What is Septoplasty Surgery?
Septoplasty Surgery has been used for centuries for the treatment of various diseases and conditions.It is done to fix crooked septum. In ancient times, it was used as a treatment for breathing problems, asthma and emphysema. In present day, it is primarily used to treat sinusitis and nasal polyps in adults and children aged between three months and twelve years old.
- It is a surgery done to correct deviated nasal septum.
- The nasal septum is the partition between the two nostrils.
- It is made up of bone ,cartilage and connective tissue.
- Deviated nasal septum causes nasal obstruction.
- Nasal obstruction can also be due to enlarged middle turbinates called Concha bullosa
Causes of DNS (Deviated nasal septum)
Almost 90 percent of the population has got deviated nasal septum ,but in most of the people are without any symptoms, so no treatment is required.
Treatment is required only in those cases in which there are significant symptoms like nasal blocking, mouth breathing, rhinorrhoea ,frequent cold, postnasal discharge and others.
Congenital -In this case deviated nasal septum occurs when the foetus is in mother’s uterus.
In congenital deviated nasal septum the deviation is mostly in the anterior portion of the nasal septum.
It can occur at the time of delivery when forceps are applied by wrong method ,in cases of difficult deliveries, in case of large birth weight babies.
It can occur in trauma cases or by injuries in which the nasal septum gets deviated.
In this case there may be a sharp angle.
Symptoms of deviated nasal septum –
- Nasal blocking which is usually more on one side
- Frequent sinusitis
- Occasionally there may be nasal bleeding .
- From the larger nostrils there can be crusting due to comparatively large air flow through the larger nostril.
- Postnasal discharge
- Whistling noise during respiration
- In severe neglected cases it can lead to sleep apnoea .
- The individual tends to sleep on one side which is the side opposite to the blocked nostril .
- In severe ,neglected cases it can prove fatal.
Diagnosis of Deviated nasal septum –
It is done by ENT specialist doctor by nasal endoscopy and CT Scan PNS (Paranasal sinuses)
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The clinical indications for Septoplasty are –
- Recurrent nasal blocking,
- frequent sinusitis
- In these above 2 indications, surgery is advised by ENT Surgeon only if there is significant extent of Deviated nasal septum on Diagnostic nasal endoscopy ,in CT-SCAN (PNS-Paranasal sinuses) and only if the patient is having frequent episodes of cold with only temporary relief by medicines, decongestant nasal drops.
- Clear-cut idea is given to the patient that 85 percent of the patients get relief from nasal blocking after Septoplasty. But in some cases patient may have nasal blocking post -op also.
- This is attributed to allergic component.
- The patient is explained in clear terms that there is no treatment to nasal allergic rhinitis, only prevention can be help to some extent and if it persists we have to bear up with it. Intermittent steroid nasal spray helps only to some extent.
- As a step prior to removal of nasal polyps,
- As a step prior to Endonasal DCR Surgery if there is inadequate access to the ENT surgeon.
- As a step prior to Septorhinoplasty
- It is a rare indication to prevent recurrent nose bleeds (Epistaxis).
- As a prerequisite for removal of pituitary tumors endoscopically by the neurosurgeon.
- As a prerequisite for cases of Sleep apnoea in which significant deviated nasal septum is present.
Septoplasty is entirely an endoscopic stitchless surgery.
- There is no incision from external aspect.
- The external appearance of the nose does not change.
- But the patient gets relief from symptoms.
At what age this surgery should be done ?
Ideally Septoplasty surgery should be done only after the age of 17 yrs as bone growth of the body totally stops after the age of 17 yrs.
But if a patient between the age of 8 yrs to 17 yrs has got severe deviated nasal septum, and he is around 8-9 yrs of age then we cannot wait till he becomes 17 yrs of age and waiting till that period can cause serous ill effects on the health of that patient and so undergoing Septoplasty is advisable in such patient .
More than adequate removal of the deviated nasal septum should be done with preservation of a portion of the roster strut to prevent the complications of depressed bridge of nose.
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Treatment of deviated nasal septum –
- Steroids sprays
- Steroid tablets in severe cases if the random blood sugar level is normal
- Exposure to allergens and irritants should be avoided
Septoplasty surgery –
Before Septoplasty surgery the patient has to undergo certain investigations for anaesthetic fitness.
Covid test -RT-PCR-Nasal and Nasopharyngeal swab test.
Only if this test is negative the patient can be admitted to hospital as it is the question of safety of other patients also who are admitted to hospital.
Blood investigations –
- CBC, Random blood sugar, BT, CT, PT, PT-INR, PTT, APTT, Sr Creatinine, SGOT, SGPT, HIV, HbsAG, Urine-Routine and Microscopy
- Chest X-ray -PA veiw
- Physician( MD General Medicine) fitness.
- If any blood thinners are being given to the patient like Aspirin or Clopidogrel then they should be stopped 3 days before the surgery.
