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Berrylin J. Ferguson, M.D., F.A.C.S
University of Pittsburgh Medical Center
Pittsburgh, PA
The nasal septum is the partition that divides one side of the nose from the other. It is rarely perfectly straight--it is slightly crooked in over 80% of people. When the septum is so crooked or deviated that it blocks the nasal passage, then a surgical operation called a septoplasty may restore clear breathing.
If your nose is congested on one side during part of the day and later congested on the other side, then it is not just the septum that is causing the nasal obstruction. In this instance, an abnormal turbinate--a structure that projects from the lateral wall of the nose into the nasal cavity--may be the cause. Usually medical treatment (such as a nasal steroid spray) is recommended before considering surgery. If the medical treatments fail to bring relief, then your doctor may also recommend a procedure known as a turbinate reduction. Turbinate reductions can be done in the office or in the operating room.
A septoplasty may be combined with a turbinate reduction so the a normal nasal airway can be restored.
It is important that the turbinate not be removed completely because its removal will result in a very dry, crusty nose that is unable to adequately humidify and warm the air. Occasionally, turbinate tissue will re-grow after turbinate surgery and the procedure may need to be repeated. This is preferable to the situation of totally removing the turbinate.
If your doctor recommends a septoplasty, then this must be done in an operating room. It may be done under general or local anesthesia with sedation. Whether you choose general or local anesthesia, the recuperative period is similar, and patients go home within 3-4 hours after the operation is completed. A variety of nasal dressings are applied in the nose along the septum. Some surgeons prefer to pack the nose with gauze or special sponge-like material. Other surgeons will use soft plastic splints for the same purpose. In addition, absorbable sutures may also be used.
Because the septal cartilage has 'memory'--it has an intrinsic tendency to assume its initial shape--the septal cartilage can sometimes bend after the surgery and cause nasal obstruction. In most cases there is no bruising or black eyes associated with just a septoplasty. If the outside of your nose is crooked, then occasionally this must be fixed along with the septum in order to get a good airway. This procedure is called a septorhinoplasty. In these situations you are much more likely to have bruising and swelling of the nose and possibly black eyes. This bruising usually resolves within two weeks.
- It is possible that your airway will not improve.
- Some swelling of the external nose or change in the external appearance is possible.
- A septal perforation (hole in the septum that connects the two sides of the nose) may occur. A septal perforation may be associated with a whistling sound, bleeding, and/or crusting. A severe septal perforation may alter the shape of the external nose. Septal perforations are rare complications of septal surgery.
- Numbness of the tip of the nose or the upper front teeth is not uncommon and usually resolves within several months following the procedure. Rarely, the numbness may persist.
- Bleeding of any significant amount is uncommon. Patients, who are undergoing nasal surgery should discontinue aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs, such as Motrin, Advil, ibuprofen, etc.) 10 days prior to surgery, since thee medications can produce bleeding.
- Septal hematoma occurs when bleeding persists underneath the skin flaps of the septum. This must be recognized within 24 hours and drained in order to prevent later saddling of the nose. This is a rare complication.
- Infection is uncommon but can occur. If nasal packing has been used and the patient develops a rash and a high fever, then the patient must immediately contact his or her physician because of the possibility of toxic shock syndrome. This is very rare complication..
- Loss of smell has been reported following septoplasty but is quite rare.
- Bleeding usually resolves within several weeks following the procedure.
- Over resection of the turbinate will result in a dry nose.
- Under resection may not totally relieve the nasal stuffiness and the procedure may need to be repeated.
- Discomfort following the procedure for more than two weeks is uncommon.
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