Septoplasty

Having some deviation of the septum is common. When a deviated septum is severe, it can block one side of your nose and reduce airflow, causing difficulty breathing through one or both sides of your nose.

The additional exposure of a deviated septum to the drying effect of airflow through the nose may sometimes contribute to crusting or bleeding in certain individuals. Septoplasty straightens the nasal septum by trimming, repositioning and replacing cartilage, bone or both.

If you experience symptoms — such as difficulty breathing through your nose — that significantly affect your quality of life, you may consider surgery to correct a deviated septum.

As with any major surgery, septoplasty carries risks, such as bleeding, infection and an adverse reaction to the anesthesia. Other possible risks specific to septoplasty include:

• Persistence in previous symptoms, such as nasal obstruction, despite surgery
• Excessive bleeding
• A change in the shape of your nose
• An opening in the septum (septal perforation)
• A decrease in the sense of smell
• A collection of blood in the nasal space that would need to be drained (septal hematoma)
• A temporary numb sensation by the upper gum or teeth

Additional surgery may be required to treat some of these complications or if the outcome of the surgery doesn't match your expectations. Talk to your doctor about your specific risks before surgery.

Before scheduling septoplasty, you must meet with your surgeon to discuss benefits and risks of the surgery. This meeting generally includes:

• Your medical history. Your doctor asks questions about conditions you have or have had, as well as any current medications.
• A physical examination. Your doctor conducts a physical examination, including any relevant testing. He or she also inspects your skin and the inside and outside of your nose.
• Photographs. Someone from your doctor's office may take photographs of your nose from different angles. Your doctor may use these photos for discussion before septoplasty, or for reference during and after surgery.
• A discussion of your expectations. You and your doctor should talk about your expectations. He or she explains what septoplasty can and can't do for you and what your results might be.

Before septoplasty, you may also need to:

• Avoid certain medications. Avoid medications containing aspirin or ibuprofen (Advil, Motrin, others) for two weeks before surgery and two weeks after surgery. These medications may increase bleeding. Take only those medications approved or prescribed by your surgeon.
• If you smoke, stop smoking. Smoking slows the healing process after surgery.
• Make arrangements for the day of the surgery. For the first 24 hours after sedation, you may have lapses of memory, slowed reaction time and impaired judgment. Therefore, arrange for someone to drive you home if you're having an outpatient procedure. Also, arrange for a family member or friend to stay with you for a night or two to help with personal care tasks as you recover from surgery.

Septoplasty straightens the nasal septum by trimming, repositioning and replacing cartilage or bone. The surgeon works through incisions inside the nose.

During the procedure

• Local anesthesia. Usually used in an outpatient setting, this type of anesthesia is limited to your nose. Your doctor injects the pain-numbing medication into your nasal tissues. If you will also have sedation, this is given with medication injected through a catheter placed in a vein — an intravenous (IV) line. This makes you groggy but not fully unconscious.
• General anesthesia. With general anesthesia, you inhale an anesthetic agent or receive an anesthetic through an IV line. This type of anesthesia affects your entire body and induces a temporary state of unconsciousness.

Discuss with your doctor beforehand which kind of anesthesia is best in your case.

During surgery, the incision is closed with absorbable thread. Soft silicone splints may be inserted inside each nostril to support the septum. To prevent postoperative bleeding, your doctor may place bandage-like material in your nose.

After the surgery, you're moved to a recovery room, where the staff monitors you and watches for any complications. You might leave later that day or, if the procedure is done in a hospital and you aren't ready for discharge, you might stay overnight.

After the procedure

To further decrease the chances of bleeding and swelling, your doctor may ask that you follow these precautions for several weeks after surgery. Depending on the extent of your surgery, you may not be asked to comply with all of them:

• Avoid strenuous activities, such as aerobics and jogging. This is to decrease the chance of a blood pressure elevation that could cause a nosebleed.
• Don't blow your nose.
• Elevate your head when you're sleeping.
• Wear clothes that fasten in the front; don't pull clothing, such as shirts or sweaters, over your head.

Though results are most often stable, cartilage and tissue may gradually move or reshape over time. The nasal tissues are relatively stable by three to six months after surgery. However, some changes can still occur for up to a year or more after surgery.

Most people find that septoplasty improves their symptoms, such as difficulty breathing, caused by a deviated septum. The level of improvement you can expect with septoplasty may vary.

Some people find that their symptoms continue even after surgery and opt to undergo a revision septoplasty to further refine the nose and septum.