Difference Between SMR and Septoplasty: Procedure, Benefits & Risks Explained

-by ENT specialist doctor-Dr Sagar Rajkuwar, Nashik ,Maharashtra ,India -clinic website-

www.entspecialistinnashik.com

Table of contents-

1. Introduction
2. What is Submucosal Resection?
3. How does SMR involve?
4. What is Septoplasty?
5. What does Septoplasty involve?
6. SMR vs Septoplasty
7. What are the potential risks that may arise following SMR and Septoplasty?
8. How to recuperate from Septoplasty or SMR?
9. What is the difference between septoplasty and SMR?
10. What is the difference between sinus surgery and septoplasty?
11. Which incision is given in SMR?
12. Seven Differences Between Submucous Resection and Septoplasty
13. What is the nasal septum?
14. Submucous resection for correcting deviated septum procedure
15. When does a rhinoplasty surgeon recommend submucosal resection?
16. Cost of septoplasty and submucous resection of the nasal septum
17. Summary
18. References

1.🔹 Introduction:

Septoplasty and Submucous Resection (SMR) are two frequently mentioned surgical treatments for nasal blockage and respiratory problems. While both seek to fix a deviated nasal septum, their approach, the amount of tissue removed, and the results of the recovery vary. It’s not uncommon for patients and even caregivers to question which treatment is preferable and how the two compare.

You can make educated choices about treatment choices, establish reasonable expectations, and plan for rehabilitation by knowing the distinction between septoplasty and SMR. This article examines the differences between these processes, their benefits, and the situations in which each is advised.

2.What is Submucosal Resection?

The submucosal resection, or SMR, is a surgical procedure designed to eliminate excess tissue from the nose’s filters, referred to as enlarged turbinates. When the turbinates become enlarged, they can block nasal airways, leading to difficulties in breathing. Some individuals may also suffer from sinusitis, headaches, and discomfort.

When a deviated septum cannot be treated using alternative methods and leads to persistent sinus infections, the physician suggests that a patient undergo an SMR.

3.How does SMR involve?

The submucosal resection procedure is classified as a day-care operation, which indicates that the patient is able to return home on the same day as the surgery. Conducted under either local or general anesthesia, the procedure takes approximately an hour and a half to complete in its entirety.

The ENT specialist executes an SMR entirely through the nostrils; therefore, the external appearance of the nose remains unchanged. Additionally, the ideal candidate for SMR is someone aged 17 or older.

After administering anesthesia, the physician makes an incision inside the nose to allow a small spinning blade called a microdebrider to cut away the excess tissue. Since the incision is made internally, the mucus lining stays unaffected.

4.What is Septoplasty?

Septoplasty is another surgical treatment performed to correct a deviated septum. Correcting the deviated septum facilitates improved airflow through the nasal pathways.

5.What does Septoplasty involve?

Septoplasty consists of the following steps –

• Prior to the procedure, the doctor provides anesthesia (general or local) for patient comfort, either through an intravenous line or injection.
• Once the patient is unconscious, the ENT surgeon creates an incision within the nasal cavity. If septoplasty is conducted alongside rhinoplasty, the incision is made along the narrow strip of tissue separating the nostrils.
• Subsequently, the surgeon elevates the mucus lining, the membrane that covers the septum, from one side. The same action is repeated on the opposite side of the nostril. Given that the mucus lining is delicate and can easily tear or create a hole, this step is crucial.
• The septum is corrected by either excising the bone or cartilage.

After aligning the septum, the physician repositions the nasal mucosal lining and stitches it back together.

Know here: How the nose looks before and after Septoplasty

To ensure the septum remains stable, the physician places splints or packaging, which are removed following the surgery. Eventually, the internal sutures inside the nose dissolve naturally over time.

6.SMR vs Septoplasty

While both SMR and Septoplasty address a deviated septum, many experts contend that these two procedures are not identical. They assert that during an SMR, substantial portions of tissue are removed, whereas, in a septoplasty, only a small portion of tissue is taken out.

SMR Septoplasty

7.What are the potential risks that may arise following SMR and Septoplasty?

