Deviated Septum & Enlarged Turbinates
The nasal septum is composed of bone and cartilage that divides the nose into two separate sides. It is covered on each side by mucus membrane. Up to 80% of patients have some degree of nasal septal deviation. When the deviation becomes so severe as to affect breathing through the nose it blocks the nasal passageway. In addition to blocking the nasal airway, some patients experience chronic sinusitis from a severely deviated septum. A septoplasty is a surgical procedure directed to straightening the septum and restore clear breathing.
Nasal congestion can also be the result of enlarged inferior turbinates. Inferior turbinates are bony structures that project from the side of the nose that function to humidify and warm the air. A swollen and abnormally large inferior turbinate will also present with nasal congestion. In some cases, patients have deviated septums and enlarged turbinates. Medical treatment for enlarged turbinates includes nasal steroid sprays and irrigations. If medical treatment fails a variety of surgical procedures are used to permanently decrease turbinate size. It is important not to resect the entire turbinate as this may lead to a very dry and crusty nose. This is also known as atrophic rhinitis.
Septoplasty and turbinate reduction is performed in the operating room under general anesthesia. The deviated portion of the septum is removed and the turbinates are surgically reduced. The surgery is done entirely inside the nose with no external incisions. Patients rarely experience bruising or significant swelling around the eyes. The surgery takes approximately one hour and patients can go home the same day. Most patients require small plastic stents which serve to maintain the straight position of the nasal septum. These stents are designed with air passageways and remain in position for approximately one week. Patients return to the office for stent removal.
Complications of septoplasty include no significant airway improvement. The septal cartilage has significant memory and sometimes despite surgical resection of deviated portions it can bend back after surgery. A septal perforation or hole in the septum can occur but is rare after surgery. Postoperative bleeding can occur but is more common in smokers, patients with high blood pressure and those taking aspirin, non-steroidal anti-inflammatory drugs or other blood thinners. Infection and loss of smell can occur but is uncommon.
A septoplasty will not significantly affect the external appearance of the nose. Rhinoplasty is a surgical procedure directed towards the external nose. When combined with septoplasty the procedure is a septorhinoplasty.