When is this procedure indicated?
Septoplasty is an operation aimed at improving the nasal breathing space and regularizing the flow of air inside the nasal passages. It is mainly indicated when the patient complains of nasal respiratory obstruction attributable to septal deviation, or in all the conditions in which an improvement in nasal flow may improve ventilation of the paranasal sinuses or middle ear (connected to the portion of the pharynx immediately posterior to the nose by the Eustachian tube), so as to prevent inflammatory processes at this site. It may also constitute a first surgical step in other nasosinus surgeries if a septal deviation makes the structures being operated on inaccessible.
How is it performed?
Depending on the case, paraseptal plates, i.e., thin silicone sheets, may be placed on the sides of the nasal septum, attached to the septum itself with sutures, and endonasal swabs. Very frequently septoplasty and turbinoplasty are combined.
Obviously, the intervention has wide variability based on the individual patient; one of the most common variants is the endoscopic septoplasty, which allows achieving a similar result, but with a deeper incision of the septal mucosa and with the help of rigid optics. However, the operation has no aesthetic purpose, and therefore the external conformation of the nose is not modified.
An incision is made in the lower, but internal portion of the nasal septum (so there will be no external scar).
The mucosa is separated from the cartilaginous and bony part of the nasal septum, on one or both sides.
The deviated portion of the nasal septum is identified and removed, leaving however sufficient "skeleton" to guarantee the stability of the nose.
The mucosa is repositioned to the remaining portion of the septum.
Patient must remain hospitalized for observation at least overnight following surgery. Any pain at the site of surgery (usually mild) is controlled with pain medication. During hospitalization, you should alert healthcare personnel to any new symptoms that appear, particularly the presence of nosebleeds. The morning after surgery, the endonasal swabs are generally removed (if present), nasal secretions are aspirated and the patient is discharged with the paraseptal plates in place and the indication to follow a therapy (which usually consists in performing nasal washes and the use of creams / nasal sprays). The first post-operative check-up is generally scheduled after 7-10 days, and on that occasion the paraseptal plates are removed and the healing of the tissues is checked, on the basis of which any further check-ups are scheduled. The patient will experiencea strong nasal respiratory obstruction for at least 10-15 days after surgery, in particular before the removal of swabs and plates; for the same period nasal secretions may appear, generally red/pink due to the presence of blood residue. You should avoid physical exertion, exposure to heat, smoking, use of medication that promotes bleeding (unless considered necessary), blowing your nose and sneezing with your mouth closed for about 3 weeks (it is useful as a substitute to do lots of nasal washes and sneezing with your mouth open), and follow any other instructions given by your health care providers.
Complications of the surgery are variable, including based on the patient's comorbidities and the extent of the septal deviation, and will be explained in detail prior to surgery. The most common ones include:
- epistaxis, which should not be confused with the presence of secretions with minimal blood component. If this occurs during hospitalization, the health care providers should be notified; if the patient has already been discharged, it is generally indicated to compress the nasal pyramid, apply ice locally if possible and go immediately to the emergency room;
- surgical site infection, for which medical re-evaluation is required for proper medical or surgical management;
- formation of synechiae (scarring adhesions), reducing the space for respiratory flow;
- hemoseptum, which is a collection of blood below the mucosa of the septum, which may result in the need for surgical drainage.
One of the complications of the surgery may be perforation of the nasal septum, which in some cases may heal on its own, in others it may stay for a long time. It is also possible that the surgery does not resolve or only partially resolves the nasal breathing obstruction. On the other hand, the possibility of aesthetic deformation of the nasal pyramid is very rare, in particular due to the "fall" of the nasal tip, if the supporting "skeleton" is insufficient.