Airway Surgery

What is the septum?

The septum is the partition between the right and left sides of the nose. At the front it is made of cartilage and at the back it is bone. Few people have an absolutely straight septum. But if the septum is deviated it can block breathing and even lead to snoring.

The septum can be bent for a number of reasons – football injuries, falling off a bicycle as a child or falling over. Most people can remember an event but others don’t and we presume the nose was squashed during birth as the baby passes through the vaginal canal.

The operation

Straightening the septum is a relatively simple procedure which takes thirty minutes and requires one night in hospital. All incisions are internal. The bent cartilage is removed and the remaining septum realigned. All stitches are dissolving. There is no bruising after the operation. Unless there is marked bleeding, packing of the nose with ribbon gauze is no longer performed.

Usually a splint is placed in each nostril to hold the new septum straight, much like one would do for a broken arm. These splints have one stitch holding them in. This stitch is removed one week after the surgery so that the splints can be taken out. At this point most people feel their breathing is vastly improved though full recovery is six weeks.

During the first few days a little bloodstained ooze is normal. Dab this with a Kleenex. You do not need to continue to wear the hospital bandage under your nose at home. The key to a healthy recovery is rinsing your nose frequently (six times a day).

The more you rinse your nose the faster the wound will heal. Rinse by inserting a syringe into the nostril and squirting the saline solution up towards the eyes, not back down the throat. Secondly, frequent rinsing will reduce the amount of postnasal discharge you experience. It is normal to have some discharge every day but an operation will increase the amount of discharge for up to six weeks. Therefore you must douche your nose for six weeks.

In the first post operative week you will notice your nose is tight but it should not be very painful. If pain increases contact Dr Dunlop. Expect to need ten days off work. The anaesthetic will make you tire easily. Expect to sleep in the afternoons.

Avoid contact sports for six weeks. Your nose can be damaged by unexpected trauma, necessitating further surgery. Also small children and large dogs should not be allowed to be close to your nose in case they accidentally bump it.

Realistic expectations

The septum is made of cartilage. Cartilage, like that of your ear, has a memory. In other words it will try to bend in one direction only. Every effort will be made to correct that surgically but a perfectly straight septum cannot be achieved. It will always tend to drift. You will have a better airway following the surgery but you may still perceive one side of the nose seems to have a better airway.

Secondly, if you suffer from allergy or hayfever, a septoplasty alone will not achieve a desirable nasal airway. Surgery corrects deviations and does not help allergy. You will still react allergically and require nasal sprays such as Nasonex or antihistamine tablets.

Possible complications

  • Bleeding – uncommon.
  • Change of shape of nose – usually this is very minor or even favourable. Realigning a bend septum can help straighten the nose. Occasionally there is collapse of the nose just between the tip and the bridge due to loss of support. This can be fixed with a rhinoplasty done at the time of septoplasty or within several months if it becomes obvious with healing and scarring.
  • Numbness of the upper teeth – temporary, lasting up to six weeks.
  • Adhesions – rare with splints. Septal perforation – rarely noticed by the patient though can possibly cause bleeding and whistling.
  • Very rare complications include leakage of the fluid around the brain and meningitis.
The septoplasty operation is straightforward and leads to relief of nasal obstruction in the vast majority of patients.

Considering rhinoplasty or rhinoseptoplasty?

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