What is a septoplasty?

The septum is a wall that divides the left nasal cavity from the right. Ideally it should run down the middle of the nasal cavity but often it deviates to one side or the other.

This condition is called a septal deviation and can make breathing through the nose difficult, either because of actual obstruction of flow, or because of the creation of turbulent airflow, which slows the air movement. In these cases, a septal repair, or septoplasty, is recommended.

The procedure is typically performed through the nose. An incision is made within the nose, and the lining is lifted off of the crooked cartilage and bone. These structural elements are then straightened in a variety of ways and the lining is then returned to its original place. Dissolvable stitches are used to keep the lining in place during healing. Occasionally plastic splints may need to be placed temporarily within the nose following surgery.

In some severe deviations, or when other surgery is to be performed on the nose at the same time, a small incision between the nostrils may be necessary. If an external incision is to be made, your surgeon will specifically discuss this issue with you.

In some patients, other structures in the nose may contribute to the blockage of airflow and your surgeon may advise that these be addressed as well. Occasionally, shelf-like structures known as turbinates can be enlarged and block normal air movement through the nose. The function of the turbinates is to increase the surface area of the nose and to act like battens to direct air through the nose. Surface area within the nose is important because the nose warms and humidifies air and removes small particles before the air reaches the lungs. When the turbinates are too large, however, they can disrupt air movement through the nose and may therefore need to be reduced in size. Your surgeon will discuss with you whether this is the case in your nose.

What are the benefits of surgery?

The goal of the surgery is to restore normal airflow through the nose. Deviated portions of the nasal septum will be straightened in order to remove blockages and portions that cause turbulent airflow. Trimming of enlarged turbinates may also play a role in achieving this goal.

What are the risks of surgery?

While the risks involved in this surgery are relatively minor and uncommon, it is important to remember that risks do exist, as they do in all activities in life. You should be aware of the risks of the surgery in order for you to make an informed decision. All surgeries carry with them the risks of bleeding, infection, and pain. The risk of bleeding is increased by certain medications so you should review all medications (prescription, over-the-counter, and herbal) with your physician prior to surgery.

Aspirin must be stopped at least 10 days prior to surgery and other anti-inflammatory medications, such as ibuprofen (Motrin, Advil,) must be stopped at least four days prior to surgery. In rare cases of excessive bleeding, small sponges may be placed at the conclusion of the procedure. These sponges are usually removed within one to two days.

Taking antibiotics after the procedure will minimize the risk of infection. Extra Strength Tylenol or a mild narcotic and Tylenol combination relieves most patients’ pain. You will receive a prescription for sufficient pain medicine after your surgery.

Rarely, septal surgery can lead to an unexpected change in the appearance of the nose or can lead to a permanent loss of the sense of smell. Another rare risk is creation of a hole in the septum, connecting the right side of the nose to the left.

This condition, called a septal perforation, can cause accumulation of dry mucus (crusting), bleeding, or a whistling sound in the nose. Because the nose is close to the eyes and brain, it is conceivable that these structures could be injured during nasal surgery as well. This is extremely rare.

Turbinate surgery carries the additional risks of increased crusting and a condition called atrophic rhinitis or ozena, in which the interior of the nose is excessively dry. Atrophic rhinitis is caused by the loss of moisturizing surface area in the nose and can be difficult to treat. Lack of improvement or even worsening of the underlying condition and the need for re-operation are other risks inherent with any surgery. Surgery also carries with it the risks of anesthesia. Septoplasty can usually be performed under local or general anesthesia. You should discuss your anesthesia preferences with your surgeon in order to determine what is best for you. You will also have an opportunity to discuss the risks and benefits of each form of anesthesia with an anesthesiologist.

What are the alternatives?

Medications to diminish the swelling of the lining of the nose may promote airflow but have drawbacks that you should discuss with your physician. If turbinate surgery is recommended, there are a number of methods to perform this portion of the procedure and you may wish to discuss these with your surgeon. The surgery is, of course, elective so that no surgery is also an option. As with any surgery, you should feel comfortable seeking a second opinion from another surgeon.

What should I expect after surgery?

