septoplasty

Septoplasty

 

Definition

Septoplasty is a surgical procedure to correct the shape of the septum of the nose. The nasal septum is the separation between the two nostrils. In adults, the septum is composed partly of cartilage and partly of bone.

Purpose

Septoplasty is performed to correct a crooked (deviated) or dislocated septum, often as part of plastic surgery of the nose (rhinoplasty). The nasal septum has three functions: to support the nose, regulate air flow, and support the mucous membranes (mucosa) of the nose. Septoplasty is done to correct the shape of the nose caused by a deformed septum or correct deregulated air flow caused by a deviated septum. Septoplasty is often needed when the patient is having an operation to reduce the size of the nose (reductive rhinoplasty), because this operation usually reduces the amount of breathing space in the nose.

Septoplasty may also be done as a follow-up procedure following facial trauma, as the nose is frequently broken or dislocated by blows to the face resulting from automobile accidents, criminal assaults, or sports injuries.

Precautions

Septoplasty is ordinarily not performed within six months of a traumatic injury to the nose.

Description

Septoplasties are performed in the hospital with a combination of local and intravenous anesthesia. In some cases, hypnosis has been successfully used as anesthesia. After the patient is anesthetized, the surgeon makes a cut (incision) in the mucous tissue that covers the part of the septum that is made of cartilage. The tissue is lifted, exposing the cartilage and bony part of the septum. Usually, one side of the mucous tissue is left intact to provide support during healing. Cartilage is cut away as needed.

As the surgeon cuts away the cartilage, deformities tend to straighten themselves out, reducing the amount of cartilage that must be cut. Once the cartilage is cut, bony deformities can be corrected. For most patients, this is the extent of the surgery required to improve breathing through the nose and correct deformities. Some patients have bony obstructions at the base of the nasal chamber and require further surgery. These obstructions include bony spurs and ridges that contribute to drying, ulceration, or bleeding of the mucous tissue that covers the inside of the nasal passages. In these cases, the extent of the surgery depends on the nature of the deformities that need correcting.

During surgery, the patient's own cartilage that has been removed can be reused to provide support for the nose if needed. External septum supports are not usually needed. Splints may be needed occasionally to support cartilage when extensive cutting has been done. External splints can be used to support the cartilage for the first few days of healing. Tefla gauze is inserted in the nostril to support the flaps and cartilage and to absorb any bleeding or mucus.

A newer option for closing perforations in the septum is a button made of Silastic, a compound of silicone and rubber.

Preparation

Before performing a septoplasty, the surgeon will evaluate the difference in airflow between the two nostrils. In children, this assessment can be done very simply by asking the child to breathe out slowly on a small mirror held in front of the nose.

As with any other operation under general anesthesia, patients are evaluated for any physical conditions that might complicate surgery and for any medications that might affect blood clotting time.

Aftercare

Patients with septoplasties are usually sent home from the hospital later the same day or the morning after the surgery. All dressings inside the nose are removed before the patient leaves. Aftercare includes a list of detailed instructions for the patient that focus on preventing trauma to the nose.

Key terms

Cartilage — A tough, elastic connective tissue found in the joints, outer ear, nose, larynx, and other parts of the body.

Rhinoplasty — Plastic surgery of the nose.

Septum (plural, septa) — The dividing partition in the nose that separates the two nostrils. It is composed of bone and cartilage.

Splint — A thin piece of rigid material that is sometimes used during nasal surgery to hold certain structures in place until healing is underway.

Risks

The risks from a septoplasty are similar to those from other operations on the face: postoperative pain with some bleeding, swelling, bruising, or discoloration. A few patients may have allergic reactions to the anesthetics. The operation in itself, however, is relatively low-risk in that it does not involve major blood vessels or vital organs. Infection is unlikely if proper surgical technique is observed.

Normal results

Normal results include improved breathing and airflow through the nostrils, and an acceptable outward shape of the nose.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Septal Deviation and Perforation." Section 7, Chapter 86 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Piatti, G., A. Scotti, and U. Ambrosetti. "Nasal Ciliary Beat after Insertion of Septo-Valvular Splints." Otolaryngology and Head and Neck Surgery 130 (May 2004): 558-562.

Wain, H. J. "Reflections on Hypnotizability and Its Impact on Successful Surgical Hypnosis: A Sole Anesthetic for Septoplasty." American Journal of Clinical Hypnosis 46 (April 2004): 313-321.

Organizations

American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS). 310 South Henry Street, Alexandria, VA 22314. (703) 299-9291. http://www.facemd.org.

American Society of Plastic Surgeons (ASPS). 444 East Algonquin Road, Arlington Heights, IL 60005. (847) 228-9900. http://www.plasticsurgery.org.

septoplasty

 [sep″to-plas´te]

surgical reconstruction of the nasal septum.

sep·to·plas·ty

(sep'tō-plas'tē),

Operation to correct defects or deformities of the nasal septum, often by alteration or partial removal of skeletal structures.

[septo- + G. plastos, formed]

septoplasty

/sep·to·plas·ty/ (sep´to´-plas″te) surgical reconstruction of the nasal septum.

septoplasty

(sĕp′tə-plăs′tē)

n.

A surgical operation to correct defects or deformities of the nasal septum, often by altering or partially removing supporting structures.

septoplasty

[sep′tō·plas′tē]

Etymology: L, saeptum, septum; Gk, plassein, to form

surgical reconstruction of the nasal septum.

septoplasty

Reconstruction of nasal septum ENT Any operation that alters the shape–eg, deviated nasal septum, often performed with rhinoplasty. See Rhinoplasty.

sep·to·plas·ty

(sep'tō-plas-tē)

Surgery to correct defects or deformities of the nasal septum, often by alteration or partial removal of supporting structures.

[septo- + G. plastos, formed]

septoplasty

An operation to correct a deviation to one side of the central partition of the nose (the nasal SEPTUM).

septoplasty

surgical reconstruction of the nasal septum.