SEPTOPLASTY
What is deviated septum?
Nasal obstruction is a common complaint in the society, approximately one third of adults have chronic nasal congestion. The septum is the part in the nose that separates the nostrils.This section (septum) consists of cartilage in front and a thin bone structure at the back of the nose. It is covered with mucosa. The deviated septum (deviation) occurs when your nasal septum is significantly displaced to the left or right side from the midline. In fact, about 80% of adults have deviation to some degree, but most of them do not cause complaints.
What is the cause of deviation?
The most important cause of deviation is nasal trauma. These traumas include womb-traumas, traumas during the birth process and after birth. Often, as a result of minor or major traumas in childhood, different growth points of the nasal septum are triggered, cartilage production increases, and the septum cartilage and/or bone begin to bend as the growth continues. Sometimes a fracture line may occur in the septum cartilage.
The severity, shape and direction of the deviation vary according to the severity and direction of the trauma. These traumas sometimes disrupt the external appearance of the nose.
What Kind of Complaints Does It Cause?
• Stuffy nose, sleeping with mouth open, snoring. Generally, a constant obstruction is observed on the deviated side , and variable obstruction due to swelling of the nasal concha from time to time on the other side. Patients unwittingly breathe more easily when they lie on the deviated side. Even if the degree of deviation does not change, the feeling of obstruction and discomfort increase after the age of 30. Sleeping with an open mouth makes the throat feel dry and sticky, especially in the morning.
Sleep quality is negatively affected and often causes feelings of fatigue upon waking. Besides, the inability of comfortable breathing through the nose reduces the effort capacity.
• Frequent Upper Respiratory Tract Infection (sinusitis, pharyngitis, etc.); People with significant deviation have more frequent upper respiratory tract infections and recover usually takes more time.
• Recurrent nosebleeds. Especially in those with sharp protrusion formed deviation, the mucosa in the protruding area becomes thinner, dries up, and occasionally causes nosebleeds.
• Difficulty smelling. The deviation may cause smell difficulties because the breathing passages are blocked, preventing scent molecules to reach the olfactory (scent region) in the upper part.
• Facial pain. Deviation may cause contact point headache by forming mucosal contact areas. This type of pain is generally located in the anterior region of the face and has a dull character. It is not too severe but uncomfortable.
• Postnasal drip
• Deviation does not directly cause heart or lung disease, but can increase an existing disease.
How is a deviated septum diagnosed?
To diagnose a deviated septum, your doctor first slightly opens and examines your nostrils with a special tool called nasal speculum. Endoscopic examination is performed to see the posterior part of the septum, the nasal concha, and the areas where the sinus canals are opened into the nose. In the endoscopic examination, an intranasal examination is performed with a 2.7 or 4 mm thick instrument called nasal endoscope, with a tiny camera and light at the tip. Both examination methods are painless and short. Further examinations are mostly not required for the diagnosis of deviation, but if there are other nasal problems such as excessive growth of the nasal concha, sinusitis, and polyps, sinus tomography can be performed with the aim of detailed evaluation of the nose and surrounding sinus structures.
How is a deviated septum treated?
The treatment of septum deviation is surgery. Deviation surgery is called "septoplasty". Septoplasty can be performed under the general and local anesthesia or with sedation without being fully anesthetized. While local anesthesia was mostly performed in previous years, nowadays general anesthesia is preferred due to the developments in anesthesia, the sufficient number and experience of anesthesiologists, and the comfort of the patient and surgeon. Before the operation, the anesthesiologist’s examination and some tests are done to determine if there are any contraindications or a risky situation for the operation.
What age and season is better to perform septoplasty?
It can be performed after the age of 16-17 for girls and 17-18 for boys, whose cartilage-bone development is mostly completed. In the absence of contraindications to surgery, there is no upper age limit for septoplasty. Pediatric septoplasty can be performed especially if deviation prevents breathing through the nose, causes sleep apnea, and adversely affects the development of mouth-jaw-teeth. However, since growth and development in children continue, we can make a limited intervention and correction without touching the growth points of the nasal septum. Approximately half of these children require reoperation at the age of 17-18. Septoplasty surgery can be performed all year round, but in patients with severe seasonal allergic rhinitis surgery is recommended after the allergy period is over, due to possibility of more frequent postoperative nasal edema, sneezing, and related bleeding.
How is Septoplasty Surgery Performed?
Through an incision made inside the nose, the nasal septum is reached. The excessively curved bone is broken and removed. If possible the cartilage curvatures are corrected inside the nose. If it is not possible, it is removed, corrected, and placed back into the nose. Then the incision is sewn with dissolvable stitches. In case of curvature outside the nose, high deviation, deviations at the tip of the septum cartilage may be difficult to correct through the nose. In this case, surgery is performed with the approach called open technique (skin is lifted upward). Septoplasty takes between 30 minutes and 1.5 hours depending on the type of deviation and the surgical approach chosen. The patient can be discharged after 3-4 hours of observation. It is difficult to correct only the nasal septum in C-shaped or S-shaped deviations and in curved noses (the nose lies to the right or left from the midline). Which side is the external part of the nose directed, the internal one will be located the same. In this case, it is necessary to correct both the outside and inside of the nose for a successful result. In other words, it is necessary to perform the aesthetic and functional nasal surgery, which we call "septorhinoplasty", together.
Postoperative period
There may be mild postoperative pain that can be easily relieved with painkillers. Septoplasty surgery does not cause any changes in the shape of the nose, swelling or bruising. At the end of the operation, flexible tampons of soft silicone are placed inside the nose (Doyle splint). The middle of these tampons is tubular, if not blocked by dried mucus or clot, you can breathe through the nose with it.
If the only septoplasty is performed, the tampons are removed after 2-3 days. If the septoplasty is combined with nasal concha surgery or aesthetics surgery, splints are removed in 3-5 days. The removal process takes 10-15 seconds and is painless. In some cases, the nasal mucosa and septum can be stitched together with dissolvable stitches avoiding the use of splints. However, silicone tampons are preferred because they reduce both bleeding and the risk of adhesion development in the nose after surgery. After the operation, there may be blood leaking for 1-2 days, and nasal mucus discharge for the next few days. Afterward, crusting occurs in the nose for 1-2 weeks. These crusts can be cleaned by softening them with saline solution. 7-10 days of rest is recommended after the operation. However, if a job that does not require effort and there is no postoperative problem, you can start to work and travel after the 5th postoperative day. The nose can be rinsed with plain water and blow slightly 10 days after the operation.
Complications
Complications are rare in septoplasty surgery. Possible complications:
• Bleeding
• Septal Hematoma
• Infection
• Septum Perforation
• Adhesions in the nose
• Recurrence of Deviation
• Collapse on the dorsum
Does Septum Deviation Recur After Surgery?
Deviation surgery (septoplasty) is an operation with high success expectation. Although it seems like an easy operation for many ENT surgeons, failure may occur if the correct determination is not made and the correct technique is not applied. However, additional techniques are required to correct high deviations, deviation of nasal tip cartilage , and broken lines formed deviations. In these cases, sometimes it is necessary to perform an open technique. It is necessary to perform aesthetic and functional nasal surgery together (septorhinoplasty) in curved noses. The most important reason for failure is that these details are ignored.
Besides, if there are other problems that cause nasal congestion other than deviation, such as enlarged concha, nasal valve stenosis or nasal polyp, it should be treated in the same session. Otherwise, even if the septoplasty is successful, nasal congestion may continue. After a successful surgery, the deviation does not recur unless there is trauma or complications developed. If the deviation surgery fails or the deviation recurs, a second or third surgery can be performed.