SMR and Septoplasty share similarities in that they both carry comparable types of risks. Some of the typical risks that individuals report after SMR or a septoplasty include-

• Nasal bleeding
• Infection
• Complications related to anesthesia
• Stuffy nose following the surgery

None of these complications are serious. Therefore, to alleviate discomfort, utilize a humidifier and adhere carefully to the post-operative guidelines provided by the ENT physician.

8.How to recuperate from Septoplasty or SMR?

It is typical to experience swelling, pain, and stuffing in the nose after an SMR or septoplasty. After a couple of days post-surgery, the physician will take out the packing. Keep in mind to take the pain medications prescribed by the physician.

Typically, health professionals advise patients to minimize the intake of blood thinners like aspirin, ibuprofen, or other medications before the surgery to lessen bleeding.

Additionally, refrain from engaging in strenuous activities such as running, lifting weights, or playing contact sports as these may increase blood pressure and lead to nose bleeding.

9.What is the difference between septoplasty and SMR?

Cartilage: The goal of septoplasty is to retain as much nasal cartilage as possible, whereas in SMR, a significant portion of this cartilage is lost. Modifications to the external shape of the nose: SMR does not alter the appearance of the nose, but Sept rhinoplasty can result in a straighter-looking nose.

10.What is the difference between sinus surgery and septoplasty?

Septoplasty aims to rectify a misaligned nasal septum—a condition where the partition dividing the nasal cavities is bent or shifted—frequently leading to challenges in breathing. In contrast to sinuplasty, which mainly focuses on the sinuses, septoplasty deals with structural problems within the nasal cavity itself.

11.Which incision is given in SMR?

Conventional SMR

The Killian incision is the incision most frequently utilized for this operation. It is an angled incision located approximately 5mm above the lower edge of the septal cartilage. The mucoperichondrial flap was raised, and a cut was made through the cartilage; the other perichondrium must remain undamaged.

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12.Seven Differences Between Submucous Resection and Septoplasty

The deviated septum is corrected by two straightforward yet very skilled rhinoplasty treatments: septoplasty and submucous resection. A deviated septum is a common issue, and many individuals can live their lives without experiencing any difficulties. However, a few people experience significant symptoms of a twisted or deviated nose septum, as well as functional and aesthetic concerns that require surgical treatment by a skilled rhinology surgeon.

13.What is the nasal septum?

The septum is a crucial cartilage component that should ideally separate the interior of the nose into two equal chambers. Nonetheless, bending it can result in issues like a crooked nose.

It’s possible that you’re not even aware that you have a deviated septum, but some septals might be a problem if they cause any of the following symptoms.

Nasal obstruction (unilateral or bilateral): The septum can make it difficult to breathe normally if it blocks a nostril. Because the nasal passages grow and constrict during a cold or nasal allergy, this obstruction becomes more apparent.

Nosebleeds: The nasal septum might dry out and cause more nosebleeds due to the curvature.

Facial pain: This symptom is often seen in cases of deviation. The pressure on one side of the face, which causes pain, is caused by the contact of the surfaces inside the nose.
An obstructed septum in the nose prevents air from traveling properly through the airways, resulting in loud and annoying breathing during sleep as well as snoring.
Awareness of the nasal cycle: the normal nasal cycle alternates between favoring blockage on one side and then the other. People with a deviated septum are frequently conscious of this cycle as a result of nasal blockage.

People with constricted nasal airways prefer to sleep on one side in order to improve nasal breathing and increase comfort in their daily lives.

Nasal congestion: Sometimes, there seems to be something constantly in the nose, which makes it feel unpleasant. This might also result in the issue of sleep apnea, where breathing either begins or stops automatically.

Sinusitis: The fluid collects in the sinus cavity because inflammatory alterations in the nasal canal and sinus tissues prevent the nostrils from draining properly, resulting in sinusitis, which causes persistent discomfort and pressure.

There are several causes for a deviated septum, including trauma to the nose from rough play or contact sports, injuries, or congenital abnormalities. A direct injury to the nose is the most frequent cause of a deviated septum in adults. The deviated septum may get worse with age, which can cause more problems. Septoplasty and submucosal resection are the two most frequent nose procedures performed to treat the symptoms of a deviated septum. The procedure is chosen according to the kind of deviation. There are five categories for septum deviation.

