Septoplasty (Repair of a Deviated Septum) and Turbinate Reduction
The bone and cartilage that divides the inside of the nose in half is called the nasal septum. The bone and cartilage are covered by a special skin called a mucous membrane that has many blood vessels in it. Ideally, the left and right nasal passageways are equal in size. However, it is estimated that as many as 80 percent of people have a nasal septum that is crooked. This is called a deviated septum. A deviated septum can cause difficulty breathing through the nose. In some cases, this can interfere with sinus drainage and cause repeated sinus infections.
What causes a Deviated Septum?
Most often, a deviated septum is a condition that occurs during birth or development. In other cases, trauma or injury to the nose causes the displacement. This is frequently the result of a sports injury or automobile accident. Occasionally, cartilage in the nasal tip deteriorates as we age, producing a deviated septum.
How Is a Deviated Septum Treated?
If the deviated septum is not too severe, symptoms may respond to treatment with medications. Antihistamines, decongestants, and nasal steroid sprays can reduce congestion and inflammation in some patients.
When medicines are ineffective, a surgical procedure known as a septoplasty may be necessary to straighten a crooked septum and improve breathing. This procedure is typically not performed until the face stops growing.
A septoplasty is an outpatient surgery performed under general anesthesia. During the surgery, the badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose. Splints will be placed to hold the nasal tissue in place, prevent nosebleeds and prevent the formation of scar tissue. Usually, the splints stay in for 5-7 days.
What to do BEFORE surgery
Here are a few things you can do before surgery to help things go more smoothly:
- Purchase a Neil Med® Sinus Rinse Kit for saline rinses you will perform after surgery . These are available at grocery stores, pharmacies, big box stores, and Amazon.
- Eliminate ALL medications that thin your blood for two (2) weeks before surgery, unless directed otherwise by your surgeon. Please see this list--Medications to Avoid Prior to Surgery
- Stop smoking at least 3 weeks before your surgery date.
- Arrange for a ride home after the procedure.
- No food 8 hours prior to surgery. No liquids for 4 hours prior to surgery.
What to expect during surgery
In most cases you will receive general anesthesia for your surgery. With general anesthesia, you will be asleep for the entire surgery. Surgery typically lasts 1 to 1 ½ hours. When your surgery is over, you will spend one to two hours in the recovery area. Most people feel well enough to go home the day of surgery.
What to expect AFTER surgery
Mild oozing is expected for several days. You may continue to have some mild bloody or brownish discharge from your nose for 1 to 2 weeks after surgery.
Your nasal obstruction will get temporarily worse after surgery as the nasal cavity naturally swells after surgery. You may feel like you have a cold or sinus infection. This is normal and improves over time.
You may not blow your nose or perform strenuous activity, heavy lifting, or bending over for 2 weeks after surgery.
Time off from work may be necessary depending on your pain tolerance and activity level required at work.
Most patients tolerate the surgery and post-operative recovery very well as the surgery and healing is not particularly painful. However, you may need a small amount of prescription pain medication.
You should have an appointment 5-7days after surgery to remove splints.
What are the risks of Surgery?
As with any surgical procedure, FESS has associated risks. Although the chance of a complication occurring is small, it is important that you understand the potential complications and ask your surgeon about any concerns you may have.
BLEEDING: Some mild oozing/bloody drainage down the back of the throat or out the front of the nose is expected after surgery. If there is any significant or heavy bleeding, or you are saturating gauze pads every hour notify us immediately. You can use a drip pad or “mustache” dressing after surgery. This is a piece of gauze folded into thirds placed immediately under both nostrils and taped to the cheeks. The nurses in the recovery room can give you supplies and show you how to do this. You may change this as needed.
After two to three days, the bleeding should subside and the dressing no longer be needed.
NASAL OBSTRUCTION: After surgery it is typical to have some nasal congestion/pressure. This is from swelling, crusts and blood clots in the nose. This typically resolves in 1-2 weeks after surgery.
SEPTAL PERFORATION: There is a very small chance (less than 5%) of developing a hole through the septum on the inside of the nose. This is rare. If this occurs it may cause no symptoms and would not need treatment. If you develop a whistling sound as you breathe, nasal crusting or intermittent nosebleeds then treatment options are available.
