Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon
Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

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Septoplasty and Turbinate Surgery

Deviation of the cartilage and bone of the septum, which divides the nasal airway into two channels, can cause obstruction and may occur after previous injury.  The very thin bony plates may have been fractured at the time of the injury and also it is possible for the cartilage to eventually grow sideways due to damage to the covering layer of mucoperichondrium, which provides nutrition to the cartilage.

The turbinates are a series of structures on the lateral wall, of the nose which normally warm, moisten and anti-humidify the air but may become larger than usual.  They consist of fleshy erectile tissue on small scroll bones (conchae) which can swell with either allergic or “vasomotor” rhinitis and block the nose.  Sometimes they are so large (hypertrophic) that they produce significant nasal obstruction.=

Septoplasty is an operation to straighten the nasal septum and this is approached by an incision on the inside of the nose under general anaesthesia.  The dissection enables the cartilage to be straightened by removing small portions of the most deviated parts of cartilage and bone.  It is closed with dissolving sutures and dressings or packs usually need to be inserted in the nose at the end of the procedure.  Typically, dissolving dressings are used, avoiding the need for uncomfortable dressing removal post-operatively.  If packs do need to be sited these are usually removed after a few hours or the following morning.

The turbinates may be reduced in size by various procedures including outfracture, submucosal reduction and trimming.  Cautery and diathermy procedures can also be used to reduce their size to attempt to improve nasal airflow; sometimes this may also be done for excessive rhinorrhoea (watery running of the nose).  Similarly dressings, or packs, may be required as above either for a few hours or overnight.  These will completely block the nose (immediately apparent on waking up) and may cause a little eye watering whilst they are in place.

The removal of nasal packs or dressings is a little uncomfortable – the use of dissolving dressings – if possible – avoids this.  Immediately after removal the nasal airway should be better but very soon afterwards it may become blocked again due to swelling of the interior of the nose.  Generally it can take up to 6 weeks to gain the full benefit of the operation in terms of airway improvement.  The tenderness and discomfort of the nose after the surgery varies considerably, depending on the extent of dissection required, but is usually controllable by simple analgesics.

Troublesome post-operative bleeding can occur, even with dressings in the nose, which can sometimes necessitate repacking or a return to theatre prior to discharge home.  It is also possible to develop “secondary” bleeding 7 – 10 days after the operation which can require reattendance to hospital or an Emergency Department.  The nose is also quite wet and oozy anyway after such procedures, although this usually improves after a few days.

With a septoplasty procedure there is a very small risk of a slight change in shape of the nose, although this is unlikely unless surgery is very extensive.

It is occasionally possible to develop anosmia – loss of sense of smell – (which can also contribute to ageusia – a loss of taste), after the operation which usually settles over one to two weeks, as does any taste problem in most cases.

Also occasionally, when the bony deviation is most pronounced along the floor of the nose, requiring extensive dissection in this area, it is possible to develop slight numbness affecting the upper two incisor teeth due to bruising of the anterior superior alveolar nerves, which travel along the floor of the maxilla to supply sensation to part of the upper lip and dentition.  This generally settles after a few days.

Occasionally the improvement in airway may not be as great as expected and, particularly in the case of turbinate surgery, may not be a permanent cure if the underlying allergy persists.  It may also be necessary to use further drops and sprays post-operatively to augment the benefit from the operation.

Very rarely it is possible that the septum will heal leaving a small perforation (hole) in the middle of the nose internally.  This is not visible externally and often produces no problems but sometimes can produce crusting.  Very rarely an infection or abscess can form which can cause further loss of the septal cartilage: this can result in a depression in the shape of the nose which may require future corrections by a small graft of cartilage.  Sometimes adhesions may develop, when tissue grows between the medial and lateral nasal walls, which require division in the clinic or even further surgical correction.

After discharge it is advisable to take at least one week off work and attempt to rest indoors for at least the first 3 to 5 days, avoid touching the nose, smoky atmospheres and exposure to people with colds.  Sneezing should be done with the mouth open!

Nasal drops or douches are frequently prescribed, along with an antibacterial nasal ointment or cream, all of which may help to optimise the final result.  Vaseline can also be useful if there is persisting dryness or sensitivity.

Rarely there may be recurrence of an obstructive problem due to further deviation of the nasal septum or regrowth of obstructive turbinate tissue, or adhesions, which may require further management, sometimes surgical!