Septoplasty (Sep-Toe-plas-tee), also known as nasal septum surgery, is a surgical procedure to repair a deviated septum with misaligned cartilage or bone. A deviated septum can cause nasal obstruction leading to difficulty breathing from the nose, snoring while sleeping, and repeated sinus infections. Septoplasty straightens the nasal septum by removing crooked bones or cartilage, reshaping misplaced cartilage, or by adding a cartilage graft to repair a hole in the septum. This procedure is not a cosmetic procedure therefore is covered by insurance.
There are many ways to perform a septoplasty, but surgical expertise is paramount. Both sides of the septal wall are lined with a fine mucous membrane (like wall papers covering a wall). A small incision is made inside the nose on this membrane; and, subsequently, the layer is peeled away from the cartilage. Another incision is made on the other side which creates two tunnels on either side of the cartilage. Next, the crooked septal cartilage is carefully removed. Some surgeons either soften the cartilage or flatten it out and place it back. Others opt to leave it out completely. Sometimes, a small bony spur that juts out at the base of the septal cartilage is also removed. Different surgeons use different techniques in the concluding steps of the procedure.
Traditionally, thin plastic sheets, with or without spongy packs, are placed against both sides of the septum to keep the thin membrane together and encourage proper healing. Because the entire procedure in done inside the nose (or endoscopically), there is no swelling or bruising to the nose or face; unless a simultaneous rhinoplasty is performed.
Recovery from a Septoplasty Procedure
If nasal packing was used, it is usually removed one to three days after the procedure. Many patients have reported that the nasal unpacking one of the most uncomfortable parts of recovery. Some high quality surgeons, including Dr. Sadati, do not use splints or packing. Instead, we help expedite the recovery process using a simple method: compress the membrane layers by sewing them together using an absorbable suture, much like a quilting stitch. Using this method, there is no packing and you breathe much better immediately after surgery. Drainage is normal and after a day or two, your nose may collect an accumulation of blood, mucous and debris.
Septoplasty procedures are usually performed on an outpatient basis at our Newport Beach Center for Surgery, and you can return home a few hours after surgery. At the Center, the procedure is usually performed under general anesthesia, but can also be done under a local combined with sedation. While most people can go back to work after a day or two, any heavy lifting should be restricted for about a week. We will conduct a follow up about two days after the surgery, when the nose has cleared of all the accumulated debris. Some people may need a second cleaning one to two weeks later.
Typically, it takes a few weeks, maybe months to feel the full benefits of the operation. During the first few weeks, crusts will fall out as wounds heal and the swelling from the surgery will subside. Scarring and tightening of the soft tissues can take weeks or months to heal. During this healing process, you will have your ups and downs in the first few weeks, but you should see consistent improvement in the following 3-4 weeks. Most patients do not require heavy pain medications; however one is prescribed just in case. You’ll probably be more bothered by the sore throat from having a breathing tube placed during intubation.
While complications are rare, there is a small risk of infection or bleeding. There is also risk associated with general anesthesia which includes allergic reactions or airway problems. By way of comparison, your chances are greater of being hit by a bus than experiencing complications under anesthesia. Other seldom seen difficulties from the procedure include loss of smell as well as a hole in the septum. A properly done septoplasty is one of the most gratifying procedures for the patient as well as the physician and success rates are very high. However, a small percentage of patients report persistent nasal congestion. This is a condition attributable to turbinate swelling due to inflammation, or by having flimsy nostrils. Fortunately, there are treatment options for both these conditions. A rare complication of septoplasty is hematoma. Excess bleeding between mucosa can lead to formation of hematoma. Septal hematoma, a large clot of blood forms between the membrane layers, must be removed immediately. If untreated, hematoma may lead to excess compression of other septal blood supply and lead to loss of healthy cartilage.