Septoplasty and Turbinate Surgery
A stuffy nose, known as nasal obstruction, is a very common problem. Patients with nasal obstruction have trouble breathing through their nose. This can force mouth breathing, which can lead to dry mouth and snoring or sleep disturbance.
Nasal obstruction can be caused by a number of problems. Common causes include allergic rhinitis, chronic sinusitis, and non-allergic rhinitis. Often narrow nasal airway passages are the result of anatomic deviations of the septum and turbinates. In addition, a deviated septum and turbinate hypertrophy may be a major factor in recurrent acute sinusitis. This should be a consideration in patients who have recurrent sinus infections every year, but who clear for periods of time with appropriate treatment.
The nasal septum is a normal structure inside the nose that divides the nose into right and left sides. A deviated septum is a septum that is not relatively straight.
The turbinates are scrolls of bone, covered by mucous membrane, that originate from the lateral wall of the nose. They usually come close to the septum, but there is some space, which allows airflow through the nose.
The nasal septum is made of cartilage and bone and is covered by a thin membrane called mucosa. Mucosa acts as skin inside the nose, providing protection for the underlying tissues. It also keeps the inside of the nose moist and produces mucus to facilitate trapping small particles from the air you breathe.
When the septum is deviated, one or both sides of the nose can become blocked. In these instances, surgery can help to correct the deviation and improve airflow.
The diagnosis of a deviated septum can be made by your ENT physician. He/she will perform a thorough evaluation of your symptoms and will examine your nose. You may undergo an in-office procedure called nasal endoscopy to diagnose the cause of your nasal obstruction. A deviated septum can also be seen on a CT scan, which may help to further define nasal anatomy and rule out any occult sinus disease.
Surgery to correct a deviated septum is called a septoplasty. Reduction in the size/shape of the turbinates is called turbinoplasty. These two procedures are often done together to get the best result possible with respect to nasal airflow. The surgery is performed as an outpatient procedure while the patient is under general anesthesia. A small incision is made on one side of the septum and the mucosa is elevated off the cartilage and bone. Some portion of the bony and cartilaginous septum will then be removed. The mucosa is replaced. The inferior turbinates may be addressed by performing a submucosal resection of the soft tissue of the turbinate, using a small microdebrider blade. You may have a small piece of packing in you nose after surgery. You will start rinsing your nose with saline solution the day after surgery. This will loosen clots and mucus and allow the tissues to heal well. The risks of septoplasty and turbinoplasty are as follows:
- Bleeding, infection, intranasal adhesions (scars), transient hypesthesia (numbness), and allergic reaction are common problems of moderate consequence. All bleeding at the time of surgery will be stopped, but some light bleeding may continue for a day or two after surgery. Antibiotics will be given prior to the start of the operation and after surgery for a period of time to prevent infection. If severe, intranasal adhesions may need to be later lysed. Hypesthesia will usually fade with time. Allergic reactions will be treated as required.
- Patient dissatisfaction and new nasal deformity are possible. There are many factors that contribute to nasal obstruction which may persist despite successful correction of a deviated nasal septum. In addition, occasionally, coexisting medical illnesses or excessive manipulation can lead to inadequate healing, resulting in new displacement or nasal collapse.
- Postoperative septal perforation occurs about 5% of the time. This complication usually does not result in functional impairment, but may require a septal button or surgical correction.
- Rarely, septoplasty can result in injury to the base of the skull and lead to cerebrospinal fluid leak., olfactory nerve injury, pneumocephalus (air in the skull), intracranial hemorrhage, and/or injury to the frontal lobe of the brain. A secondary intracranial infection could occur as a result of injury to this area of the skull. Treatment will consist of placement of a lumbar drain for CSF leak, hospitalization and possibly a surgical repair of the leak.
You can expect to have pain, fatigue, nasal stuffiness, and mild nasal drainage after your surgery. Pain is usually well controlled with oral pain medications. The stuffiness of your nasal cavity will gradually subside over one to two weeks. You may have drainage of some blood and mucus after surgery, which is normal. Your doctor will see you at one week follow up to assess the healing process and give you instruction on any further treatments necessary.