Septoplasty: Procedure, Recovery, Cost and Safety

Septoplasty is a surgical procedure whereby the deviation and / or crookedness in the nasal cartilage and bone is corrected so the airflow through the nose improves and breathing becomes easier.

Parts of your nose may also get blocked by turbinates,a name for enlarged bone structures. Long term sinusitis, nasal polyps also create blockages in the nasal airway making it difficult for one to breathe freely. Septoplasty is also conducted as a cure for long term sinusitis and nasal polyps. It is the most common ENT surgical procedure.

In simple terms, septoplasty originates from septo i.e. wall or partition, and plasty i.e. moulding, grafting or forming any part of the body. Septoplasty therefore means, repositioning of the deviated or corked wall or partition of the nose.

A cartilage and a bone in our nose serves the purpose of dividing the cavity of the nose into the right and the left. This cartilage and bone is known as the nasal septum. Sometimes, this nasal septum may be off-center or deviated. The reason for such deviation may be a broken nose, trauma or an injury. Such deviation or crookedness may also be completely natural. You are likely to experience difficulty in breathing with a deviated or crooked septum. This difficulty arises from the blockage to the nasal cavities due to the same.

Other conditions like sinusitis, nasal polyps, turbinates may be treated using medication, nasal sprays etc., septoplasty surgery is the only known treatment for a deviated septum.

Your deviated septum makes breathing through the nose extremely difficult. You have no option other than breathing through the mouth. This will make your mouth feel dry most of the time and is often the cause of disturbed sleep. You will often observe that you need to sleep on one side only to fall asleep and you are likely to make noise while you sleep with a deviated septum. Septoplasty surgery is the only remedy for this condition.

Septoplasty also treats sinus, nasal polyps and enlarged turbinates.

There are five primary reasons arising of a deviated or crooked septum that necessitates septoplasty surgery. Here’s a brief on them:

• Lack of Sleep: A deviated septum most often, deprives you of sound sleep. Loud snoring, dry mouths, restlessness, inability to sleep except in a single position all add up to give you disturbed sleep and headaches as you wake up and persist throughout the day, every day.
• Unbearable Headaches: As if adding insult to injury, a crooked or deviated septum often induces migraines and facial pain, sure shot ingredients for adding to your headache due to sleeplessness. Your muscles are under constant strain , giving you physical tension.
• Chronic Nasal Disorders: A feeling of persistently dripping nose? Almost constant feeling of coldness? Very frequent bouts of sneezing? Suffering from post nasal drip? These are not allergies so keep off those anti-allergy medicines. There is a single culprit behind all of these – a crooked or deviated septum.
• Nose Bleeds: This condition calls out for immediate attention of a doctor. If they start getting frequent, you have possibly delayed your visit more than you should have and septoplasty surgery has become overdue.
• Respiratory Issues: This issue will keep appearing time and again with septoplasty. The septum with an incorrect shape will cause reduction in air flow. Your body will fail to breathe normally and you are most likely to develop troubled breathing and sleep apnoea. Sleep apnoea often develops into a serious sleep disorder. You may unknowingly encounter repeated starts and stops to your breathing while you sleep. Loud snoring and feeling of tiredness even after a full night of sleep are symptomatic of sleep apnoea.

Septoplasty is a type of reconstructive plastic surgery. It is performed to straighten or reposition a deviated or crooked septum and enable normal flow of air through both sides of the nose.

Here’s an outline of the septoplasty surgery procedure with steps:

• You are kept in a supine position with your head tilted towards your surgeon
• Your nasal hair is trimmed.
• You may be administered some nasal decongestant prior to anaesthesia.
• The ENT surgeon will cut a wall on one side of the nose.
• The mucosa (a thin membrane covering and protecting the septum) will then be lifted or removed.
• Reshaping or repositioning, as required, is done to the bone and cartilage of the septum.
• If required, removal is done for parts of the bone and cartilage for reshaping and thereafter they are repositioned.
• The mucosa is replaced over the septum.
• Splints or soft packing may be inserted to keep the nasal tissue in place. This prevents formation of scar tissue as well as bleeding from the nose. The splints are retained for about 7 to 14 days. The packing is removed after about a day to a day and a half.
• At times, dissolving stitches may be done and allowed to dissolve on their own.

You may seek more information by contacting Pristyn Care, a one-stop guidance, consultation, surgery with comprehensive pre and post operative care packages for septoplasty and other ENT procedures.

