so, they will usually set up another appointment in 7 days to remove the splints.
If no complications occur, the doctor typically will send the individual home on the same day as the procedure. A family member or friend should be present to accompany them.
Some congestion and bleeding will be expected to occur following discharge from hospital as your body recovers. These symptoms should resolve over the next 2 weeks.
Pain is also common, for which people can take painkillers in line with their doctor’s advice.
As the nose heals, people can avoid the following to ease recovery:
- for at least 2–3 days, blowing the nose
- drinking alcohol
- smoking tobacco
- returning to work too soon
- crowds, especially in areas where people are more likely to encounter cigarette smoke and other individuals with colds or coughs, increasing the chances of getting sick
Although septoplasty is a very low-risk procedure, people should be aware of the potential complications and approach their doctor with any concerns.
The risks of septoplasty include:
Bleeding: A small amount of bleeding is common with nasal surgery, and people generally tolerate it well. In rare cases, however, excessive bleeding might occur. In these situations, the surgeon may have to stop the procedure to prevent putting the individual at further risk.
Very rarely, a packed red blood cell transfusion will be necessary, but a doctor will only give this in an emergency.
Infection: Because the nose is not a sterile environment, an infection might occur after a septoplasty.
Toxic shock syndrome: This is a very rare and life-threatening infection that requires immediate treatment.
Tooth and nose numbness: Some of the nerves that lead to the gums, front teeth, and upper jaw go through the nose. Septoplasty increases the risk of injury to these nerves and ongoing numbness. The numbness usually resolves after a few months.
Septal perforation: A small hole can sometimes develop in the nasal septum during or after the surgery, especially in the case of postoperative infection. If the perforation leads to bleeding or other similar complications, a person might require further surgery.
Spinal fluid leak: Though it is extremely rare, a septoplasty could injure the brain and create a leak of the fluid that nourishes the brain and spinal cord, creating a further risk for infection.
Continuing symptoms: Although a large majority of people report a significant improvement in their nasal obstruction symptoms, a small risk remains that surgery may not help symptoms.
Other: On rare occasions, people might experience a change in their sense of taste or smell, persistent facial pain, vocal changes, visual defects, or swelling and bruising around the eye.
The nasal septum is a structure that supports the nose and separates the right and left airways, dividing the two nostrils.
Mucosa, a thin layer of tissue membrane, covers the septum.
The mucosa protects and covers the septum. It also helps retain moisture inside the nose. The septum might naturally bend a small way in one direction throughout childhood.
However, in most people, the septum is straight.
What are the turbinates?
The nasal turbinates are long, curly, and narrow bone structures that extend into the breathing passageway of the nostrils. In each nostril, they create four air passages in the nasal airway and occur on the lateral walls of the nostrils.
The mucosal tissue in the nose mostly covers the turbinates. When a person inhales air through the nose, the largest turbinates are mostly responsible for filtering, heating, and humidifying the air.
The mucosal lining the turbinates also traps and filters airborne particles. This means that the turbinates are an essential part of the immune system that fights disease.
The main reason for having a septoplasty is to correct a deviated septum that is blocking the nose and affecting airflow.
A deviated septum occurs when the septum bends enough in one direction to become crooked. This can make breathing difficult.
Sometimes, a septoplasty is necessary during other procedures, such as sinus surgery or tumor removal. Doctors may also recommend a septoplasty for people when non-surgical treatments have not successfully treated obstructive sleep apnea or snoring problems.
Enlarged turbinates can also lead to breathing problems for some people. Surgery addressing the turbinates may also help.
Nonsurgical treatments for nasal blockages can help people breathe better. People should discuss these options with a doctor before surgery.
Over-the-counter (OTC) and prescription medications are available for people with allergy-related congestion, as well as allergy shots. The option of trying saline rinses and decongestant sprays is also available.
In cases of bacterial infection, a doctor may also prescribe antibiotics to help clear up the nasal airways.
A doctor will normally only consider septoplasty if these measures are not successful.
Can a septoplasty be cosmetic?
A septoplasty is performed to correct a deviated nasal septum. Most septoplasties are not cosmetic but instead address functional issues, including obstructions to airflow through the nostril(s).
If a septoplasty is part of cosmetic surgery, it would likely be during a rhinoplasty. Sometimes, to achieve the desired cosmetic effect from a rhinoplasty, a septoplasty is also necessary.
A cosmetic surgeon performs a rhinoplasty to alter the external appearance of the nose. Most medical professionals consider this cosmetic.
When a surgery involves both a septoplasty and rhinoplasty, doctors call this a septorhinoplasty.
A medical insurer will generally take medical necessity into consideration for reimbursement purposes. If septoplasty and rhinoplasty are cosmetic, the insurer may not fund treatment.