Understanding Septorhinoplasty for Deviated Septum

Introduction and Terminology

Septorhinoplasty is a surgical procedure often employed in the treatment of a common condition known as a deviated septum. The nasal septum is the thin wall separating your nasal passages. When it deviates, or shifts to one side, it can lead to breathing difficulties, snoring, sleep disorders, and recurrent sinus infections. The term ‘septorhinoplasty’ combines two procedures: ‘septoplasty’ (the correction of the septum) and ‘rhinoplasty’ (reshaping of the nose for functional or aesthetic reasons).

In the United States, deviated septum affects a significant portion of the population, with septorhinoplasty being one of the most frequently performed procedures to treat this condition. A study by the National Institutes of Health (NIH) estimates that about 80% of all nasal septums are off-center, a condition that’s noticeable in almost one in four adults.

Indications for Septorhinoplasty

Septorhinoplasty is recommended for a variety of reasons. Primarily, it is used to treat symptoms associated with a deviated septum that can significantly impact quality of life. Some of the indications for this procedure include:

• Chronic nasal congestion: When one nasal passage is smaller than the other, it can cause difficulty breathing.
• Recurrent sinus infections: A deviated septum can restrict or block sinus drainage, leading to recurrent infections.
• Nosebleeds: The surface of the septum can become dry, increasing the risk of nosebleeds.
• Sleep disturbances: Deviated septum may contribute to snoring and obstructive sleep apnea.
• Difficulty with exercise: Breathing problems can affect athletic performance and make exercise challenging.
• Facial pain: In severe cases, a deviated septum can lead to long-term facial pain.

It’s important to note that septorhinoplasty may also be considered for patients seeking improvements in the aesthetic appearance of their nose in addition to addressing the functional issues related to a deviated septum.

Pre-Op Preparation

Preparation for septorhinoplasty begins several weeks ahead of the scheduled procedure. It involves making lifestyle adjustments, planning for post-op care, and attending pre-surgery consultations and check-ups.

• Fasting: Typically, patients are advised to fast (no food or drink) for at least 12 hours before the surgery.
• Medication adjustments: Certain medications, especially those that can increase bleeding such as aspirin and other NSAIDs, may need to be stopped before the procedure.
• Pre-op labs or imaging: Pre-operative testing may be required to evaluate your overall health status and readiness for surgery.
• Pre-clearance authorization: You may need to receive medical clearance from your primary care doctor or a specialist, depending on your general health and existing conditions.
• Logistics: Arrange for transportation after the surgery, as you will not be able to drive yourself home. Also, secure work or school leave for the duration of your recovery.

Please note that these are general guidelines, and individual instructions may vary based on your personal health situation and the specific practices of your surgical team. Always consult with your healthcare provider for precise directions. Our telemedicine primary care practice can assist with pre-operative clearances and ordering of pre-op labs and imaging.

Procedure Technique for Septorhinoplasty

The procedure of septorhinoplasty may sound complex, but when broken down into a series of steps, it becomes easier to understand. In the hands of a skilled surgeon, this intricate procedure can significantly improve both the function and appearance of your nose. Here’s a step-by-step guide to what happens during septorhinoplasty:

1. Anesthesia

The first step in a septorhinoplasty is ensuring your comfort. You will be given general anesthesia or sedation, which means you’ll be either completely asleep or in a relaxed, semi-awake state throughout the procedure. This decision is typically based on your preference, your health condition, and your surgeon’s advice.

2. Making the Incision

Once you’re comfortable, your surgeon will make a small incision. This can be done in two ways – ‘open’ or ‘closed’ technique. In an ‘open’ septorhinoplasty, the incision is made across the strip of tissue separating your nostrils, called the columella. In a ‘closed’ septorhinoplasty, all incisions are made inside the nose. The choice between ‘open’ or ‘closed’ technique depends on the complexity of your case and your surgeon’s expertise.

3. Correcting the Deviated Septum

With access to the internal structure of your nose, your surgeon will begin the task of correcting the deviated septum. This usually involves removing or reshaping portions of the septal cartilage and bone that are causing the deviation. The aim here is to create a straight path for air to flow through your nostrils.

4. Reshaping the Nose

If your procedure includes rhinoplasty for cosmetic changes, this is when those adjustments will be made. Your surgeon might reshape your nasal bone and cartilage to achieve the desired appearance. This could involve reducing a hump on the nose bridge, refining the nasal tip, or altering the width of the nostrils. This part of the procedure is highly individualized, based on your facial structure and aesthetic goals.

5. Closing the Incision

After the necessary adjustments have been made, the surgeon will close the incisions. If the ‘open’ technique was used, stitches will be used to close the incision on the columella. In the ‘closed’ technique, dissolvable sutures are typically used inside the nose.

6. Nasal Packing and Splints

Following the surgery, the surgeon may place a soft silicone splint inside each nostril. This helps to support the newly straightened septum. In some cases, packing might be used to control post-operative bleeding. A splint or a bandage might also be applied outside your nose for additional support and protection.