- If the physician gives fitness, then we can proceed further for Septoplasty surgery.
- Preparation for surgery –
- The patient is asked to remain NBM for at least 6 hrs prior to the surgery.
- Just before the surgery the anaesthetic will speak with the patient and explain the aspects of anaesthesia.
- In children and uncooperative adults, General anaesthesia is required.\
- In cooperative adults it can be done in local anaesthesia in which the ENT surgeon gives injection of 2 percent xylocaine with adrenaline into the nasal septum.
- The anaesthetic gives iv sedation.
- Septoplasty can be done endoscopically also by the ENT surgeon.
- Steps of Septoplasty surgery /Septoplasty procedure –
- Hemitransfixation incision endoscopicaly on the nasal septum.
- Elevation of the mucoperichondrial flap.
- Tiny incision on the septal cartilage and going to the opposite side and similarly elevating the mucoperichondrial flap.
- Cutting the deviated portions of bone and cartilage and discarding them.
- Cris cross incisions are given on the nasal septum anterior to the hemitransfixation incision to break the spring action.
- Septal spur if any is removed.
- If there is Concha bullosa then it’s trimming is required.
- If the sinuses are affected then Functional endoscopic sinus surgery may be required.
- If allergic rhinitis is there thermal cauterization of the inferior turbinates is required.
- Flaps are reposited and bilateral nest cell packing is done .
- Sterile dressing is given.
- Patient is shifted to ICU for first 3-4 hrs and then to Semi special room of hospital.
- Post op 4-6 hrs NBM is required.
- After 24 hrs from surgery nasal pack is removed and the patient is given discharge from hospital if there is no nasal, post nasal bleeding or any other problems.
Potential risks of Septoplasty surgery
- Risks associated with a septoplasty are rare, but they can include:
- perforation of your septum, which happens when a hole forms in your septum-this will not happen if the ENT surgeon is qualified and experienced.
- Toxic shock syndrome
- Altered nose shape -if more than the required amount of bone and cartilage is removed.
- These above complications are rare if appropriate care is taken by operating ENT surgeon
Post op discharge prescription contains
- alkaline nasal douching
- nasal decongestant drops
Recovering from a septoplasty
- Septoplasty is usually performed as an outpatient procedure unless major complications arise.
- This means that patient will be able to go home on the same day as the procedure, once the anesthesia has worn off.
- Patient should also limit his physical activity for several weeks after surgery to minimize swelling and promote healing.
- This includes most forms of intense exercise, such as running, lifting weights, and playing contact sports.
- These activities can increase the blood pressure and lead to heavy bleeding.
For a quicker recovery
- the things that need to be done –
- elevating your head at night to keep the swelling down
- not blowing your nose for at least three days after surgery
- After discharge from the hhospital patient needs to come for follow up with the ENT surgeon in his clinic after 7 days from the date of discharge from the hospital.
Results of Septoplasty surgery /Septoplasty procedure –
- Around 85 percent of the patients experience improvement in nasal symptoms after Septoplasty.
- Clear-cut idea is given to the patient by the ENT surgeon that allergic symptoms might persist even after Septoplasty and Septoplasty has nothing to do with allergic symptoms.
- Such patients may require intermittent steroid(Futicasone) spray.
- They may opt for Immunotherapy also.
Commonly asked questions
- Is Septoplasty a cosmetic surgery ?
- It may be a part of cosmetic surgery when it is done along wit septorhinoplasty.
- In this surgery correction of the external nasal deformity is done ,so it is cosmetic.
- In this surgery along with Septoplasty Rhinoplasty is also done
- Septoplasty alone by itself is no cosmetic surgery.
- Is Septoplasty a serious surgery ?
- No not at all.
- It is not a major surgery.
- It is a minor surgery.
- It can be done under local anaesthesia in adults, -that means by giving anaesthetic injection into the nasal septum and mild sedation by I. V route by anaesthetic .
- There is no need to make the patient totally unconscious.
- Only in small children and in uncooperative adults general anaesthesia is required.
- Is Septoplasty painful ?
- No not at all.
- In general anaesthesia there is no question at all, but even in local cases by local anaesthetic injections iv sedation there is no pain at all.
- What is cost of Septoplasty surgery ?
- It varies from nation to nation, and from state to state.
- How long is Septoplasty surgery?
- It’s duration is hardly 20-30 minutes.
- How successful is Septoplasty surgery.
- Almost 85 percent of the patients of deviated nasal septum get relief from nasal obstruction from Septoplasty.
- If associated nasal allergic rhinitis is there then Immunotherapy is required.
- For good results and reasonable budget Septoplasty surgery pl contact –
Prabha ENT clinic, plot no 345,Saigram colony, opposite Indoline furniture Ambad link road ,Ambad ,1 km from Pathardi phata Nashik -Dr Sagar Rajkuwar (MS-ENT), Cel no- 7387590194,9892596635
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