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Steven Y Park, MD  
Male, 46
New York, NY

Specialties: Sleep-breathing disorders

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An Insider’s Guide to Septoplasty

Apr 21, 2010 - 12 comments
Tags:

Nasal congestion

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turbinate surgery

,

nasal packing

,

Septoplasty



The septoplasty operation is one of the most misunderstood surgical procedures that lay people, and even many physicians have. Some people even equate septoplasty with having a nose job, which is not true. Although, some people use having a crooked septum as an excuse to undergo a rhinoplasty, septoplasty, done correctly, can help patients breathe better, and more importantly, sleep better.

Understanding the Anatomy

In order to fully appreciate if septoplasty is the right procedure for you, you must understand the anatomy of how it’s done. The nasal septum is the midline cartilaginous structure that divides the two halves of your nasal cavity. The part in the back of the septum is made of bone. Whenever the septum is crooked to a significant degree, your nose can be stuffy, and a septoplasty can be offered if medical therapy doesn't work.

However, having a crooked septum doesn't mean that you'll have a stuffy nose, or that you'll need a septoplasty. No one has a perfectly straight septum. There are other parts of your nasal anatomy that contributes to your ability to breathe, which includes your nasal turbinates and your nostrils. The turbinates are wing-like structures that jut in from the side-walls of your nose that look like wings. They normally warm, filter, smooth and humidify the air that you breathe. Inside this structure is the bone and the outside is a mucous membrane lining. The middle part is made of very vascular tissues that can swell tremendously when filled with blood. This is regulated by your involuntary nervous system. This nervous system normally swells and shrinks the turbinates, alternating from side to side, every few hours (called the nasal cycle).

Do You Have Flimsy Nostrils?

The other structure that is often overlooked is your nostrils. For most people, breathing in causes a mild vacuum effect that causes a mild collapse and a constriction of the nostrils. But in some people with either flimsy or weakened nostrils (from a prior rhinoplasty), they collapse very easily, even with a slight bit of inspiration. If you are one of these people, you may benefit from nasal dilator strips (Breathe-rite is one brand). Sometimes these strips are not strong enough, or it can irritate the skin. Another option is to use internal nasal dilators which work much better. Some of the more common brands are Breathewitheez, Nasal Cones, and Nozovent.

What's Involved with Septal Surgery?

The septoplasty procedure can be done in conjunction with a turbinate procedure. There are many ways to perform a septoplasty, but the most important point is that it should be done well. The septum is covered on both sides by a mucous membrane. After an incision is made inside the nose on the mucous membrane, this layer is peeled away from the septal cartilage. The other side is also entered, which creates two tunnels on either side of the septal cartilage. The crooked part of the septal cartilage is next removed. Some surgeons either soften the cartilage or flatten it out and place it back, and others leave it out completely. In many cases, a small portion of bony spur that juts out at the base of the septal cartilage is also removed. The last part of the operation is where different surgeons use different techniques. Traditionally, thin plastic sheets with or without soft sponge-like packs are placed against the septum on both sides to keep the mucous membrane together for proper healing. If a large clot of blood forms between the two mucous membrane layers, the remaining cartilage may lose it's blood supply and literally melt away.
Because the entire procedure in done inside the nose (or endoscopically), there is no swelling, bruising or changes to the outside of the nose or face (unless a rhinoplasty is done simultaneously).

What to Expect After Surgery

Nasal packing, if placed, are removed anywhere from 1-3 days after the procedure. Many patients report that this is one of the most uncomfortable parts of undergoing this procedure. Some surgeons, like myself, don't use any packs or splints using the following method: compressing the two mucous membrane layers by sewing the two layers together using an absorbable suture, like a quilting stitch. This way, nothing needs to be removed, and you're breathing much better right after the surgery. It's expected with this procedure that your nose will get clogged up after a day or two with accumulation of blood, mucous and debris.

This operation is usually performed as an outpatient procedure, so you'll go home a few hours after surgery. It's usually performed under general anesthesia, but can also de done under local anesthesia with sedation for certain situations. Most people can go back to work after a day or two. Heavy straining or lifting should be restricted for about one week. In my practice, I see the patients about 2 days after the surgery, when the nose is cleaned of all the accumulated debris. Some people need a second cleaning 1-2 weeks later.

Typically, it may take a few weeks to months to feel the full benefits of this operation. During the first few weeks, crusts will build up and fall out as wounds heal. This is also the time when the swelling from the surgery goes away. Afterwards, scarring and tightening of the soft tissues can take weeks to months. You may have your ups and downs in the first few weeks, but you should see consistent improvement by 3-4 weeks.

