Broward Head Neck & Facial Plastic Surgery 220 S.W. 84 th Ave Suite 203 Plantation, Florida 33324 954.474.0243
Septoplasty and turbinate surgery
The following information is designed to help you understand the problems that have been diagnosed which are causing difficulty with your nasal respiration. Nasal respiratory problems frequently cause patients to breathe through their mouth and to develop dryness in the throat. This is often most noticeable at night time when you are lying down. This is because the veins located within the nose do not have any valves which retard the flow of blood into their tissue; therefore, the tissues within the nose swell, that is fill with blood when you are laying down. This swelling of the tissue contributes to the nasal obstruction. Generally this swelling primarily involves the turbinates but can also involve the nasal septum.
Additional causes of nasal obstruction can be due to allergy problems. Most patients with allergy problems will have some of the following symptoms: watery nasal discharge, sneezing, frequent throat clearing to remove mucous causing a sensation of something stuck in the throat, teary eyes, scratchy throat, chronic cough and possibly skin problems. Patients may also experience headaches and pressure in the sinus areas. In general, if you've used over-the-counter sinus medication and had significant relief of your symptoms, it is likely that you do have some element of allergies. Patients who have tried these medications and had little or no response or who do not like the use of these medications may be candidates for nasal surgery to correct their nasal respiratory obstruction.
Why correct nasal obstruction in the first place?
Studies have shown that the effectiveness of nasal breathing is greater and more efficient than breathing through the mouth. First, oral breathing done on a regular basis often dries the throat, creating discomfort and a sore throat. Second, nasal breathing is far more efficient because nasal respiration allows the following to occur; filtration of the air with removal of dust, particulate matter, allergic substances as well as bacteria, viruses and fungi which are found in the air. This removal does help your body develop immunity because these removed products are presented to the immune system, and this allows your system to develop immunity. Third, the nose provides resistance to air flow which is generally matched with the lung pressures in order to help the lung open and expand properly. Fourth, the nose is designed to humidify air with great efficiency. Fifth, the nose provides proper resonance of the voice; voice quality is thus affected by constant nasal congestion and obstruction.
What can be done to correct the nasal obstruction that you are experiencing?
In general, you have probably been prescribed a series of either decongestants, antihistamines, nasal sprays or had other evaluations to try and treat causes of your nasal congestion. It may be that you cannot tolerate medications to help improve your breathing because of medical problems or because you do not like medications due to reactions or the fear of chronic medication usage. In these situations, if you desire improvement in your nasal respiration and breathing, surgery can offer you an excellent opportunity to improve breathing.
The septum is the partition or structure which separates the two halves of your nose. Many times this structure is twisted or deviated to one side or another or possibly to both sides. This causes increased resistance to nasal breathing which causes a sense of obstruction. In addition, the turbinates, which are humidifiers located inside the nose, can often be enlarged and obstructing air flow. Surgery to correct the nasal breathing addresses both the septum and the turbinates. Occasionally, only septal work is necessary, but most of the time a combination is required. To fix the septum and straighten it as much as possible, one must preserve the strength and integrity of the septum or else the appearance of the nose can change. Through years of training and surgical experience I have developed techniques which are very safe, reliable and reproducible to obtain improvement in nasal respiration. In general 95 percent of the patients who undertake septal and turbinate surgery to correct nasal obstruction will have improvement in nasal respiration.
The septum is accessed through a small incision inside the nose that is not seen by other individuals. Sutures are used to close this incision at the end of the surgery. Through this small incision the entire length of the septum can be evaluated and corrected as necessary. A variety of techniques are performed to ensure correction of the septum. It would be unfair and unrealistic to expect every crooked septum to be perfectly straight after surgery. Indeed, there is memory or a tendency of the septal cartilage to try to return to its previous state. However, use of reinforcing sutures, methods of weakening and then repositioning the septum are available, which significantly improve the overall configuration and placement of the septum so that you achieve improvement in your breathing.
At the time when septal surgery is performed, it is generally necessary to address the turbinates. These humidifiers travel the full length of your nose. They are long fingerlike structures, and in certain instances can be moved towards the side of the nose so that more breathing space is created in the middle of the nose. Sometimes the turbinate tissue will be trimmed, or an electrical current will be passed over the tissue to remove some of the excess tissue. This is particularly useful in patients with allergic problems, who have large turbinates blocking their breathing. This tissue heals slowly and requires local care after the surgery, this will be taken care of in the office and by administration of saline sprays after surgery.
Generally, the first night after surgery a packing of telfa gauze coated internally and externally with antibiotic ointments is utilized to reduce bleeding and nasal discharge. This packing is loosely tied over the front of the nose with a black silk suture. You'll be asked to remove this packing the first or second day after surgery. There will be some resistance on initially pulling the packing and then the packing can easily be removed. Local care will then commence using saline sprays.
What are the risks involved in septal and turbinate surgery?
First, most patients will experience some mild or occasionally moderate pain from the surgery. This is generally short-lived, lasting only a few days and perhaps up to one week. Second, there will be crusting and discharge which is created from the internal work on the nose. This takes approximately one or two weeks to resolve and sometimes if extensive turbinate work is done, may take four or six weeks to resolve. To help reduce this, patients are asked to use saline or saltwater spray in the nose after surgery. Third, occasionally patients will have light bleeding after the surgery. In most cases the bleeding is minor and can be controlled by using saline spray and Afrin spray. Occasionally a patient will have to return to the office for control of the bleeding and rarely go to the operating room for control of this postoperative bleeding. Fourth, occasionally scar tissue or scar bands will form inside the nose. These are really very minor problems and can easily be taken care of in the office. Fifth, most patients will experience congestion, pressure and headaches during the healing phase. This can last from days to several weeks after surgery. Each patient heals at a different rate which affects how long this will last. Sixth, because a portion of the septum sits above the teeth you may have some tenderness or change in the sensation of your front or incisor teeth. Generally normal sensation will return over a matter of weeks in to months as the nerves return to the old area. Occasionally, there will be some pain in that area which may require some anti-inflammatory or aspirin like medications. Seventh, rarely a small hole or perforation will developed in the septum from the surgery. This is unlikely with the techniques that I use and the care which is taken to ensure that a good blood supply remains in the nose. There are other more serious complications which can occur with septal surgery but these are so rare and unusual that I do not discuss them here. I would recommend that, if you are concerned or interested in knowing even more details than have been presented regarding this surgery, that you talk to me and I will inform you of these remote and unlikely complications.
Stephen E. Guilder M.D.
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