What is Septoplasty Surgery?

Septoplasty Surgery has been used for centuries for the treatment of various diseases and conditions.It is done to fix crooked septum. In ancient times, it was used as a treatment for breathing problems, asthma and emphysema. In present day, it is primarily used to treat sinusitis and nasal polyps in adults and children aged between three months and twelve years old.

• It is  a  surgery  done  to  correct  deviated nasal septum.
• The  nasal  septum  is  the  partition  between the two  nostrils.
• It  is  made up  of  bone ,cartilage  and connective tissue.
• Deviated nasal septum causes  nasal  obstruction.
• Nasal  obstruction  can  also  be  due to  enlarged  middle  turbinates  called  Concha  bullosa

Causes  of  DNS (Deviated nasal septum) 

Symptoms of  deviated nasal septum –

• Nasal  blocking  which  is  usually more on  one  side
• Frequent  sinusitis
• Occasionally  there  may  be  nasal bleeding .
• From  the  larger  nostrils  there  can be  crusting  due to comparatively  large  air flow  through  the  larger  nostril.
• Snoring
• Postnasal  discharge
• Headache
• Whistling  noise  during  respiration
• In  severe  neglected  cases  it  can lead to  sleep  apnoea .
• The  individual  tends  to  sleep  on  one  side  which is  the  side  opposite  to  the  blocked  nostril .
• In  severe ,neglected  cases  it  can  prove  fatal.

Diagnosis of  Deviated nasal septum –

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The  clinical  indications  for  Septoplasty are –

• Recurrent  nasal  blocking,
• frequent sinusitis
• In  these  above  2 indications, surgery is  advised  by  ENT  Surgeon  only  if  there is  significant extent of Deviated  nasal  septum  on  Diagnostic  nasal  endoscopy ,in  CT-SCAN (PNS-Paranasal sinuses) and only  if the  patient  is  having  frequent  episodes  of  cold  with  only  temporary  relief by  medicines, decongestant  nasal  drops.
• Clear-cut  idea  is  given  to the patient that  85 percent  of the  patients get  relief  from  nasal  blocking  after  Septoplasty. But  in  some  cases patient  may  have  nasal  blocking  post -op also.
• This  is  attributed  to  allergic  component.
• The  patient  is  explained  in  clear  terms  that  there  is  no  treatment  to  nasal  allergic  rhinitis, only  prevention can  be help  to  some extent and  if  it  persists  we  have  to  bear  up with it. Intermittent  steroid nasal  spray  helps  only  to  some extent.
• As  a  step  prior to removal of  nasal polyps,
• As a step  prior  to  Endonasal  DCR  Surgery if  there  is  inadequate access  to  the  ENT  surgeon.
• As  a step  prior to  Septorhinoplasty
• It  is  a  rare  indication to  prevent  recurrent  nose bleeds (Epistaxis).
• As  a  prerequisite  for  removal  of  pituitary  tumors endoscopically by the neurosurgeon.
• As a  prerequisite  for  cases  of  Sleep  apnoea  in  which  significant deviated  nasal  septum is  present.

• There is no  incision from  external  aspect.
• The  external  appearance of the  nose  does  not  change.
• But  the  patient  gets  relief  from  symptoms.

• Steroids  sprays
• Decongestants
• Antihistamnics
• Steroid tablets  in  severe  cases  if  the random  blood sugar  level is  normal
• Exposure  to  allergens  and  irritants  should be avoided

Septoplasty surgery –

• CBC, Random  blood  sugar, BT, CT, PT, PT-INR, PTT, APTT, Sr  Creatinine, SGOT, SGPT, HIV, HbsAG, Urine-Routine and Microscopy
• ECG
• Chest  X-ray -PA veiw
• Physician( MD General Medicine) fitness.
• If  any  blood  thinners are  being  given to  the  patient  like  Aspirin or  Clopidogrel  then they  should be  stopped  3 days  before  the  surgery.
• If  the  physician  gives  fitness, then  we  can  proceed  further  for  Septoplasty  surgery.
• Preparation  for  surgery –
• The  patient  is  asked  to  remain NBM for  at least  6 hrs  prior to the  surgery.
• Just  before  the  surgery  the  anaesthetic  will  speak with the  patient  and  explain  the  aspects  of  anaesthesia.
• In  children and  uncooperative  adults, General  anaesthesia  is  required.\
• In  cooperative  adults  it  can be  done  in  local  anaesthesia  in  which  the  ENT surgeon  gives  injection  of  2 percent  xylocaine  with  adrenaline  into the nasal  septum.
• The  anaesthetic  gives  iv  sedation.
• Septoplasty  can  be  done  endoscopically  also  by  the  ENT surgeon.
• Steps  of  Septoplasty  surgery /Septoplasty  procedure –
• Hemitransfixation  incision  endoscopicaly on  the  nasal  septum.
• Elevation of  the  mucoperichondrial flap.
• Tiny  incision  on the  septal  cartilage  and  going  to  the  opposite side  and  similarly  elevating  the  mucoperichondrial  flap.
• Cutting  the  deviated  portions  of  bone  and  cartilage and  discarding  them.
• Cris cross  incisions  are  given  on  the  nasal  septum  anterior  to  the  hemitransfixation  incision  to  break  the  spring  action.
• Septal  spur  if  any  is  removed.
• If there  is  Concha bullosa  then  it’s  trimming  is  required.
• If  the  sinuses are affected  then Functional endoscopic sinus surgery  may be  required.
• If  allergic  rhinitis  is  there  thermal  cauterization  of the  inferior turbinates is  required.
• Flaps  are  reposited  and  bilateral  nest cell  packing is done  .
• Sterile  dressing  is  given.
• Patient  is  shifted  to  ICU  for  first  3-4 hrs  and then  to Semi special  room of  hospital.
• Post  op 4-6 hrs  NBM  is  required.
• After  24 hrs  from  surgery  nasal  pack  is  removed  and  the  patient is given  discharge from hospital if  there is  no  nasal, post nasal  bleeding or  any  other  problems.