NUMB UPPER MIDLINE LIP AND UPPER MIDLINE TEETH: There is a nerve that runs along the bottom of the nose that descends down to the upper lip and upper four middle teeth. If your septum is deviated low in the nose along the bony middle crest, removal or reshaping of this may either temporarily or permanently affect this sensation nerve. You would look no different externally; however, you would feel numbness as if you had an anesthetic shot in this region by your dentist. If this occurs, it is most often temporary. Rarely is it permanent.
CONTINUED NASAL CONGESTION: Although nearly all patients undergoing septoplasty/turbinate reduction find improvement in their ability to breathe through their nose, there is a small chance of insignificant improvement or no improvement. If this occurs, this should be discussed with your surgeon so that other options can be entertained. Please also be aware that diminished smell prior to surgery won’t likely improve.
SEPTAL RE-DEVIATION: The septum is made of both cartilage and bone. Some cartilage must remain in order to maintain support of the nose. If the remaining cartilage was deviated, it may have a slight tendency to re-deviate. This usually does not cause problems, but in rare instances, might need further surgery.
EXCESSIVE DRYNESS OF THE NOSE: This is rare. Typically, patients that undergo surgery for nasal congestion have a wet and/or congested nose. If nasal dryness postoperatively occurs, it is usually temporary. It is rare for this to be permanent. If this is to occur, please discuss this with your surgeon. There are some options to help with this problem.
SCARRING: Although rare, scarring can occur after surgery. This can lead to persistent nasal obstruction. Small scar bands can be removed in the office. Rarely do patients require another surgery to remove scar bands.
CHANGE IN THE EXTERNAL SHAPE OF THE NOSE: Some cartilage must remain in order to maintain support of the nose. If an excessive amount of cartilage is removed the tip of the nose or bridge of the nose can droop. This is an uncommon complication of surgery.
CERBORSPINAL FLUID LEAK: The septum attaches to the skull base. There is an extremely rare risk of creating a leak of spinal fluid (the fluid surrounding the brain) with septal surgery. Should the rare complication of a CSF leak occur, it may create a potential pathway for infection, which could result in meningitis. If a CSF leak were to occur, it might require surgical closure and extend your hospitalization.
What is Turbinate Hypertrophy?
The turbinates are small bones located inside the nose that are covered with nasal lining and blood vessels that help warm and humidify air, and direct airflow through your nose. Turbinate hypertrophy refers to enlargement or swelling of the turbinates. If these turbinates become enlarged, breathing can become more difficult.
What Are the Symptoms of Turbinate Hypertrophy?
The most common symptoms of turbinate hypertrophy include:
- Difficulty breathing through the nose
- Congestion in alternating sides of the nose
- Nasal congestion while lying down
- Noisy breathing or breathing through the mouth during sleep
- Increased nasal drainage
What Causes Turbinate Hypertrophy?
Turbinate hypertrophy is typically caused by inflammation in the nose. This can be caused by many conditions including:
- Upper respiratory infection, or the common cold
- Sinus infections
- Environmental irritants such as pollution, smoke, chemical
- Hormonal changes
How is Turbinate Hypertrophy Treated?
Medications such as saline sprays and nasal steroid sprays are first line treatments. For short term causes nasal decongestant sprays can be used for up to three days. Allergy treatment may also be necessary.
If medications do not help improve your symptoms, then a turbinate reduction may be recommended.
A turbinate reduction is a surgical procedure that can be performed in the office or in the operating room. In may be performed alone or in conjunction with other nasal surgeries such as a septoplasty or sinus surgery. The goal of surgery is to decrease the size of the turbinates. This procedure is usually performed through the nostrils. What to expect before, during and after surgery are the same as listed above.
What are the complications that can occur with turbinate surgery?
Complications from turbinate surgery are rare but can include:
- Anesthesia complications
- Dryness and crusting inside the nasal cavity
- Regrowth of the turbinate swelling and recurrent nasal congestion
- Empty nose syndrome (ENS)--this is an unusual condition that is usually associated with significant resection of the turbinates. In this condition, the nose continues to feel congested and obstructed despite the nasal passage being opened after surgery.