The surgical treatment of a deviated septum is a difficult procedure that requires the top rhinologic surgeons, who are skilled in both esthetics and functional problems brought on by the procedure before and after surgery. The operation for a deviated septum has undergone several changes in recent years in an attempt to maintain the septum structure. A thorough examination of the nasal bones and its form in relation to the rest of the face structure is required for the diagnosis of both septoplasty and submucous resection.

The goal of both procedures is to straighten the nose and fix the septum within to improve breathing. The patients benefit from this in both their professional and personal lives. They do, however, differ in a number of ways, including:

Surgical methods: The septoplasty seeks to rectify the deviated septum, and the resection method removes the excess tissues (enlarged nose’s inferior turbinates) from the septum to open up the airways. In the submucous resection (SMR) procedure, the deviated septum is removed or the external deviation indication is lessened. Septorhinoplasty involves lifting the flaps from the nose’s concave side, whereas SMR involves the surgeon raising the flaps on both sides to gain access to the septum.

Kind of procedure: Septoplasty is a conservative treatment with little tissue removal, while SMR is a radial surgery that involves a lot of tissue excavation and removal.
Submucous resection to address the nasal deviation can be carried out through an open rhinoplasty, and septoplasty or the Septorhinoplasty can be performed through open nose surgery.

Surgery age: Septoplasty can be performed on children as well to provide instant relief, while SMR can only be performed on children over 17 when the bones and cartilage have ceased to grow.

Cartilage: In a septoplasty, the goal is to preserve as much nasal cartilage as possible, while in an SMR, the nose loses most of this cartilage.
Because the submucous resection procedure removes the majority of the nasal cartilage, it is challenging to conduct further surgery following this form of deviation rectification, but the rhinoplasty surgeon is able to carry out additional surgery in cases of Septorhinoplasty.

Changes to the nose’s exterior architecture: Although septorhinoplasty can give you a straighter-looking nose, SMR does not affect the nose’s appearance.

14.Submucous resection for correcting deviated septum procedure

The inferior turbinate in the nose is reduced in size via the highly effective surgery known as the SMR. The main purpose of turbinates is to facilitate breathing and maintain the humidity and warmth of the air we breathe. There are tree turbinates on each side of the nose. Breathing problems can result from an enlarged turbinate located near the base of the nose.

Furthermore, if the deviated septum is interfering with the patient’s daily activities and cannot be treated by other methods, SMR becomes the best option for instant and long-lasting relief. The following is a list of things you need to know about submucous resection of the nasal septum:

• The operation only lasts for a day, and the majority of patients don’t need to spend the night in the hospital.
• The procedure lasts approximately 1.5 hours, and the surgeon will employ local or general anesthesia..
• The surgeon cuts up the extra tissue after making minor incisions in the nose. The mucus layer is not disturbed by this procedure.
• After that, the surgeon will close the incisions, and you’re on your way to healing. The exterior of the nose shows no evidence of any external injury.

15.When does a rhinoplasty surgeon recommend submucosal resection?

A crooked septum does not need an SMR, but a nose surgeon will advise one if you’re looking for relief from it.

• Persistent sinus infections that have not improved with standard therapies
• Septal deviation causes nosebleeds.
• A crooked septum causes breathing difficulties.

This procedure can also be performed in conjunction with regular sinus surgery to provide the surgeon greater access to other areas of the nose. In addition to cleft palate surgery, SMR is also performed.

16.Cost of septoplasty and submucous resection of the nasal septum

The cost of each procedure varies since they correct different issues. The price of septoplasty and SMR varies according to

• A surgeon’s knowledge and experience
• The clinic’s location
• If necessary, additional adjustments are made along with it.
• Costs of anesthesia and hospitalization

In general, insurance covers the operation if it is performed for therapeutic purposes, so you should contact your insurance company and find out.

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17.🔹 Summary:

Septoplasty and submucous resection (SMR) are two surgical methods that are employed to treat a deviated nasal septum and facilitate breathing, but they have varied procedures and results. Because greater amounts of tissue and cartilage are removed during the more extreme procedure of SMR, it is less appropriate for youngsters and more challenging to perform subsequent revision operations. Septoplasty, in contrast, is a conservative operation that maintains the majority of the cartilage, may be carried out even in youngsters, and typically makes subsequent modifications simpler if necessary.

