Septoplasty

After an evaluation by your Capitol ENT physician, you may be diagnosed with a
deviated nasal septum as a cause for nasal airway obstruction. A septoplasty may be recommended, which is a surgical procedure designed to straighten the nasal septum.

This procedure is typically performed in the operating room under general anesthesia as an outpatient procedure, meaning you typically go home the same day. During the procedure, your surgeon first raises the lining, or mucosa, covering the septum off of the underlying cartilage and bone. This cartilage and bone can then be reshaped and removed as needed, taking care to leave adequate support for the nose, so as not to change its external appearance. The lining of the septum is then laid back down and dissolvable stitches are sometimes used inside the nose. Your surgeon may or may not place splints or packing in your nose that may need to be removed after surgery.

After surgery, the majority of patients will experience significant improvement in their symptoms. However, it does take time for the body to heal, and some patients may notice dramatic improvement immediately following surgery, while others may take several weeks before they feel substantially better. This depends on a number of factors including the extent of surgery that was done and the patient's personal experience. Remember, it takes time for the nose to fully heal after surgery.

• Pain Some patients experience minimal pain after surgery, while others may experience significant pain for several days. You will be prescribed pain medication to help you control pain after surgery. If you are hesitant about using prescription pain medication, you can take over-the-counter Tylenol.
• Bleeding It is common to see blood-tinged nasal secretions during the first week after surgery. It is helpful to keep your head elevated and avoid blowing your nose. If you need to sneeze, it helps to sneeze with your mouth open to reduce pressure in your nose. Avoid strenuous exercise for the first 2 weeks after surgery. Also, avoid medications that can thin your blood such as aspirin, ibuprofen, Advil, Aleve, Motrin, Coumadin, plavix, herbal medications, and vitamins until cleared by your surgeon. It is NOT normal to have heavy amounts of bleeding after surgery. If you have significant bleeding that does not stop after holding pressure on your nose for several minutes, or are concerned that you are bleeding too much, call our office or on-call number immediately, or go to the closest emergency room for further evaluation.
• Nasal congestion/obstruction Some patients may notice dramatic improvement in their nasal congestion immediately after surgery, while other patients may not notice improvement for several days to weeks. After surgery, nasal congestion may be related to a number of factors including packing, crusting, and normal post-surgery swelling. Be patient, follow your post-operative care instructions, and follow up with your surgeon. It will get better.
• Fatigue It is common to feel tired in the first days to weeks after surgery. Remember to take it easy while your body is recovering.
• Return to work Plan to take some time off after surgery. Some patients will be ready to go back to work in a matter of days, while others will need 1-2 weeks to recover. This will depend on the extent of your surgery, your recovery experience, and the nature of your work. If you have a desk job, you may be able to go back to work before the end of a week, but expect to be tired and limit your work demands. If you have a job that demands strenuous labor, you may need to take as much as 2 weeks off until your body has time to heal. Be patient. If you push yourself too hard and too fast, you may risk slowing the healing process. With time, the vast majority of patients experience significant long-term improvement.
• Medications Your surgeon may prescribe medications for you take after surgery, and these may include antibiotics and pain medication. Take these as directed.
• Packing You may or may not have packing and/or splints in your nose after surgery. If you have packing, it comes in two varieties. One is absorbable and will dissolve on its own with time and regular saline irrigations. The other is not absorbable and will be removed by your surgeon at your follow-up visit. You should discuss this with your surgeon.
• Saline irrigations Your surgeon may instruct you to regularly spray or irrigate your nose with saline after surgery. These irrigations help facilitate your recovery after surgery and help to clean and moisturize your nose and sinuses.

Risks of septoplasty
As with any surgical procedure, septal surgery does have associated risks. Fortunately, the risk of a complication is very small, but it is important that you understand the potential complications and ask your surgeon about any concerns you may have.

• Bleeding Most nasal surgery involves some degree of blood loss, which is generally very well tolerated. However, very rarely, significant bleeding can occur and require termination of the procedure. Blood transfusion is rarely necessary and is only given in case of emergency. You should avoid any blood thinning medications including aspirin, ibuprofen, Advil, Motrin, Aleve, and herbal and vitamin supplements for 10 days prior to surgery.
• Persistent symptoms The goal of surgery is to improve the structural problems that are leading to your nasal blockage. A large majority of patients (over 90%) have significant improvement in their nasal obstruction symptoms after surgery. However, many different factors can impact the final outcome, and some patients may have persistent nasal obstruction after surgery. In very rare instances, patients may notice no improvement or worsening of their obstruction symptoms.
• Toxic shock syndrome This is a very rare infection that can occur in the nose, usually when packing is placed, but sometimes when no packing is used. This is a life threatening infection and requires immediate treatment. If you note a change in your blood pressure, heart rate, fever, and skin discoloration, please notify our office immediately. The incidence of this complication is thought to be less than one case in one hundred thousand septoplasties.
• Tooth and nose numbness The nerves that go to the gums and front teeth of the upper jaw come through the nose. Surgery on the septum can lead to stretching or injury to these nerves. This can lead to some numbness of the incisors of the upper jaw. In most instances, the numbness is temporary. Similarly, the tip of the nose may be numb after septoplasty. Sometimes, sensation can take weeks or even months to return. Temporary numbness or pain in these teeth postoperatively is common, but it almost always resolves within several months. Rarely, some patients can have persistent numbness of this area.
• Septal perforation A septal perforation is a hole in the nasal septum. This can develop during or after surgery, especially if there is an infection. Sometimes, a perforation can lead to crusting, bleeding, obstruction, and whistling nose with breathing. Great care is taken during your procedure to prevent such a complication, but there is still a small risk this may occur. If the perforation does not cause any symptoms, then nothing further needs to be done. For perforations that are symptomatic, surgical closure or placement of a synthetic septal button can be performed.
• Spinal fluid leak Because the top of the nasal septum is located below the skull, there is a rare chance of creating a leak of cerebrospinal fluid (the fluid that surrounds the brain) or injuring the brain. Should the rare complication of a spinal fluid leak occur, it may create a potential pathway for infection, which could result in meningitis. If a spinal fluid leak were to occur, additional surgery and hospitalization may be necessary. This is an extremely rare problem after septoplasty.
• Other risks Other uncommon risks of surgery include alteration of sense of smell and/or taste, facial pain, change in the resonance or quality of the voice, nasal dryness and/or crusting, swelling or bruising around the eye, and change in the external appearance of the nose.

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