Generality

Septoplasty is the surgical procedure that serves to straighten the deviated nasal septum. This operation is necessary for all those people who, due to a deformity of the septum, suffer from intolerable disorders, such as disturbed sleep, nasal obstruction, respiratory problems, frequent epistaxis, dry mouth etc.

The intervention requires a particular preparation, useful both to the doctor and to the patient: the first is used to learn more about the individual to be operated, the second is used to know how the procedure and the risks it runs will take place.

Septoplasty is performed only after anesthesia and requires, if there are no complications, a few weeks to recover.

The results are satisfactory and it is rare for the patient to continue to experience the pre-operative disorders that forced him to intervene.

What is septoplasty

Septoplasty is the surgical procedure for the correction of the deviated nasal septum .

A deviated nasal septum means a deformity of the osteo-cartilaginous lamina vertically interposed between the two nasal cavities; this deviation compromises the normal flow of air through one or both nostrils, sometimes seriously.

Since the deviation of the nasal septum is a permanent condition, septoplasty represents, for those suffering from this disorder, the only real therapeutic solution that can be adopted.

WEEKLY AND RHOPLASTIC ARE THE SAME WHAT?

Many people think that septoplasty and rhinoplasty are the same surgical procedure on the nose. In reality, these are two decidedly distinct interventions, above all in terms of goals and costs.

Rhinoplasty is an operation of aesthetic surgery, practiced to satisfy the needs of those who are not happy with the shape and general appearance of their nose.

Septoplasty, on the other hand, is a general surgery operation, performed exclusively for therapeutic purposes. In fact, we are subjected to septoplasty more by demand than by will.

Why are they confused then?

Beyond the fact that there are two operations on the nose, many people take advantage of septoplasty to work on the same occasion, including rhinoplasty and to remedy some aesthetic defect.

When you run

Many people have a deviated nasal septum (some since birth), but they are not aware of it for lack of obvious manifestations. In fact, in a large number of cases, the nasal septum has such little accentuated deformities that the flow of air, through the cavities of the nose, is normal.

Other individuals, on the other hand, develop anomalies with very annoying consequences, which negatively affect the quality of life, due to aging or due to serious traumatic events. For example, they cannot breathe through one or both nostrils (pathological nasal obstruction or congestion ); suffer from sleep disorders (again due to respiratory problems); they are prone to repeated episodes of epistaxis, complaining of symptoms of dry mouth ( xerostomia ), since they breathe with the mouth; they perceive a continuous sensation of pressure inside the nose.

Between the two types of subjects, they are obviously the second to absolutely need the intervention of septoplasty. The latter has the purpose of re-establishing normal breathing, through both nostrils, and to improve the entire symptomatology described above.

Preparation

Before septoplasty, the patient must meet with the operating surgeon, who will explain all the characteristics of the operation (from the actual procedure to the risks involved, etc.); the patient will also have to undergo a series of specific tests and checks for the nose. These tests are very important, as each individual, whether or not he has a deviated nasal septum, has a very particular nose anatomy.

In addition to this cognitive meeting, several pre-operative precautions are then recommended.

THE KNOWLEDGE EXAMINATION

The cognitive exam includes:

  • A survey on clinical history . The doctor asks several questions to the patient: what drugs he takes, what medicines he is allergic to, how much he suffers from a deviated nasal septum, if he suffers from other pathologies, to which anesthetics and sedatives is allergic, etc.
  • A thorough physical examination . It is used to assess the patient's state of health and the anatomical appearance of the nose.
  • Photographs of the nasal septum to be operated . They are made from various angles and are used by the doctor to realize, even at the time of surgery, what the appearance of the patient's nasal cavities is. They are also an object of comparison during post-operative checks.
  • Relative discussion of what septoplasty is . Doctor and patient discuss the procedure, the post-operative phase, the possible risks and the purpose of the operation. It must be clear that the intervention could lead to complications, some even of an aesthetic nature.

PRE-OPERATIVE MEASURES

Like any surgical procedure, septoplasty also involves the adoption of some pre-operative measures, necessary for everything to work out for the best.

First of all, it is recommended to avoid certain drugs, such as aspirin and ibuprofen (a non-steroidal anti-inflammatory drug), which expose more to the risk of bleeding. It is a good rule to avoid such hiring both before and after the operation, for a period of time of about two weeks.

The second recommendation is not to smoke throughout the post-operative recovery phase. In fact, cigarette smoking slows down and makes the healing process of skin tissues and the inner lining of the nose less efficient.

Finally, the patient is required to present himself at full fast from at least the previous evening (in the event that general anesthesia is provided) and to be accompanied by a relative and a friend, who has the task of bringing him home to concluded septoplasty. In fact, it should be remembered that the effects of anesthesia and sedation remain, after surgery, for several hours.

Post-operative effects of anesthesia and sedation:
  • Reduced reaction capacity
  • Dizziness
  • Loss of balance
  • Momentary amnesia
  • Reduced concentration

risks

Septoplasty is a safe and outpatient type of intervention. However, like any surgical operation, it can lead to bleeding, infections, adverse reactions to anesthesia and other more specific complications, which should not be overlooked.

