Rhinology (Allergy & Sinus) : Rhinology Procedures and Treatments

Septoplasty & Turbinite Surgery

INTRODUCTION

Nasal obstruction is a fairly common problem. Patients with nasal obstruction have trouble breathing through their nose. This can force them to breathe through their mouth, leading to a sensation of a dry mouth. In many patients, these symptoms get worse at night when they are lying flat. This can cause them to have less restful sleep.

NASAL OBSTRUCTION

Nasal obstruction can be caused by a number of problems. For example, things like allergies can cause nasal obstruction. Another very common cause of nasal obstruction is narrow nasal passages. Often, narrow nasal passages are the result of problems with the nasal septum and turbinates.
The nasal septum and the turbinates are normal parts of the nose. The nasal septum is the structure that divides your nasal passages into the right and left sides. A deviated septum refers to a septum that is crooked.
The turbinates are also inside the nose, near the septum. There is usually space between the septum and turbinates to allow air to pass through the nose. The turbinates can cause nasal obstruction if they are too large. There are several different types of turbinates in the nose. The ones that most commonly affect airflow are called the inferior turbinates.

NASAL SEPTUM

The septum is made of cartilage and bone. The cartilage and bone of the septum are lined by a thin membrane called mucosa. This layer acts like a layer of skin for the inside of the nose. This layer covers and protects the cartilage and bone. It also helps to keep the inside of the nose moist.
When the septum is deviated, one or both sides of the nose can become blocked. In these instances, surgery can help correct the deviation and improve airflow.

DIAGNOSIS

The diagnosis of a deviated septum can be made by your doctor. Your doctor will perform a thorough evaluation of your symptoms and will examine your nose. You may undergo a procedure in the office called a nasal endoscopy to diagnose the cause of your nasal obstruction. A deviated septum can also be seen on a CT scan, but a scan is often not necessary to diagnose the cause of nasal obstruction.
After making the diagnosis, your doctor can discuss treatment options for you. If you have troublesome symptoms, you may be a candidate for surgery to straighten your septum.

SURGERY

Surgery to correct a deviated septum is called a septoplasty. Septoplasty is most commonly performed to help relieve nasal obstruction. Sometimes, septoplasty is a necessary part of other surgical procedures like sinus surgery or nasal tumor removal.
During a septoplasty, your surgeon will attempt to straighten the cartilage and bone that have led to the septum being deviated. During the procedure, the lining (the mucosa) is first lifted off the cartilage and bone. The cartilage and bone can then be reshaped. Sometimes, portions of the cartilage and bone need to be removed. The lining is then laid back down.
Because the septal cartilage has ‘memory’—it has a tendency to assume its initial shape— the septal cartilage can sometimes bend after the surgery.
Septoplasty is a procedure that is done in the operating room under anesthesia. The procedure is typically performed under general anesthesia, but your doctor can help you decide if local anesthesia is an option for you. The procedure is typically performed on an outpatient basis. This means that patients come in and go home the same day.
You may have splints or packing inside your nose during the healing process. In some instances, there may be nothing more than dissolving stitches inside your nose. Your surgeon can let you know whether packing or splints will be placed in your nose and how long they will stay in place.

POST-OPERATIVE CARE

You can expect to have pain, fatigue, nasal stuffiness, and mild nasal drainage after your surgery. Pain is generally mild with this type of surgery and is typically well controlled with oral pain medications. The stuffiness typically results from swelling after the procedure, and typically generally starts to improve after the first week. You may have drainage of some mucus and blood from your nose after surgery. This is a normal part of the healing process.
You may be asked to use saline sprays or irrigations after your surgery. Please check with your surgeon about any post-operative care you will need to perform to allow your nose to heal properly.