Rao's ENTRao's ENT

Septoplasty and Turbinate Surgery

What is septoplasty?

Located right between the right and left sides inside the nose is an about 7 cm long (in adults) thin piece of cartilage and bone called septum that separates the two nostrils. In some cases, because of an injury or due to natural growth, this septum bends to one or both sides creating a nasal blockage. The surgery performed to reposition this septum is called a septoplasty.

A bent septum can cause a blocked nose. Sometimes it can be a hindrance in undertaking another procedure such as sinus surgery. A septoplasty’s objective is not to change your nose’s external appearance but it can be combined with a nose reshaping surgery called septorhinoplasty to straighten the nose and improve its external aesthetics as well.

A septoplasty can be done under local or general anaesthesia and it requires about 30-45 minutes. As the surgery is usually done through and inside the nose, there are no incisions or scars visible from outside. The surgeon makes an incision inside the nose and straightens the septum by removing a part of its bone and cartilage and positioning the rest in the middle and held fast by surgical stitches.
Complex cases and septorhinoplasty procedures may require an external surgical cut between the two nostrils.

Unfortunately not. A bent septum is a structural issue that cannot be rectified by medications or alternate therapies. Only a surgery can bring a bent septum to its correct place in the middle of the nose.

The turbinates are spongy-bony structures made of bone and soft tissue on the side walls inside the nose and projecting into the nasal passages as twin ridges of tissue. When we breathe in air and it flows through the nose, the turbinates heat and humidify it. If either the bone or the tissue of the turbinates enlarges or swells up, it can obstruct nasal airflow. Such enlarged turbinates are called hypertrophic turbinates.

Enlarged turbinates can obstruct the nasal air passage and make the patient breathe through the mouth. When turbinates are reduced in size, the nasal air passage becomes more comfortable and normal breathing can be gained..

Turbinates’ size reduction can be achieved either by shrinking them or by taking a chunk out of them.

Shrinking the turbinates – This turbinates are reduced in size without any tissue/bone removal by heating up a section of the turbinate using specialised surgical devices. It leads to scar tissue formation and the turbinate shrinks.   Methods to achieve this include cauterisation, coblation and radiofrequency reduction.

Removing a part of turbinates – In one such method called submucosal resection, the surgeon takes out some ‘stuffing’ from inside the turbinate to reduce its size. The surgeon can do this using a device called microdebrider that lets him accomplish this task through a small opening in the turbinate. In some other cases, a larger portion has to be removed.

After the ENT surgeon has set a date for your surgery, you are advised the following precautions:

  • If you are on any blood-thinning medications such as aspirin, ibuprofen, omega 3 and/or vitamin E, stop their intake at least a week before the surgery. If you require prescription blood thinners for another medical condition, please get your surgeon to provide guidance on stopping and re-starting them.
  • Till the preceding night of the surgery, duly take all medications prescribed to you by your ENT surgeon. Bring along any remaining medicines in original packaging when you check in for surgery the next morning. Also bring along any non-prescription medications in their original packaging that you are currently taking.
  • Get a good night’s sleep. Have a good dinner but do not eat anything at all from midnight onwards prior to the surgery day.
  • Make sure you bring your hospital file with you at the time of the check-in for surgery duly including all required test reports such as the major surgical profile, pre- anaesthetic check up sheet, radiological investigation films and reports (X-ray, CT scan, MRI, PET scan etc.) and any others investigations advised by your ENT surgeon. We advise you to ready this file a day before the surgery.
  • You should be accompanied by an attendant. We advise bringing along a close family member.
  • Please ensure that you report at the hospital at least three hours prior to your surgery’s scheduled timing.
  • Report at the reception desk in time and the hospital staff will guide you through the next steps.
  • If you have felt any changes in your physical condition such as cough, cold, fever or throat pain, be sure to mention it to your doctor and anaesthetist. If you are allergic to any drugs, be very sure to mention that as well.

Please read the following information carefully to get further clarity on the pre-operative instructions including special instructions for patients with diabetes, respiratory or cardiac problems.

First 24 hours:

  • Take complete bed rest in the post-operation ward.
  • You are not allowed any drink or food till 4-5 hours after the surgery. After the surgical staff gives the go-ahead, you can sip water. A while later you can take milk or Horlicks etc. However, caffeinated beverages such as tea, coffee or aerated drinks are to be avoided as these can cause gastric irritation when consumed on an empty stomach. You can start a semi-solid diet in moderate quantities after 12 hours. You can resume normal food from second day onwards.
  • Your nose will be packed after the surgery for 1-2 days and you will have to breathe through the mouth. Before your discharge though, the hospital staff will remove this packing.
  • On the 10th day from the date of the surgery, you will receive an endoscopic nose cleaning in the Minor Procedure Room. Please plan your schedule to accommodate it.

After discharge:

  • You will be discharged either on the same day or the next day of your surgery, as deemed fit by the operating surgeon.
  • Be sure to take all medications on schedule as prescribed by your surgeon.
  • You will be prescribed nasal sprays (5-6 times daily in each nostril) starting from the day of discharge. Please ensure that you spray towards the side wall and not the centre of the nose always.
  • Till 2 weeks after the surgery, it is normal to have a ‘stuffy’ feeling in the nose that comes from the swelling caused by the surgery. Irritating though it may be, please do not:
    • Blow your nose
    • Breathe back forcefully
    • Probe the inside of your nose with finger

Any of the above can cause bleeding.