Here is the list of the main risks that can be run due to septoplasty:

  • Persistence of the typical symptoms of the deviated nasal septum, such as nasal obstruction, dry mouth, disturbed sleep, epistaxis, etc., even after septoplasty surgery.
  • Undesirable change in the shape of the nose . Some interventions of septoplasty may disappoint patients from an aesthetic point of view, even if the purpose of the operation is completely different. More than a risk, it is a side effect.
  • Figure: a septal perforation Sector perforation. It is an opening of a damaging nature at the level of the nasal septum. The appearance is roundish, so it resembles a hole, and can cause respiratory problems, a sense of pressure on the nose, loss of blood and frequent crusty formations. These symptoms can be more or less intense depending on the extent of the septal perforation: the greater the opening, the more severe the symptoms.
  • Reduced sense of smell .
  • Hematoma with nasal septum . It is a collection of blood within the nasal cavities. To resolve this situation a drainage is required.
  • Temporary numbness of the upper gum and dental arch .

To resolve some of these complications (for example, persistence of symptoms or septal perforation), a second surgical intervention is needed, with corrective purposes.

Procedure

Septoplasty is performed by straightening the deviated nasal septum and repositioning it vertically in the center of the two nasal cavities.

The operation involves anesthesia, which can be local or general depending on the characteristics of the patient (age, allergies to anesthetics, etc.) and the intentions of the operating surgeon.

ANESTHESIA

Local anesthesia . By local anesthesia, the sense of sleep is understood to be limited to the nose. The anesthesiologist, who is a specialized doctor, gives the patient, in addition to anesthetic drugs, also painkillers and sedatives. Anesthetics and painkillers are injected into the inner tissue of the nose, while sedatives are introduced intravenously. The effects are sufficiently powerful and lasting, so that the subject operated does not perceive any discomfort.

Once the operation is over and the anesthesia has disappeared, the patient needs a few hours to recover.

General anesthesia . If the patient, during preoperative analysis, has declared to be allergic to local anesthetics or to faint easily, he is sedated with general anesthesia.

With general anesthesia, anesthetic drugs are administered before and during the entire procedure, making the person completely unconscious.

The intravenous infusion of sedatives stops when the operation is finished. The total recovery of the senses and motor skills could take even a whole night, to be spent in the hospital.

THE SETTOPLASTICA

Septoplasty is performed in the following way.

First of all, the surgeon makes an incision inside the nose, in such a position that he has free access to the osteo-cartilaginous component of the nasal septum.

At this point, try to straighten the deviated lamina and reposition it in the center of the nasal cavities. If it fails or if the deviation is very accentuated, opt for a subdivision of the nasal septum into several pieces: each piece is removed individually, modified separately and reinserted into its original position. The modification can also involve the removal of small portions of lamina.

Figure: a nose before and after the surgery of septoplasty

Once this procedure is completed, the surgeon applies resorbable sutures, to close the incision, and plastic tubes (or thin silicon sheets), to facilitate the correct welding of the nasal septum.

To prevent bleeding, it is possible for the operating doctor to practice a special absorbent dressing on the nose.

IMMEDIATELY AFTER THE INTERVENTION

Once the operation is completed, the patient is taken to a comfortable hospital or clinic recovery room, and kept under observation until all the effects of anesthesia have disappeared. Only at this point, in fact, does the surgeon give the green light to discharge.

If one has resorted to general anesthesia, it is advisable to allow the person operated on to spend the entire night in the hospital, for completely precautionary reasons.

Post-operative phase

The recovery phase can last one or more weeks, depending on how invasive the intervention was.

During this time, the patient is at risk of bleeding and the operated area is very painful. Hemorrhages and pain are two natural consequences of the operation, which, however, must be treated with extreme care, if you do not want to worsen the situation.

The concerns and precautions to be taken are:

  • Avoid strenuous activities and exercise, as these are situations in which blood pressure rises. An elevated blood pressure, in these cases, favors the loss of blood from the nose.
  • Do not blow your nose, for any reason.
  • Keep your head up when you sleep. It is a question of finding a right balance between a conciliating sleep position and one in which the head remains elevated.
  • Wear clothes that are buttoned to the front (shirts, waistcoats ..) and avoid, instead, those that slip from the neck, such as t-shirts and sweatshirts.

COMPLETE HEALING

Complete recovery (for complete recovery means not only the absence of pain but also the risk of being no longer at risk of complications) generally requires between 3 and 6 months, but, in some situations, it may also require a year.

Results

Septoplasty is a safe operation and guarantees excellent results, even if, obviously, the best benefits are those who have only a slightly deviated nasal septum.

Although this is a rare event, if pre-operative disturbances caused by the deviated nasal septum (respiratory problems, disturbed sleep, etc.) should remain, it is advisable to undergo a second septoplasty operation.