Both procedures help alleviate nasal congestion, sinus infections, snoring, and breathing problems. However, they have common possible dangers, such as bleeding, infection, nasal congestion, or difficulties during anesthesia. The majority of recovery strategies include hydration, pain control, and avoiding strenuous exercise.

In conclusion, septoplasty is typically preferred for children, milder instances, and patients who may need additional surgical changes, while SMR is typically recommended for significant abnormalities and persistent problems. Patients and carers can make educated choices about the best course of treatment by learning the distinctions between septoplasty and SMR.

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Deviated septum surgery options

Septoplasty is the primary surgical procedure for a deviated septum, which involves straightening the septum using endonasal (internal) or endoscopic methods, even if this may be done through either approach. An extracorporeal technique may be used in severe cases.

A septoplasty is occasionally performed in conjunction with additional treatments such as rhinoplasty (for nasal reshaping) or functional endoscopic sinus surgery if there are also sinus problems. Although less invasive methods, such as balloon septoplasty, may be taken into account, their efficacy might vary.

The diagnosis

A healthcare provider performs a physical examination to diagnose a deviated septum. A test requires using a bright light to peer into the nose, and occasionally a device to widen the nostrils. If necessary, a lengthy tube-shaped scope with a strong light at the end may display farther back in the nose.

Surgery is used to address a deviated septum that is producing symptoms. A deviated septum can only be corrected via surgery. If a deviated septum doesn’t cause any symptoms, no therapy is necessary.

A healthcare expert may advise using decongestants, antihistamines, or nasal steroid sprays to treat symptoms if allergies or sinus issues are exacerbating them.

Reconstruction surgery
Surgery to fix the deviated septum may be an option for individuals who continue to experience symptoms even after taking medication. Septoplasty is the term for this operation.

The nasal septum is straightened and positioned in the middle of the nose during a standard septoplasty. In some cases, the surgeon may need to chop and remove portions of the septum prior to repositioning them.

Changing the shape of the nose

Rhinoplasty, the surgical reshaping of the nose, is occasionally performed simultaneously with the treatment of a deviated septum. Modifying the nose’s cartilage and bone to alter its size, shape, or both is the process of rhinoplasty.

Outcomes of rhinoplasty
On the left, the nose of a woman prior to rhinoplasty. The same woman is pictured on the right one year following the procedure.

Different Septoplasty Methods

Septoplasty via the Endonasal (Closed) Approach:
This is a popular, minimally invasive procedure in which the surgeon inserts incisions into the nostrils in order to reach and reshape the septum without making external incisions.

Septoplasty via Endoscopy:
Similar to endonasal, but with a small camera (endoscope) that magnifies the nasal structures for more accurate correction of the deviation.

Septoplasty Outside the Body:
Reserved for severe or complex deformities, where the septum is removed, corrected, and then reinserted.

Alternative Surgical Choices

Submucosal Resection:
Frequently employs a motorized instrument called a microdebrider to remove little portions of the septum or to shrink the turbinates, which are tissue in the nasal passage.

Turbinate Surgery (Turbinoplasty):
If enlarged turbinates are the cause of blockage, surgery, frequently performed in conjunction with septoplasty, can be used to shrink them.

Septoplasty Using Balloons:
Some patients may benefit from a non-invasive operation in which a balloon catheter is used to gently widen the nasal passage by repositioning the septum.

Nose Surgery (Rhinoplasty):
Although the primary goal of rhinoplasty is to alter the nose’s outer form, it can be performed in conjunction with a septoplasty to address both cosmetic and structural issues.

What Affects Your Choices

Severity of Deviation: Complex deformities might necessitate alternative surgical techniques.

Other Conditions Present: Sinus problems may require further sinus surgery.

Patient Preferences: The choice between methods may depend on the desired result, such as maintaining the current form of the nose.
Methods can be carried out under general anesthesia or local anesthesia with sedation.

What Happens Following Surgery

The majority of septoplasty procedures are carried out on an outpatient basis, which means that you can go home the same day.
To stop bleeding and edema, some patients may need nasal packing (a gauze-like substance), which is usually taken out during a follow-up appointment.
Raising your head while you sleep, blowing your nose, and refraining from engaging in hard activities are all part of recovery.