Generality
Septoplasty is the surgery that serves to straighten the deviated nasal septum. This operation is necessary for all those people who, due to a septal deformity, suffer from unbearable disorders, such as disturbed sleep, nasal obstruction, breathing problems, frequent nosebleeds, dry mouth etc.
Septoplasty is performed only after anesthesia and requires, if there are no complications, a few weeks to recover.
The results are satisfactory and it is rare that the patient continues to manifest the pre-operative disorders that forced him to undergo surgery.
What is septoplasty
Septoplasty is the surgical operation for the correction of the deviated nasal septum.
By deviated nasal septum, we mean a deformity of the osteo-cartilage lamina vertically interposed between the two nasal cavities; this deviation compromises the normal flow of air through one or both nostrils, sometimes severely.
ARE SEPTOPLASTICS AND RHINOPLASTICS THE SAME WHAT?
Many people think that septoplasty and rhinoplasty are the same nose surgery procedure. In reality, these are two decidedly distinct interventions, especially from the point of view of purposes and costs.
Rhinoplasty is a "cosmetic surgery operation, practiced to meet the needs of those who are not happy with the shape and general appearance of their nose."
Septoplasty, on the other hand, is a "general surgery operation, performed exclusively for therapeutic purposes. In fact, we undergo septoplasty more out of need than out of will."
Why then are they confused?
Beyond the fact that there are two interventions on the nose, many people take advantage of septoplasty to operate, on the same occasion, also for rhinoplasty and remedy some cosmetic defect.
When you do
Many people have a deviated septum (some since birth), but are unaware of it due to a lack of obvious manifestations. In fact, in a large number of cases, the nasal septum presents such little accentuated deformities that the flow of air through the cavities of the nose is normal.
Other individuals, on the other hand, develop in the course of their existence, due to aging or due to serious traumatic events, anomalies with very annoying consequences, which negatively affect the quality of life. For example, they are unable to breathe through one or both nostrils (obstruction or pathological nasal congestion); suffer from sleep disturbances (again due to breathing problems); are prone to repeated episodes of nosebleeds, complain of symptoms of dry mouth (xerostomia), as they breathe through the mouth they perceive a continuous sensation of pressure inside the nose.
Preparation
Before the septoplasty, the patient must meet with the operating surgeon, who will expose all the characteristics of the intervention (from the actual procedure to the related risks, etc.); the patient will also have to undergo a series of specific examinations and checks for the nose. These tests are very important, as each individual, whether or not he has a deviated nasal septum, has a very particular "anatomy of the nose.
In addition to this cognitive meeting, several pre-operative precautions are then recommended.
THE KNOWLEDGE EXAMINATION
The cognitive exam includes:
- An "inquiry into the clinical history. The doctor asks the patient several questions: what drugs he is taking, which drugs he is allergic to, how much he suffers from a deviated nasal septum, if he suffers from other pathologies, to which anesthetics and sedatives are he allergic, and so on.
- A thorough physical examination. It is used to evaluate the patient's state of health and the anatomical aspect of the nose.
- Photographs of the nasal septum to be operated on. They are carried out from various angles and are used by the doctor to realize, even at the time of surgery, what is the appearance of the patient's nasal cavities. They are also an object of comparison during post-operative checks.
- Discussion about what septoplasty is. Doctor and patient discuss the procedure, the post-operative phase, the possible risks and the purpose of the operation. It must be clear that the operation could involve complications, some of which are also of an aesthetic nature.
PRE-OPERATIVE MEASURES
Like any surgical procedure, septoplasty also involves the adoption of some pre-operative measures, necessary for everything to proceed in the best possible way.
First, it is recommended to avoid certain medications, such as aspirin and ibuprofen (a non-steroidal anti-inflammatory drug), which put you at greater risk of bleeding. It is a good rule to avoid such assumptions both before and after the surgery, for a period of time of about two weeks.
The second recommendation is not to smoke during the entire post-operative recovery phase. In fact, cigarette smoke slows down and makes the healing process of the skin tissues and the inner lining of the nose less efficient.
Finally, the patient is asked to present himself with a complete fast for at least the previous evening (if general anesthesia is required) and to be accompanied by a relative and a friend, who has the task of bringing him home to In fact, it should be remembered that the effects of anesthesia and sedation persist, after the operation, for several hours.
- Reduced ability to react
- Dizziness
- Loss of balance
- Momentary amnesia
- Reduced concentration
Risks
Septoplasty is a safe and outpatient surgery. However, like any surgical operation, it can involve bleeding, infections, adverse reactions to anesthesia and other more specific complications, which should not be neglected at all.