Most people don't use any pain medications, but one is prescribed just in case. You'll probably be more bothered by the sore throat from having a breathing tube placed during intubation.

What Are The Risks?

Complications are rare, but with any surgical procedure, there is a small chance of infection or bleeding. There is also a small risk any time someone undergoes general anesthesia, which includes, allergic or medication reactions or airway problems. In terms of overall risk, it's riskier when you cross the street. Other very rare complications such as smell loss or a hole in your septum have been reported.

A septoplasty, if done properly, is one of the most gratifying procedures for both the patient and the surgeon. Success rates are very high. However, there are a few percent of patients where nasal congestion still persists, or it comes back after a few weeks to months. In this situation, there are two main possible reasons: there is persistent turbinate swelling due to inflammation, or you have flimsy nostrils. There are treatment options for both theses conditions.

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by Tammy2009, Apr 22, 2010
Thanks for the information ... I get this done in June so hopefully my breathing will improve enough to stop the mouth breathing at night (and thus improve the asthma) and stop the need for Nasacort.  

Will I honestly only need a couple of days off of work?  I have been told I should get 2 weeks off because it hurts a lot but I can't see me needing that.  I work at a pet store so I could get away without lifting food or putting away stock and would just need to walk around and help customers, so a lot of talking.  I only been suggested 2-3 weeks off work for my jaw surgery next year so a couple of days for septoplasty seems more reasonable.  However, I am also getting my tunbinates reduced as well.

I can't wait ... I'm really hoping it helps the sleeping so I don't crash for 3 hours in the afternoon after sleeping 10-11 hours at night.  It has been nearly impossible to study for exams with that, I need more hours in the day!




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by Kaz23888, Apr 24, 2010
I had this operation done. I couldnt breathe at all from my nose a few months ago. I did it, nothing changed!! But what happened is that I went for scans and angio-MRI, which showed that i had a juvenile angiofibroma!
Septoplasty isnt painful, but expect headache the first couple of days, and when the packing is removed, YOU WILL THANK THE SURGEON TILL YOU DIE!!

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by mammo, May 08, 2010
My husband had septoplasty 4 days ago.  Just a few hours after sugery the gauze was removed from under his nose which was to absorb any blood.  He has disolvable packing in one nostril, and has been breathing very well out of the nostril that was giving him all the problems prior to surgery.  He's had no pain, just some tenderness if touching his nose, some seeping, and very little bleeding.  He was making business calls from the recovery room. He rested the day of his surgery but has been out and about ever since.  He was scared to have this surgery, not sure why, and now he laughs as it was really nothing and appears to have been well worth it.  Since his packing is dissolving on it's own, he doesn't have to endure the removal of any packing.

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by abby51, May 09, 2010
I had septoplasty surgery about 5 years ago and while it helped me to breathe better, I would not do it again, and thank goodness will not have to. I had to have major septal repair (it was basically laying flat at one part) and repair of vestibular stenosis . I was vomiting blood, had to miss a week of work, the packing got stuck in my nose and had to be cut out, and the dissolvable stitches did not dissolve. None of this was the fault of the surgeon and, in fact, I was very pleased with the surgeon and the final results. I do not think the problems I had are the normal.


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by Momoftyntrev, May 30, 2010
I had septoplasty and turbinate reduction on May 5th, along with a tonsilectomy.  Because of having both operations, the dr. kept me overnight at the hospital and I am thankful that she did, as it was nice to have people taking care of me since I was in a lot of pain.  It is a little over 3 wks. later and I am only breathing a little better, so I hope that it gets better w/ time.  The surgeon I had was great and she explained everything to me.  Once the stints were removed, my surgeon told me to clean inside my nose w/ half water, half peroxide w/ qtips to clean the crusty stuff off and that helped a lot.  Also, bought  a  bottle of Ocean nasal spray and sprayed it in my nose every couple hours for the  next couple days and that helped keep my nose clear as well.  Got really sick of jello and ice cream, as that was all I could have for the 1st 2 wks. because of the throat pain I endured from the tonsilectomy.  One thing, I had a lot of pain in my ears when I swallowed and the doctor gave me a prescripton for Celebrex.  I took the rx at noon and by 2:00, the pain in my ears was gone.  I only had to take that for 4 days and the pain went away completely!  I was told that the ear pain was caused from the tonsilectomy.