  • Healing - The majority of the healing in your nose will take place over the course of four to six weeks. In patients with allergies or over-reactive nasal and sinus lining, the process can take much longer. During this time, you will want to keep your nose out of dusty or smoky environments. This includes tobacco smoke.
  • Medications - Following your surgery you will receive prescriptions for a number of medications. Typically these include pain medicine and antibiotics. It is essential that the prescriptions be filled promptly and the medications taken as directed. Crusting of blood and mucus can slow the healing process. In order to keep your nose moist and prevent the crusting, you should use saline (salt-water) nasal spray for at least two weeks following surgery. These sprays can be purchased over the counter at your pharmacy. For the first five days following surgery, you should use the spray at least once an hour while you are awake. Thereafter, you can reduce use to four or five times a day. However, you cannot over-do it with the salt water, so use it more frequently if you wish.
  • Fatigue - Fatigue for two or three days following the surgery is common. Patients who have general anesthesia often find the fatigue can hang on for an extra day or two. You will want to take it easy for a few days following surgery. You should also avoid strenuous physical activity for a few days. Moderate activity (like going for a walk) is acceptable.
  • Work - Most individuals return to work within four to seven days following surgery. Some return earlier, some later. Plan to be out for a week and return as soon as you feel up to it.
  • Travel - Many of our patients come from some distance. We prefer you stay in the local area overnight following the surgery. If necessary, you may travel by air after the surgery.
  • Post-operative visits - Depending on the extent of your septal surgery, expect to see your doctor within the first three weeks after surgery and, if necessary, another visit four to six weeks later.

What are a few things to be aware of?

  • Bleeding - Oozing from the nose is common for 24–48 hours following surgery. You should probably put an old pillowcase on your pillow or put a towel over it. Additionally, you may want to sleep with your head elevated on an extra pillow to minimize the oozing. After a couple of days, the discharge from your nose may turn maroon or dark brown. This change is due to old blood and is normal. It does not mean that the nose or sinuses are infected.
    Occasionally, persistent bleeding from the nose can develop. If this occurs, sit upright and breathe through your nose for 5–10 minutes. This should relieve most bleeding. If it does not, or if the bleeding is heavy, contact our office.
  • Nausea - Nausea and even vomiting following general anesthesia are not uncommon. They can also occur after local anesthesia, but less often. The nausea usually fades after about 12–24 hours. Try to sip liquids to avoid dehydration during these periods. If the nausea is severe notify our office.
  • Crusting - During septal surgery, incisions are made inside the nose. Like incisions on the external skin, scabs will form as these heal. Mucus may also accumulate on these crusts and block breathing through your nose. Do not attempt to remove these, but instead continue to use the saltwater nasal spray to soften the crusts. If the problem is severe, your physician may prescribe other treatments.
  • Pain - Some discomfort following the procedure is to be expected but usually is not especially severe. Use the pain medicine as needed. As soon as you feel ready, try to switch to an over the counter pain medicine like extra-strength Tylenol. For the first two to three weeks after surgery, do not use medications that contain aspirin, Ibuprofen, or other anti-inflammatory compounds, as these promote bleeding. Sometimes after anesthesia, your muscles may ache all over like you have lifted weights or strained muscles, particularly in the first day or two after surgery. Take Tylenol for this and stretch your muscles—it will subside.

What are the "don'ts?"

  • Nose blowing - You may sniff (even vigorously) if you feel you need to clear your nose. Realize that the interior of the nose will be swollen for four to seven days and may not clear—even with the most forceful attempts. Blowing your nose too early in the healing process can cause bleeding. You may begin to blow your nose lightly three days after surgery.
  • Bending, lifting, straining - Placing your head below your waist (to do things like tie your shoes), lifting anything over 10 pounds (including children) and straining will all increase the risk of bleeding. You should avoid these activities for one full week following surgery.

When should I call a doctor?

Promptly report the following symptoms to your doctor:

  • Fevers (100.6 or higher)
  • Any symptom of infection: marked swelling of the tip of the nose, or redness with increasing tenderness at the tip of the nose
  • Severe headache accompanied by nausea, vomiting, or unusual change in your behavior
  • New rashes
  • Swelling or bruising around the eyes