Septoplasty

Overview:

Septoplasty is a common nose surgery done to correct the deviated nasal septum. It is a type of functional nasal procedure. The nose is divided by nasal septum into two halves. It is made of bone and cartilage. The abnormal shape of the nasal septum is called the deviated nasal septum which can cause breathing difficulties due to nasal obstruction. Septoplasty corrects the nasal septum and makes it easier to breathe. 

Structure of the nasal septum:

The nasal septum is the main part that divides the nose into two parts and supports the external nose. This helps in the passage of the air from the external nose into the body while warming the air. Any deviations in the structure of the nasal septum cause nasal blockages, difficulty in breathing, and worsening sleep problems. The nasal septum is composed of a membranous part in the front, a cartilaginous part behind, and a bony part at the end. Any deviations in these parts reduce the area and obstruct the airflow leading to nasal blockage. 

Indications:

Septoplasty is mainly indicated for deviated nasal septum. It is mainly done in adults and adolescents but not in children. It is also indicated:

• For the removal of nasal polyps 
• Treating sinusitis that has been affecting for a long time
• Control frequent nose bleeds 
• Clear nasal blockages in the airway 
• Obstructive sleep apnea 
• Frequent facial pains and headaches 

Septoplasty can be done as a separate procedure or in combination with other surgeries like rhinoplasty and turbinoplasty. Septoplasty is also done to get better access to target areas during endoscopic sinus, skull base, or eye surgery procedures. 

Contraindications:

There are many contraindications for this procedure like 

• Rhinosinusitis and vasculitis should not be directly indicated 
• Individuals having drug abuse issues (cocaine) are not indicated for the surgery unless they have stopped using the drugs for 6-12 months. 
• Habit of smoking 
• Unrealistic expectations and those who get little benefit from the procedure 
• Systemic health should be free of life-threatening conditions and able to withstand anesthesia. 

Types of septoplasty:

There are three ways of doing the septoplasty procedure. They are Endonasal, endoscopic, and extracorporeal procedures. 

The endonasal procedure is done by making cuts at the edge of the septum using a special instrument called the nasal speculum. Special tools are used to open the cartilage and the bone while avoiding damage to the mucosa. By assessing the septal deformity, the deviated septum is corrected along with preserving the structure for nasal support. 

The Endoscopic procedure is similar to the endonasal procedure but uses a special instrument with a camera called the endoscope. This helps in the better visualization of the nasal structures for correction. 

Extracorporeal procedure is preferred for complex nasal septum deformities involving the entire nasal septum. These are also done in fracture cases where the above methods cannot be done. This can be done as an open or closed procedure again. 

Before the procedure:

Before septoplasty, an individual should understand the importance and necessity of the procedure by discussing it with the healthcare provider (HCP). All the medications taken by the individual should be informed to the HCP along with the history of previous diseases, infections, surgeries, and allergies. Based on the medications taken, some medicines are advised to stop depending on the health condition and risk vs. benefits. 

These include over-the-counter medications, blood thinners, and opioid painkillers. Medicines will be prescribed before undergoing the surgery. Certain routine blood and urine investigations are carried out to rule out any infections or other conditions not known to the individual. Assessment based on a physical examination is done to understand the condition of the nose, facial proportions, changes to be made, and final results that can be expected. 

Photographs of the nose will be taken in different angles and sometimes software simulation is done to show the results. septoplasty is done on an empty stomach. Hence it is advisable to stop eating or drinking 8 hours before the procedure. 

During the procedure:

Septoplasty can be done under local or general anesthesia. Nasal hair is trimmed and the individual is placed with the head tilted back. The nasal septum is straightened by either trimming or replacing the cartilage or bone in a septoplasty procedure. Incisions or cuts may be given from the inner parts of the nose or between the nostrils. Special instruments called speculum are used during the surgery to elevate the tissues. 

Based on the location and type of the deviation, various tools are used. Septum that is pushed to one side can be corrected by moving them to a proper place. Spreader grafts are strips of cartilage that can be used to correct a deviated septum. The cuts are closed by sutures and soft silicone splints are placed to support the septum. The endoscopic method is done for isolated septal deformities and the Extracorporeal method is used for complex septal deformities where the whole septum is corrected and replaced. 

After the procedure:

An individual can leave home if the procedure is done under local anesthesia or a day later if the procedure is done under general anesthesia. Medications like painkillers and antibiotic creams are given to subside the pain. A follow-up appointment is given in 1-2 weeks for changing the dressing. Instructions will be given on home care like:

• Sleeping with raised head end 
• Stop blowing the nose for 2 weeks 
• Do not wear clothing from the head end 
• Strenuous exercises should be avoided for 6 weeks 

Side effects:

Pain, bleeding, infections, and allergy to anesthesia are some of the side effects of the procedure. 

Risks and complications:

Certain risks associated with the procedure include a total change in the shape of the nose, loss of sense of smell, septal perforation, clots, and serious bleeding. 

Conclusion:

Septoplasty is a surgical procedure for correcting the deviated septum of the nose. This is a functional procedure that increases the breathing function of the nose. It is one of the most commonly performed surgeries to correct the nose. 

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