Septoplasty involves an out-patient procedure lasting about 30 to 90 minutes. The entire surgery takes place inside the nose. It is executed under general anaesthesia or local anaesthesia, as decided upon by the surgeon on the merit of the case. Most patients are discharged on the day of their surgery. There is no breaking of the nose in the surgical procedure.

Some small degree of pain with some pressure on the sinus and the nose in general is unavoidable in sinus surgery. It is akin to a sinus infection and resembles a dull aching sensation in your sinuses. This lasts for just a few days.

Despite being one of the safest and most successful procedures, there are instances of complications that have arisen with septoplasty surgery.

Some such complications and septoplasty risks that have been observed are:

• Bleeding: While some quantum of bleeding is associated as with any other surgical procedure, on rare occasions heavy bleeding may happen. If indeed it does, contact your ENT specialist on an urgent basis. In extremely rare cases, a blood transfusion with packed red blood cells may become necessary.
• Infection: The possibilities of an infection are alive, as with all surgeries.
• Toxic shock syndrome: After the surgery as well as after release, it is advisable to keep a watch over the patient’s BP, heartbeats, signs of fever, any discolouration or any other unusual symptoms. These are associated with toxic shock syndrome which is a rare, life threatening infection. Seek immediate treatment if these symptoms occur.
• Tooth and nose numbness: A few nerves connect to the gums, front teeth and upper jaw through the nose. There may be some numbness in the event of damage or compression to these nerves from septoplasty surgery. The situation lasts for a few months and heals on its own.
• Septal perforation: If there is any postoperative infection, or, even otherwise, a small hole in the nasal septum may occur. Bleeding or any such complication arising in association with such a hole, may require further surgery. Connect to the ENT surgeon immediately as such an incident is noticed.
• Spinal fluid leak: In extremely rare cases, a septoplasty has been associated with an injury to the brain. This has created a leak of the brain and spinal cord nourishing fluid. Such fluid leak becomes a cause for imminent infection.
• Continuing symptoms: Despite a vast majority of septoplasty surgeries being totally successful, outside chance of symptoms recurring does remain in a miniscule percentage of cases where pre-existing symptoms return.
• Other: Persistent facial pain, swelling and bruising around the eye, vocal changes, visual defects, change in taste or smelling prowess etc. have been known to happen in some isolated instances of septoplasty.

Conditions to consult a doctor for septoplasty, if:-

• You have trouble breathing through your nose.
• You are unable to sleep well and often wake up while sleeping with a dry mouth.
• You get persistent headaches from morning and through the day, getting worse progressively.
• You have frequent nasal disorders like frequent sneezing, dripping nose and feeling of coldness.
• You have nasal bleeding.

After a septoplasty procedure, call the doctor or surgeon if you have:-

• Any trouble in breathing.
• Heavy bleeding from your nose which is not being controlled.
• Nasal pain that gets worse even after use and application of medications.
• High fever accompanied by chillness.
• Headaches.
• Any feeling of disorientation.
• Stiffness of the neck.

Septoplasty is an extremely safe surgery. However, as with any other surgery, some risks remain. Risks include bleeding and infection. The anaesthetic used may cause an adverse reaction. In rare cases, symptoms like nasal obstruction, inability for regular breathing etc. may continue.

You need septoplasty to relieve you of all symptoms associated with a crooked or deviated septum, like:-

• Sleep apnoea and lack of sleep.
• Persistent headaches that become unbearable.
• Recurring chronic nasal disorders.
• Bleeding from the nose.
• Issues with breathing normally.

The success rate for septoplasty is very high, ranging between 85 to 90 per cent across most countries. Most patients have reported significant improvement in nasal breathing within a fortnight of their septoplasty surgery, curing their symptoms from a badly deviated septum.

Septoplasty surgery cost in India varies from Rs. 35,000/- to Rs. 60,000/-. The variation depends not only on the cost of living of the city where the treatment is being done, but also varies based on the severity of the condition, its necessary treatment, need for any additional surgical procedures (e.g. rhinoplasty i.e. reshaping of the nose) required, etc.

For information on septoplasty with comprehensive guidance, pre and post surgery care and expert surgery at reasonable cost get in touch with Pristyn Care.

