Deviated Nasal Septum – Septoplasty and Nose Surgery in Sydney

nasal-septoplasty

The nasal septum

  • The nasal septum is the wall dividing the nasal cavity into halves
  • The septum is composed of cartilage and bone covered on each side by mucous membrane
  • The ideal nasal septum is midline, separating the left and right sides of the nose into passages of equal size
  • The nasal septum may develop bends as it grows or be damaged by injury to the nose – called nasal septum deviation – causing a blocked nose
  • Nasal septoplasty surgery opens up the nasal passages blocked by a bent septum to improve breathing

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Picture of Deviated Nasal Septum

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Nose after septoplasty surgery

Nasal septal deviation

Diagnosis

    • A blocked nose is often caused by a bent nasal septum
    • Nasal examination including nasal endoscopy will assess the internal structures of the nose and identify the cause of a blocked nose
    • If sinusitis is suspected in addition to a nasal septal deviation, then a CT scan will be helpful
Nasal septum - septoplasty and sinus surgery in sydney

CT scan showing a deviated nasal septum and turbinate enlargement

 

Surgical procedures

  • Nasal septoplasty is often performed together with other procedures as needed including:
    • Endoscopic sinus surgery
    • Rhinoplasty
    • Turbinate reduction surgery / Turbinectomy
  • Nasal septoplasty may also be performed to improve access to the sinuses during endoscopic sinus surgery
  • Septoplasty surgery may be performed together with a rhinoplasty to reshape the nose and improve the appearance of the nose
  • Nasal septoplasty is a surgical procedure performed through the nostrils, so accordingly no bruising or external signs occur
  • When septoplasty surgery is combined with a rhinoplasty, the external appearance of the nose is altered and temporary swelling/bruising of the face is evident
  • A septoplasty may be performed together with surgery to reduce the turbinates (turbinate reduction) when the turbinates are blocking the nasal passages
  • Turbinate reduction surgery or turbinectomy works together with nasal septoplasty surgery to increase the size of the nasal passages and improve breathing through the nose

Septoplasty surgery

  • The time required for the nasal septoplasty averages about one to one and a half hours, depending on the severity of the blocked nose
  • In most cases an internal incision is made within one of the nostrils
  • The lining covering the nasal septum is lifted and the underlying cartilage and bone are straightened
  • The septum is realigned as close to the midline as possible leaving the normal support of the tip of the nose intact
  • Once the septum is realigned the incision is closed with dissolving stitches and the nose may be packed or internal splints may be placed
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Anatomy of the nasal septum

Anaesthesia for septoplasty surgery / septoplasty turbinectomy

  • Nasal septoplasty can be done with a local or combination of local and general anaesthetic
  • Septoplasty can be done either on a day surgery basis or with an overnight hospital stay
  • The anaesthetic is in your system for the first 24 hrs after surgery so you must be accompanied home by a responsible adult, and have an adult with you for the remainder of the 24 hrs after surgery
  • During the first 24 hours do not drink alcohol, do not drive, and do not operate machinery
  • You may drink normally, and eat a light meal if you feel like eating

Recovery after septoplasty surgery

  • Nasal septoplasty is reconstructive surgery of the bone and cartilage of the nose – the tissues of the nasal cavity are affected by this operation and will be tender and swollen until healing is complete after about 2 to 4 weeks
  • This advice sheet gives information to help make you more comfortable following the operation and will encourage rapid, uneventful healing
  • Pain after nasal septoplasty is usually well controlled with Panadol or Panadeine as directed
  • Dissolvable nasal packing may be placed to prevent bleeding – this will be cleared by regular nasal saline irrigations
  • For best results, nasal saline irrigations are recommended – on each side of the nose 4-5 times a day, starting 24 hours after surgery, for 14 days
  • Avoid forcefully blowing the nose for the first few days after surgery – clearing the nose with saline irrigations is preferable
  • Bending, straining, heavy lifting, strenuous exercise and sneezing should be avoided for the first 7 days after septoplasy surgery
  • You may shower, bathe and wash hair etc., as you normally would – if you have a dressing on your nose avoid getting this wet
  • Avoid very dry, dusty and smoky environments

Local symptoms after septoplasty surgery

  • A variety of local symtoms are common for days to weeks after surgery including nasal stuffiness, a blood stained nasal discharge and numbness of the nose and upper central teeth
  • Nasal stuffiness and nasal discharge will improve with nasal saline flushes
  • Rarely nasal septal infection may develop – this may have occurred if the nose becomes very red, hot and swollen
    • If this occurs you must seek attention from your local doctor straight away who will arrange for antibiotics to be prescribed

Late complications

  • The main delayed complication of note is nasal septal perforation which may occur in 1 to 2  percent of patients
    • Most perforations do not cause problems
    • Occasionally symptoms may include bleeding, crusting and whistling which require surgical repair of the perforation
  • A septoplasty may rarely cause a saddle nose deformity or drooping of the nasal tip (less than 1 in 500 patients) – in this situation corrective surgery may be required

Follow up

  • Generally follow up after nasal septoplasty will include
    • A visit at 2 to 3 weeks to have the nose checked
    • A final surgical check up at 3 months
    • In addition you will need to be seen by your local doctor one week after surgery
    • You will need to ring to make appointments for these visits

If you have questions about treatment for a blocked nose or septoplasy see your local doctor who will arrange for you to visit an ENT Specialist.

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