Septoplasty

A slight nasal septum deviation is usually common but if this deviation is very severe, it may cause the blockage of the airflow on one side of the nose, leading to difficulty in breathing either through one or both the nostrils. In cases, wherein the nose becomes claggy without any airflow in and out, it makes the bacteria grow inside the nose and results in inflammation and infections.  In some cases, this may also further lead to too much drying of the nose leading to crusting and ultimately bleeding from the nose. The surgical procedure of septoplasty repositions straightens the bone by trimming and then replaces the bone and the cartilage. Some of the cases, wherein septoplasty is recommended by the physician, are mentioned below:

• To repair the deformed nasal septum which may be due to an injury or a birth defect.
• Difficulty in breathing properly through the nose
• Increased breathing from the mouth, which may cause infections in the mouth
• To treat uncontrollable nosebleeds due to excessive drying of the nose.
• To treat nasal or sinus drainage
• Increased headaches due to sinus
• The swelling in the nose
• Septoplasty is also advised to clearly see inside the nose to detect other problems in the nose.

Septoplasty being a surgical procedure, does have some risks involved with it. Some of the risks are as mentioned below:

• Perforations or openings in the nasal septum
• Heavy and uncontrolled bleeding from the nose
• Changed shape of the nose
• Reduced sense of smell
• Numbness in the facial anatomical structures of the face especially, teeth or upper maxilla
• Septal hematoma (clotting of blood in the nose area which needs immediate drainage)
• Sometimes allergic reactions to the medicines used during the surgery
• Heart issues, in rare cases
• Recurrence of the nasal blockage which may need another surgical procedure
• Continued difficulty in breathing
• Uneven looking nose
• Change in the color of the skin treated
• Leakage of the cerebral spinal fluid
• Damage in the eyes
• Urgent requirement of blood transfusion (rare cases)
• Scarring

The doctor will explain the septoplasty procedure to the patient in detail including the risks involved. Some preparations needed are as mentioned:

Before the procedure:

• Medical history – The doctor will take a complete medical history of the patient i.e. knowing about all the conditions, allergies, surgeries, the patient has undergone in the past or any prevailing conditions. Also, the doctor will ask about if the patient is taking any medications at present, or has taken in the past.
• Physical examination – A complete physical examination is done by the doctor, especially focusing on the in and out breathing of the nose, to be sure of the problem area to be fixed.
• Photos – Sometimes, the doctor may also take some pictures of the patients affected nose area from different angles, in order to use it for discussion before the surgical procedure, during or after septoplasty as a reference.
• Patient expectation – The doctor discusses the expectations of the patient from the septoplasty procedure and hence also informs the patient about the risks and the benefits for the specific case.
• The patient is advised to avoid taking any blood-thinning medications, such as ibuprofen, aspirin, etc., before the septoplasty. The medications are to be avoided two weeks before and after the surgical procedure. The use of such medicines may lead to excessive and uncontrolled bleeding. Hence, it is important to take the medicines as and when prescribed by the doctor.
• The patient is also advised, not to eat or drink after midnight before the surgery day. This is done specially in the cases wherein general anesthesia is to be given to the patient, during the surgery. Hence, the patient should ask beforehand on the type of anesthesia to be given during the surgery. In case of general anesthesia, the doctor advises the patient to remain empty stomach and with an empty bladder.
• Quit smoking – It is advised to quit smoking as it delays the healing process after the surgery.
• Companion – As septoplasty is a surgical procedure and needs anesthesia administration, the patient may not be in a condition to drive back home alone. So, it is advised to get a companion along to take care of the patient.

During the procedure:

The surgical procedure of septoplasty repositions straightens the bone by trimming and then replaces the bone and the cartilage. During the procedure, the local anesthesia is given to the patient i.e. localized only to the patient’s nose. In some cases, the surgeon might feel the need for administering general anesthesia. In such cases, the patient’s complete body becomes numb and goes into a temporary state of unconsciousness, at least for a few hours.

A painkiller medicine is administered to the affected nose. An incision is made on one side of the patient's nose. As a result, the mucous membrane covering the nose wall becomes elevated.  The surgeon then puts some soft splints made of silicone into the nose, in each nostril of the patient, to provide good support to the nasal septum. The incision is then closed with the help of an absorbable thread called suture. After the surgery the surgeon put a bandage on the nose to stop the bleeding.

After the procedure:

After the surgical procedure is done, the patient is shifted to a recovery room. There the hospital staff monitors the patient’s vitals and condition carefully. According to the condition of the patient after the surgery, the surgeon advises the discharge process.

The patient is allowed to go home the same day of the surgery if the vitals are normal. In certain cases, the patients might feel some nausea or vomiting due to the general anesthesia. However, if the vomiting does not stop, the patients is advised to contact the doctor immediately as it may trigger the nose-bleeding and affect the healing process.

To prevent any post-surgical complications, the doctor advises some of the following points:

• The patient is advised not to perform strenuous physical activities or exercises. This is to prevent nose-bleeding problems after the surgery.
• Not to blow the nose as it may lead to the opening up of the sutures on the nose or disturb the healing process.
• Keep the nose elevated while sleeping.
• Avoid wearing clothes that are worn from over the head. Instead, wear clothes which have buttons or which are tied from the front like shirts.
• Sometimes, the patient might face drainage or swelling for a few days after the surgery. But this will go away eventually. In case of an emergency, the patient is advised to contact the doctor immediately.
• Avoid any straining during passing stool. If the patient has a constipation problem, then laxatives are advised to soften the stool.
• Avoid touching or rubbing the nose.
• Avoid taking a bath for at least 1 day after the surgery. The best way to clean the body is sponging.
• Avoid bending and lifting heavy things.
• Avoid sneezing, if it is unavoidable. The patient is advised to try sneezing through the mouth.
• If there is any swelling observed in the cheeks, nose, lips or around eyes, then the doctor advises the patient to apply ice on the affected area in order to decrease the swelling.
• It is advised to avoid some blood thinning medications such as ibuprofen, aspirin, etc. This is to be avoided for at least two weeks after the surgical procedure. The use of such medicines may lead to excessive and uncontrolled bleeding. Hence, it is important to take the medicines as and when prescribed by the doctor.
• In case of nausea or vomiting after the surgery, which may happen as a result of general anesthesia, the doctor advises taking some soft and light diet that is easily tolerated by the patient.

The deformed or deviated nose is replaced in shape after the surgery. It may take 3 to 6 months to properly heal. The surgical procedure of septoplasty helps improving the following symptoms:

• Repairing and shaping of the nasal septum, which is deformed due to an injury or a birth defect.
• Improved breathing process
• Increased breathing from the mouth due to nose blockage can be cured by fixing the nose.
• Treatment of uncontrollable nosebleeds, which may happen due to excessive drying of the nose.
• The problem of nasal or sinus drainage is corrected
• Headaches due to the sinus problem are treated
• Decrease in the nose swelling

Q1. Are there any complications for which a doctor is needed even after getting discharged from the hospital?

A1. Some of the problems which might need a doctor after getting discharged from the hospital are as mentioned.

• Sudden onset of bleeding from the nose, which is uncontrollable even after applying ice or cold packs.
• Chronic headache or shooting pain, which is not being cured even after taking pain medications.
• Very high fever i.e. more than 101 F.
• No reduction or increase in the swelling and inflammation of eyes or nose.
• Neck stiffness
• Disorientation