As preparation for septoplasty, your surgeon is expected to meet and discuss the risks and benefits of the surgery with you. As per practice, your discussions are expected to cover:

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• Your medical history. Your doctor will need to know about your current medical conditions. He will also seek information on your previous conditions. Your on-going medications or supplements will require listing out.
• A physical examination. A complete physical examination will be done. Your skin, and the your nose, externally and internally, are likely to be examined. Additionally few blood tests, an X-Ray and ECG would form part of the protocol.
• Photographs. Your nose may be photographed from different angles. These are for reference during the surgical procedure as well as after the surgery.
• A discussion of your expectations. You are likely to be explained possibilities through septoplasty and its limitations. The risks involved are also generally explained and your expectations too are discussed.
• You are likely to be advised for temporary discontinuation of some medicines, especially the blood thinners.
• You would be informed to remain without any food or drink for a certain period of time before your surgery.
• Smoking, alcohol etc. would be prohibited for a few days prior to surgery.

There are no restrictions for your normal diet with septoplasty. If you encounter an upset stomach, plain rice, broiled chicken, toast, plain curd and such bland, low-fat foods are advised.

After surgery irregularity in bowel movement is common. To avoid constipation and straining with bowel movements, include plenty of fluids, fleshy fruits and fibrous food in your diet.

Foods and drinks to avoid after septoplasty surgery are:-

• Hot and spicy foods. Such foods induce nose irritation and sinuses, hindering recovery through increased swelling and build-up in fluid.
• Foods that are prone to irritating tissues are strictly to be avoided.
• Alcoholic beverages.
• Caffeinated drinks, e.g. coffee or soda.
• Alcohol. Being a blood thinner alcohol induces risk of post-surgery bleeding.
• Any other food that may develop colds and induce sneezing, running nose etc. This tolerance factor of the individual to cold drinks, ice cream etc. matters in this.

A septoplasty procedure is usually an outpatient one. Septoplasty procedure consumes about 30 to 90 minutes and septoplasty recovery is quite fast. Most patients are discharged and leave for home on the surgery day itself. Septoplasty recovery time in terms of swelling is about two to three days, and complete recovery usually happens in about three months.

Septoplasty is the only permanent solution for a deviated or crooked septum. All other measures may usher some relief, but those are strictly temporary with all symptoms returning after some time. The cartilaginous septum continues to grow up to the age of about 16-17 years. Septoplasty done at ages lower to this, may see re-deviation happen to the cartilage due to its growth with age. Hence, septoplasty for permanent relief is best done after the age of 17.

• Avoid blowing your nose for about 2–3 days.
• Refrain from consumption of alcohol until completely healed.
• No smoking.
• Do not resume work too soon, follow the advice of your doctor.
• Avoid getting into or moving with crowds. You run every chance of falling sick exposing yourself to areas where you are likely to encounter cigarette smoke as well as many individuals who may be having colds and / or coughs.

• Septal haematoma is one of the side effects of septoplasty surgery. Septal haematoma occurs when the bleeding happens below the mucoperichondrium. Its remedy is through drainage or aspiration. Drainage prevents the chance of the development of a septal perforation.
• Perforations may also happen. This is due to bilateral, opposing mucosal perforations inadvertently happening during the process of surgery. A saddle nose, which is a loss of height of the nose due to collapse of the nasal bridge, may develop in the event of a perforation approaching the keystone area. Correction requires surgery to revise the situation.
• Spinal fluid leakage is a very rare risk in septoplasty. Spinal fluid leakage occurs when the top of the septum, which is in close proximity to the skull and brain and surrounded by protective cerebrospinal fluid, leaks. Under such a rare occurrence, infection can result. Meningitis, a serious condition of inflammation of membranes surrounding the brain and spinal cord may result.
• Hyposmia, or the loss of ability to smell, may develop in some cases. This usually resolves by itself over a period of time, usually about six months or so.
• There may be some instances of intranasal adhesion. Generally, using splints made of elastomeric silicone substantially reduces any risk of this side-effect.
• Numbness or sensitivity of the upper teeth or lip are reported in some cases. This is attributed to the manipulation of the nasopalatine nerve in the process of the operation. The nasopalatine nerve is a terminal branch of the maxillary nerve. This nerve is in the nasal cavity, running from it through the incisive canal. The numbness or sensitivity is mostly short-lived. Your normal sensation gets restored in a few months.

Septoplasty surgery is a very frequently done and most common of all ENT procedures. It is a safe procedure with extremely favourable long term outcomes reported in a vast majority of patients. Cure has given permanent relief from septal deviation causing obstructive symptoms in patients. Septoplasty, whether through an endonasal procedure, or endoscopic septoplasty done with a zero degree Hopkins rod endoscope used instead of the nasal speculum with a headlight in the endonasal method and complex septum deviation difficulties where extraction of the entire septal cartilage needs removal and correction, have all produced excellent results. It will continue to play its stellar role in the cure for septum deviation or crookedness causing obstruction to flow of air through the nose.