Please note that while this guide aims to provide a comprehensive overview, each person’s experience with septorhinoplasty can be unique based on their individual anatomy, the specific techniques used by the surgeon, and the desired outcome. Always consult with your healthcare provider for information tailored to your specific situation.

Duration of Septorhinoplasty

The duration of a septorhinoplasty procedure typically ranges from 1 to 2 hours, depending on the complexity of the case. However, it’s important to note that this does not include the pre-operation preparation or recovery time in the hospital.

Post-Op Recovery from Septorhinoplasty

After your septorhinoplasty procedure, you will spend some time in a recovery area, usually about 1 to 2 hours, before you can go home. Ensure to arrange transportation, as driving is not recommended immediately after the surgery.

Post-operative appointments will be scheduled to monitor your healing process. The initial follow-up visit is generally within a week after surgery to assess your recovery and remove any external sutures or splints. More visits may follow based on your individual healing progress.

There is usually no need for specific physical therapy post-septorhinoplasty, but some lifestyle changes may be necessary. You should avoid strenuous activities for a few weeks and refrain from blowing your nose for a week or so after surgery. Smoking is discouraged, as it can impede healing.

The amount of time off work varies among patients and the nature of their jobs but generally ranges from 1 to 2 weeks. Complete recovery and final results can take up to a year as minor swelling gradually subsides.

Our practice offers flexible hours up until 9pm on weekdays and 5pm on weekends and can provide necessary work or school notes for your convenience.

Effectiveness of Septorhinoplasty

Septorhinoplasty has been shown to be highly effective in treating deviated septum and improving nasal function. Studies indicate that about 85 to 90 percent of patients report significant improvement in breathing and reduction in symptoms like nasal congestion and recurrent sinus infections post-procedure.

The success of the procedure depends on several factors. Key among them is the skill and experience of the surgeon. Proper pre-operative planning, precise execution of the procedure, and effective post-operative care also play crucial roles in determining the effectiveness of septorhinoplasty.

Conversely, certain circumstances can lower the effectiveness of the procedure. These can include severe deviation of the septum, presence of other nasal or sinus conditions, and poor patient compliance with post-operative care instructions. Additionally, the presence of certain medical conditions like diabetes or a compromised immune system can potentially affect healing and outcomes.

It’s important to have realistic expectations from the procedure. While septorhinoplasty can greatly improve breathing and alleviate symptoms associated with a deviated septum, it is not always able to achieve perfect symmetry or cosmetic results. In some cases, revision surgery may be required to optimize the outcomes.

Remember, each patient’s experience with septorhinoplasty can be unique. Always consult with your healthcare provider for information tailored to your specific situation.

Adverse Events with Septorhinoplasty

While septorhinoplasty is generally a safe procedure, like any surgery, it does carry some risks. Here are some possible adverse events:

• Excessive bleeding (<1%): Some patients may experience nosebleeds or excessive bleeding during or after the surgery. This often results from the body’s response to incisions made during the procedure.
• Infection (2-3%): Although rare, infections can occur post-operatively. Symptoms might include persistent fever, uncontrolled pain, or unusual discharge from the nose.
• Nasal obstruction (5-15%): In some cases, patients may continue to experience nasal obstruction due to post-operative swelling or inadequate correction of the original issue.
• Septal perforation (1-2%): A hole in the septum can occur if both surfaces of the septum are injured during surgery, although this is uncommon.
• Alteration in sense of smell or taste (<1%): Temporary changes in smell or taste can occur due to swelling in the nasal passages, though this is typically temporary.

The mortality rate for septorhinoplasty is extremely low, well below 0.01%.

Alternatives to Septorhinoplasty

While septorhinoplasty is often the best choice for severe deviated septum, other options exist. Non-surgical treatments, like nasal steroids or decongestants, can help reduce inflammation and open up the nasal passages. Nasal strips can also provide temporary relief. Lifestyle modifications, such as avoiding irritants (like smoke) and using a humidifier, can also help manage symptoms.

For less severe cases, a less invasive procedure known as septoplasty might be sufficient. This surgery solely corrects the deviated septum without altering the external appearance of the nose.

Experimental or Emerging Technologies

In the quest for less invasive and more efficient treatments, newer technologies are being explored. One such technique is the use of balloon sinuplasty, which employs a balloon to widen the nasal passages and improve breathing. Initial studies show promising results, but more research is needed to fully understand its effectiveness and potential risks for deviated septum treatment.

Conclusion

Septorhinoplasty is an effective surgical option for treating a deviated septum, with a high success rate and a low risk of serious complications. It is important to understand the procedure, its benefits, and potential risks to make an informed decision. Alternatives exist, and emerging technologies continue to be explored. As with any medical procedure, it’s crucial to consult with a healthcare provider to understand what is best for your individual situation.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.