These blockages are often caused by the wall between the nostrils being displaced, known as a deviated septum. They can also be caused by enlarged bone structures called turbinates.
Septoplasties are also performed to treat long-term sinusitis, for the removal of nasal polyps, and other conditions that block the nasal airway. Occasionally, surgeons will recommend a septoplasty to stop recurrent nosebleeds.
A septoplasty is a fairly common procedure and is the third most common head and neck procedure in the United States. However, it is usually only performed when other treatments for nasal blockages are ruled out.
What is the septum?
The nasal septum is a structure that supports the nose and separates the right and left airways, dividing the two nostrils.
Nasal blockages requiring septoplasty are often caused by the wall between the nostrils being displaced.
The septum is covered with a thin layer of membrane called mucosa.
The mucosa acts like a layer of skin inside the nose by protecting and covering the septum. It also helps keep the inside of the nose moist.
It's natural for the septum to slightly bend in one direction throughout childhood.
For the most part, the septum is straight.
What are the turbinates?
The nasal turbinates are long, narrow bone structures that extend into the breathing passage. They create four air passages in the nasal airway and are found near the septum.
The turbinates cover most of the nose's mucosal tissue and are necessary for the process of moving oxygen from the air to the body's cells. When air is inhaled through the nose, the largest turbinates are mostly responsible for filtering, heating, and humidifying the air.
The mucus that covers the turbinates also traps and filters out airborne particles larger than 2 to 3 micrometers. This means that the turbinates are an essential part of the body's immune system.
Reasons for having a septoplasty
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 like sinus surgery or tumor removal. Doctors may also recommend a septoplasty for people when non-surgical treatments have not treated sleep apnea or snoring problems.
Enlarged turbinates can also lead to breathing problems for some people, and a septoplasty may help.
Septoplasty often involves general anesthesia, which puts the patient to sleep during the surgery. Sometimes, surgeons will choose to use local anesthesia instead, but this is something they will discuss with the patient first.
As with other surgeries that use general anesthesia, patients will be asked not to eat, drink, or even chew gum after a certain time the night before the procedure. A doctor or nurse will provide further instructions on when and how to take medications if needed.
To reduce the risk of bleeding, it's likely the patient will also be asked to stop the use of blood-thinning medication at least a week before surgery. Anyone who is taking prescription medication or blood thinners should discuss them with the surgeon.
Although the risk is very small, patients should be aware of the potential complications and speak to their doctor if they have any concerns. The following are some risks related to septoplasty:
- Bleeding: Some bleeding is common with nasal surgery and is generally well tolerated. In rare cases, excessive bleeding may occur. In these situations, the surgeon may have to stop the surgery to prevent putting the patient at further risk. Very rarely, a blood transfusion will be necessary, but it is only given in an emergency.
- Infection: Because the nose is not a sterile environment, an infection can occur after a septoplasty.
- Toxic shock syndrome: This is a very rare and life-threatening infection that requires immediate treatment. After surgery, patients and their families should look out for changes in blood pressure or heart rate, fever, discoloration, or any other unusual symptoms they weren't warned about.
- Tooth and nose numbness: Some of the nerves that go to the gums, front teeth, and upper jaw go through the nose. There's a risk that a septoplasty could injure them. The numbness usually goes away after a few months.
- Septal perforation: A small hole in the nasal septum can sometimes develop during or after the surgery, especially in the case of infection. If the perforation leads to bleeding or other similar complications, it may need further surgery.
- Spinal fluid leak: Though it is extremely rare, a septoplasty could injure the brain and create a leak of the fluid that surrounds the brain. If this occurs, it could create a further risk for infection.
- Continuing symptoms: Although a large majority of patients report a significant improvement in their nasal obstruction, there's a small chance that surgery may not help.
- Other: Rarely, patients will experience a change in their sense of taste or smell, persistent facial pain, change in their voice, and swelling and bruising around the eye.
Step-by-step guide to a septoplasty
Before the surgery, a nurse will review the details of the surgery and answer any questions. The patient may be asked to complete some routine tests such as a blood test, X-ray, or heart trace.
The patient will also be asked some general questions about their health regarding any medications they take or allergies they have.
During septoplasty, the cartilage and bone are reshaped, and portions are sometimes removed.
On admission, the patient meet with the anesthesiologist, who will discuss details about anesthesia with them.
During a septoplasty, the surgeon will attempt to straighten the cartilage and bone that caused the septum to bend. The mucosa lining is lifted off the cartilage and bone. Then, the cartilage and bone are reshaped, and portions are sometimes removed. After that, the lining is placed back on.
If enlarged turbinates are causing a blockage, the surgeon may attempt to shrink them. In some other cases, the surgeon will remove a portion of the turbinate.
Results and recovery
About 90 percent report an improvement in their nasal blockage after surgery, according to the American Rhinologic Society.
It's common for the patient to feel drowsy for a few hours straight after surgery. Some will feel nauseous from the anesthesia and maybe some pain. Patients should report this to the nurse, who can offer medications to help.
There will be some packing in both nostrils, which will require the patient to breathe through their mouth to begin with. The packing is there to help stop any bleeding that occurs right after surgery. It is removed when the patient is discharged.
Rarely, there will be splints in the nose. These are usually removed within 7 days in an another appointment.
The patient will be sent home the same day as the procedure if there are no complications. A family member or friend should be there to accompany them home.
It's normal to expect some congestion and bleeding, which should get better over the next 2 weeks. Some pain is also common, for which people can take painkillers as instructed by a doctor.
Life after septoplasty
As the nose heals, patients can follow these tips:
- Avoid blowing the nose for at least 2-3 days
- Avoid drinking and smoking
- Avoid going back to work too soon
- Avoid crowds - areas where people are more likely to encounter smoke and people with colds or coughs increase the chances of getting sick
Alternatives to septoplasty
There are some nonsurgical treatments for nasal blockages that can help people breathe better. People should discuss these options with a doctor before surgery.
There are over-the-counter and prescription medications available for people with allergy-related congestion, as well as allergy shots. There is also the option of trying saline rinses and decongestant sprays.
In cases of infection, a doctor may also prescribe antibiotics to help clear up the nasal airways.