Sleep Apnea Treatment
Septoplasty
The nasal septum is the partition that divides one side of the nose from the other. It is rarely perfectly straight--it is slightly crooked in some of the people. When the septum is deviated enough it may block the nasal passage, causing difficulty breathing, congestion, snoring, obstructive sleep apnea, or chronic sinusitis. The nasal septum can be deviated as a result of nasal trauma or congenital.
Septoplasty is the procedure that straightens the nasal septum by repositioning the cartilage, trimming bones or cartilage, or by building up certain areas using a cartilage graft. Septoplasty can be preformed as a combined procedure with rhionplasty in patients whom have a deviated nasal septum and the nasal deformity called Septorhioplasty. Septoplasty may also be preformed together with nasal turbinectomies in patients with symptoms of blocked nasal air passage caused by deviated nasal septum and hypertrophied turbinates. Please see turbinectomies for further information.
Patients with obstructive sleep apnea whom have deviated nasal septum or enlarged turbinates will require setoplasty and/or turbinectomy reduction so they may use their CPAP machine.
Septoplasty is preformed in the Operating Room under general anesthesia or sedation. This is an out patient procedure unless the patient has severe medical problems that require monitoring over night. Following surgery, soft silicone splints are placed inside each nostril to support the septum. The nose may also be packed with cotton to prevent bleeding. The doctor usually removes the splints and cotton packs two to five days after surgery. To further decrease the chances of bleeding and swelling, follow these precautions for several weeks after surgery:
- Avoid strenuous activities, such as aerobics and jogging.
- Don't blow your nose.
- Brush your teeth gently to limit movement of your upper lip.
- Wear clothes that fasten in the front; don't pull clothing, such as shirts or sweaters, over your head.
Patients are seen in the office for multiple follow up visits after surgery. Patients will need anywhere between 3 to 7 days recovery time prior to returning back to work.
As with any major surgery, septoplasty carries risks, such as infection and an adverse reaction to the anesthesia.
Complications of Septoplasty
- It is possible that your airway will not improve.
- Some swelling of the external nose or change in the external appearance is possible.
- A septal perforation (hole in the septum that connects the two sides of the nose) may occur. A septal perforation may be associated with a whistling sound, bleeding, and/or crusting. A severe septal perforation may alter the shape of the external nose. Septal perforations are rare complications of septal surgery.
- Numbness of the tip of the nose or the upper front teeth is not uncommon and usually resolves within several months following the procedure. Rarely, the numbness may persist.
- Bleeding of any significant amount is uncommon. Patients, who are undergoing nasal surgery should discontinue aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs, such as Motrin, Advil, ibuprofen, etc.) 10 days prior to surgery, since these medications can produce bleeding.
- Septal hematoma occurs when bleeding persists underneath the skin flaps of the septum. This must be recognized within 24 hours and drained in order to prevent later saddling of the nose. This is a rare complication.
- Infection is uncommon but can occur. If nasal packing has been used and the patient develops a rash and a high fever, then the patient must immediately contact his or her physician because of the possibility of toxic shock syndrome. This is a very rare complication.
- Loss of smell has been reported following septoplasty but is quite rare.
Additional surgery may be required to treat some of these complications or if the outcome of the surgery doesn't match your expectations. Talk to the doctor about your specific risks before surgery. Though results are permanent, cartilage and tissue may gradually move or reshape over time. Because of the slow healing process, final results may not be evident up to a year after surgery. Most people find that septoplasty improves their signs and symptoms, such as nosebleeds and nasal obstruction, caused by a deviated septum. The level of improvement you can expect with septoplasty, however, depends on the severity of your deviation and your desired outcome. Some people find that their symptoms continue even after surgery and opt to undergo a revision septoplasty to further refine the nose and septum.