Here then is the list of the main risks that can be run due to septoplasty:
- Persistence of typical symptoms of deviated nasal septum, such as nasal obstruction, dry mouth, disturbed sleep, epistaxis, etc., even after septoplasty.
- Unwanted change in the shape of the nose. Some septoplasty operations could disappoint patients from an aesthetic point of view, even if the aims of the operation are completely different. More than a risk, it is an undesirable effect.
-
Figure: a septal perforation Septal perforation. It is a "harmful opening in the nasal septum. The appearance is rounded, so it resembles a hole, and can cause breathing problems, pressure in the nose, blood loss and frequent crusting." These symptoms can be more or less intense depending on the extent of the septal perforation: the greater the opening, the more severe the symptoms.
- Reduced sense of smell.
- Nasal septal hematoma. It is a collection of blood inside the nasal cavities. To solve this situation a drainage is needed.
- Temporary numbness of the gingival and upper dental arch.
To resolve some of these complications (for example, persistence of symptoms or septal perforation), a second, corrective surgery is needed.
Procedure
Septoplasty is performed by straightening the deviated nasal septum and repositioning it vertically in the center of the two nasal cavities.
The operation involves anesthesia, which can be local or general depending on the patient's characteristics (age, allergies to anesthetics, etc.) and the intentions of the operating surgeon.
ANESTHESIA
Local anesthesia. By local anesthesia, we mean that the sense of falling asleep is limited to the nose. The anesthetist, who is a specialized doctor, administers to the patient, in addition to anesthetic drugs, also pain relieving drugs and sedatives. Anesthetics and painkillers are injected into the internal tissue of the nose, while sedatives are introduced intravenously. The effects are sufficiently powerful and long-lasting, so much so that the operated subject does not perceive any discomfort.
After the operation and the anesthesia has disappeared, the patient needs a few hours to recover.
General anesthesia. If the patient, during the preoperative tests, declared to be allergic to local anesthetics or to faint easily, he is sedated with a "general anesthesia."
With general anesthesia, anesthetic drugs are administered before and during the entire duration of the operation, which make the person to be operated on completely unconscious.
The intravenous infusion of sedatives stops when the operation is finished.The total recovery of the senses and motor skills could also require an "entire night, to be spent in the hospital.
THE SEPTOPLASTICS
Septoplasty is performed in the following way.
First of all, the surgeon makes an "incision" inside the nose, in a position such that he has free access to the osteo-cartilage component of the nasal septum.
At this point, try to straighten the deviated lamina and reposition it in the center of the nasal passages. If it fails or if the deviation is very pronounced, opt for a subdivision of the nasal septum into several pieces: each piece is removed individually, modified separately and reinserted in its original position. The modification may also involve the removal of small portions of the lamina.
Figure: a nose before and after septoplasty
At the end of this procedure, the surgeon applies resorbable sutures, to close the incision, and plastic tubes (or thin silicone sheets), to facilitate the correct sealing of the nasal septum.
To prevent any bleeding, it is possible that the operating doctor applies a particular absorbent dressing on the nose.
IMMEDIATELY AFTER THE INTERVENTION
At the end of the operation, the patient is taken to a comfortable recovery room of the clinic or hospital, and kept under observation until all the effects of the anesthesia disappear. Only at this point, in fact, the surgeon starts free on discharge.
If general anesthesia is used, it is advisable for the operated person to spend the entire night in the hospital for completely precautionary reasons.
Post-operative phase
The recovery phase can last one or more weeks, depending on how invasive the surgery was.
During this time, the patient is at risk of bleeding and the operated area is very painful. Bleeding and pain are two natural consequences of the operation, which, however, must be treated with extreme care, if you do not want to worsen the situation.
The regards and precautions to be taken are:
- Avoid strenuous activities and exercise, as these are situations where blood pressure rises. High blood pressure, in these cases, promotes nosebleed.
- Don't blow your nose, for any reason.
- Keep your head up when you sleep. It is a question of finding a good compromise between a sleep-inducing position and one in which the head remains elevated.
- Wear clothes that button at the front (shirts, vests ..) and avoid, instead, those that slip on the neck, such as t-shirts and sweatshirts.
COMPLETE HEALING
Complete recovery (by complete recovery, we mean not only the absence of pain but also the no longer being at risk of complications) generally takes 3 to 6 months, but, in some situations, it can also require a year.
Results
Septoplasty is a safe operation and guarantees excellent results, although obviously the best benefits are obtained by those with a slightly deviated nasal septum.
Although this is a rare event, if the pre-operative disturbances caused by the deviated nasal septum persist (breathing problems, disturbed sleep, etc.), it is advisable to undergo a second septoplasty operation.