• Risks associated with a septoplasty are rare, but they can include:
• bleeding
• perforation of your septum, which happens when a hole forms in your septum-this  will  not  happen  if  the  ENT  surgeon  is  qualified  and experienced.
• Bleeding,
• Infection
• Toxic  shock  syndrome
• Altered  nose  shape -if  more  than  the  required amount of  bone and cartilage is  removed.
• These  above complications  are  rare  if  appropriate  care  is  taken  by  operating  ENT surgeon

• Antibiotics
• analgesics
• antihistamnics
• steroids
• alkaline  nasal  douching
• antacids
• nasal  decongestant  drops

• Septoplasty is usually performed as an outpatient procedure unless major complications arise.
• This means that patient will be able to go home on the same day as the procedure, once the anesthesia has worn off.
• Patient should also limit his physical activity for several weeks after surgery to minimize swelling and promote healing.
• This includes most forms of intense exercise, such as running, lifting weights, and playing contact sports.
• These activities can increase the blood pressure and lead to heavy bleeding.

For a quicker recovery 

• the  things  that  need to be done –
• elevating your head at night to keep the swelling down
• not blowing your nose for at least three days after surgery
• After  discharge  from the  hhospital  patient  needs to come for  follow up with  the  ENT surgeon  in  his  clinic  after  7 days from the date of  discharge from the  hospital.

• Around  85 percent of  the  patients  experience improvement  in  nasal  symptoms  after  Septoplasty.
• Clear-cut  idea is  given  to  the  patient by the  ENT surgeon that  allergic  symptoms might  persist  even  after  Septoplasty and Septoplasty  has  nothing to do  with  allergic  symptoms.
• Such  patients  may  require intermittent  steroid(Futicasone) spray.
• They  may  opt  for  Immunotherapy also.

• Is  Septoplasty  a cosmetic surgery ?
• It  may be  a  part of  cosmetic surgery  when  it is  done  along  wit septorhinoplasty.
• In  this  surgery  correction of  the  external  nasal  deformity  is  done  ,so it is cosmetic.
• In  this  surgery  along  with  Septoplasty  Rhinoplasty is  also  done
• Septoplasty  alone  by  itself  is  no cosmetic surgery.
• Is  Septoplasty  a  serious  surgery  ?
• No not  at  all.
• It  is  not  a  major  surgery.
• It is a  minor  surgery.
• It can be  done  under  local  anaesthesia  in  adults, -that  means  by  giving  anaesthetic  injection  into  the  nasal  septum  and  mild sedation  by  I. V route  by  anaesthetic .
• There  is  no  need to make  the  patient  totally  unconscious.
• Only  in  small  children  and in uncooperative adults  general  anaesthesia  is  required.
• Is  Septoplasty  painful  ?
• No not  at  all.
• In  general  anaesthesia  there  is  no question  at all, but  even  in  local  cases by  local  anaesthetic  injections  iv sedation  there  is  no  pain  at all.
• What is  cost  of  Septoplasty  surgery ?
• It varies  from  nation  to  nation, and  from  state to state.
• How  long  is  Septoplasty  surgery?
• It’s  duration  is  hardly  20-30 minutes.
• How  successful  is  Septoplasty  surgery.
• Almost  85 percent of  the  patients  of  deviated  nasal  septum  get  relief  from  nasal  obstruction from  Septoplasty.
• If  associated  nasal  allergic  rhinitis  is there  then  Immunotherapy is required.
• For  good results and  reasonable budget  Septoplasty surgery pl contact –