  • Till 2 weeks after the surgery, you will also feel dryness and lumpiness in the throat.
  • Till 2 weeks after the surgery, your nose will secrete blood-stained watery fluid. This is expected and simply needs to be gently wiped using a soft, clean cloth or tissue.
  • Do not rub or press your nose. Do not attempt to clean it from inside. Gentle cleaning from outside is permitted.
  • Stay away from places with dust, smoke, or anything that can cause an allergic reaction to induce excessive sneezing or watering of nose and eyes.
  • While normal diet is allowed, we advise you to abstain from cold foods such as ice creams and cold drinks or any other foods that can cause an allergic reaction to induce excessive sneezing or watering of nose and eyes.
  • If a sneeze comes, please open your mouth and sneeze out to protect the nose.
  • While regular body bath is allowed post the day of discharge, wait till your doctor gives clearance to have a head bath.
  • Protect your nose from pressure by abstaining from heavy lifting, straining, or undertaking any vigorous work for at least 3 weeks after the surgery. Also stay away from contact sports and any activity that can injure your nose.
  • Never bend your head below the heart level.
  • You can resume office work a week after the surgery. However if your work requires strenuous activity, we advise not resuming it till two weeks after the surgery.

Before endoscopic nose cleaning on 10th day after the surgery:

  • You can have breakfast.
  • Please take any medicines given to you specifically for the day of nose cleaning.
  • We advise you to be accompanied and driven to and from the hospital by a close relative. Your hospital procedure time (including examination and waiting) could be 4 hours approximately. Kindly plan accordingly.
  • Please report at the hospital at least 15 minutes before the scheduled time.
  • Please bring along any leftover medicines prescribed at discharge in their original packaging.
  • You can return to work after the endoscopic cleaning.
  • Mild bleeding from nose up to two days after nose cleaning is normal. Please wipe using clean, soft cloth or tissue.

Outpatient review dates post endoscopic nose cleaning:

  • You will need to come for reviews twice – 10 days after endoscopic nose cleaning for the first review and 10 days after that for the second review.
  • If you suffer any problem in-between or after the reviews, please schedule a visit to the OPD of the hospital.

What to do if your nose starts to bleed:

  • Have someone help you. If you are alone, call a relative or friend to come and stay with you.
  • Do not bend your head. Do not lie down. Stay seated with your head in a normal upright position. Put a towel under your nose to absorb the blood.
  • Spit out any blood that drains down your throat.
  • Apply an ice-cold compress over the bridge of your nose. Dip and wring a cloth in ice-cold water to use as a compress.
  • Do the following as a first aid but only if your doctor has told you to – Apply pressure to your nose by pinching your nostrils tightly closed for 10 minutes. Repeat thrice for 10 minutes each time.

When to call the doctor:

Call your doctor immediately under any of the following circumstances:

  • If your nose does not stop bleeding in 5-10 minutes.
  • If bright red blood in heavy amounts is coming out of your nose.
  • If your body temperature is above 99.6 degrees Fahrenheit.
  • If your nose is draining excessively and you are sneezing a lot.
  • If pain medication is not able to dull your pain.

As with any other surgical procedure, septal and turbinate procedures too come with a few associated risks. While the odds of any complication are nominal, you should understand the potential risks and clarify your concerns from your surgeon well in advance.

  • Bleeding: Some degree of bleeding is expected in nasal surgeries. Very rarely, significant bleeding may require termination of the procedure. Blood transfusion in a nasal surgery is rare and is strictly an emergency measure. We have already mentioned it in pre-operative precautions and remind you once more that you should stop use of blood thinners such as aspirin, ibuprofen, omega 3 and vitamin E at least a week before surgery. If you require prescription blood thinners for another medical condition, please get your surgeon to provide guidance on stopping and re-starting them.
  • Persistent symptoms: Over 90% patients get significant relief from nasal obstruction after this surgery that basically improves a structural problem to bring relief. However some patients may get limited or nominal relief. In a rare case, the obstruction symptoms may even worsen.
  • Infection:  As the nose is not a sterile environment free of microbes, post-surgery infection can attack but only in rare cases.
  • Toxic shock syndrome: In rarest of rare cases (just 1in every 100000 septology procedures), a very serious infection called “Toxic Shock Syndrome” can also strike. This is a life threatening situation that needs immediate treatment. If you note a change in your blood pressure, heart rate, fever and unusual symptoms of skin discoloration, contact your surgeon immediately.
  • Tooth and nose numbness: As the nerves going to upper jaw gums and front teeth pass through the nose, septal surgery can stretch/ injure these to cause numbness of the incisors of the upper jaw and/ or the nose tip. In most instances, the numbness is temporary. This is mostly a temporary phenomenon that resolves itself in anywhere from a  few days to weeks to months. In rare cases, this numbness can persist.
  • Septal perforation: A septal perforation (hole in the nasal septum) can develop during or after surgery, especially in case of an infection. At times, this hole can cause crusting and obstruction. Your surgeon will be very careful to avoid this but there is always a small risk of this happening. If the perforation does not cause any bleeding or crusting, no further action is needed. If perforation leads to symptoms, a surgical closure or placement of a synthetic septal button is advised.
  • Spinal fluid leak: As the top of the nasal septum is located below the skull, a leak of cerebrospinal fluid or a brain injury can occur and create a potential pathway for infection such as meningitis requiring additional surgery and hospitalization. It is an extremely rare risk that seldom occurs after septology but you should know that there is a very minute chance of this occurring.
  • Other risks: Other rarely witnessed septology risks include changes in ability to smell or taste, persistent / worsening of facial pain, change in voice quality, and swelling or bruising of the area around the eye. There is also a very small risk that your nose may look slightly different after a septoplasty.

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