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by Shawmiester, Nov 10, 2010
I am trying to schedule a septoplasty and turbinate reduction (I'm waiting for insurance approval) and have read several comments from people who have stopped up noses after the surgery.  One of the main reasons that I have put this surgery off until now is because I have severe anxiety whenever my nose is stopped up and could not bear it if I had packing or a splint affecting my breathing through my nose.  My doctor said there would be no packing and that the stint he uses has a built in airway so that I should breathe better immediately after the operation than I have in years.  He did say that this airway could become clogged but could easily be cleared by him.  I am wondering about all these posting that I have seen from people who have had their nose clog up after having their splints removed?  If I can breathe with the splints in is there still the possibility that there will be swelling (that could limit my nose breathing) after they are removed?  If so is there anything I could do to help it like decongestants or Afrin?

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by Steven Y Park, MDBlank, Nov 11, 2010
Shawmeister,

Having a bit of congestion is possible after any type of nasal surgery. Vigorous use of nasal saline and occasional use of Afrin typically gets my patients through. Since I don't use splints or packing, my experience may be different.

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by peter476, Apr 03, 2011
Steven

My own procedure was a septoplasty and a turbinoplasty and my surgeon did not use splints - his technique seems very similar to yours.  I agree that the operation is worthwhile, however I do think you need to provide a greater range of recovery times.  In my own case I had an overnight stay in hospital which was very useful, as I had a lot of bleeding from my nose and at one pont I I had an ice-pack on my neck and on my head.  While  my wife could also have applied ice-packs it was much less alarming being in a hospital overnight, even if it did cost us some more money.  My wife and I would have been really worried with the amount of bleeding that occurred if we had been at home.

My progress was one overnight stay at the hospital and then the following day in bed at home having to breathe completely through my mouth and in a lot of discomfort only able to sleep or lie on my back with my head elevated.  I was completely plugged up for about two days which made swallowing quite difficult.  I recommend yoghurt and ice-cream and lemonade ice-blocks, these all lower your temperature which is good for coagulating the bood and also feels nice. I also ate peppermint chocolates which tasted nice and made the blood and mucus that was going down my throat break up.  I've also cautiosly used the NeilMed saline solution; I found I needed to be quite careful as when I used it vigourously I caused sharp pain in one of my ears.  Fortunately the pain went away, but after that I was very careful.

In my case I will take 5 days off work plus 2 days for the weekend, although I expect to work from home for half-mornings on the last two days. At the moment I'm on the 4th day, and still have quite a bit of blood and mucus coming from my nose, although every day is better than the previous day.   I would recommend to people that .they plan  this amount of time off work and then if they beat it, they are well off.  A colleague of mine at work has also had this surgery and his experience was almost identical to mine - 7 days at home having a very quiet time before coming back to work.

I expect to get a lot of relief from this operation and I do not regret the time, money and pain- but I would recommend to anyone reading this that they expect the above and plan for it,  It's not fun, but then worthwhile things are often tough.  Thanks for your blog on Septoplastys - your description of the procedure is very clear and accurate.  It's good to have this level of patient information.

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by parton, Jan 05, 2012
Hello, I was so glad to find this site!
My daughter, l7 years old,  in Oct 2011 had turbinectomy, bilateral, plus repair of septal deviation following lifelong nasal congestion which impaired her speech therapy, as she also had oral motor speech disorder (she lacked proprioception of her tongue and had decreased neural sensation around her mouth, was in 3rd percentile of speech problems).  They said she needed better airway opening before anything further could be done to improve her speech. I stalled since she was 5 years old and they recommended this.  SInce she had surgery she has had frequent sore throats, one incident of strep throat, post nasal drip occasionally bloody, one sinus infection, and no improvement in her breathing.  She has been on antibiotics for the sinus infection,strep throat, and an unrelated medical issue since the surgery, and today is missing school again for a bad sore throat.  She has her tonsils but her adenoids were takenout.  She previously had allergy testing which was negative for all environmental substances and positive only for food sensitivities not allergies-though as a teen she has refused to try dietary changes.  She is missing more school now than prior to the surgery.  We see the ENT again for follow up next week,we wonder if you have any suggestions for us prior to that appointment.  Thank you so much.  Frustrated mother.  

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by CC3233, May 26, 2012
I too had a septoplasty and turbinoplasty done. The first day or two was the worst. No pain, just a little soreness, breathing through your mouth is a little annoying, hoarseness and the bloody drainage is gross. However, I'm now day 4 post-op and the hoarseness is better and the bleeding is getting less and less. I can now eat some grilled fish with steamed veggies. Anything that's soft feels great! I have been staying away from milk products these past few days due to producing phlegm already. I have no packing in my nose, however I've been wearing a gauze drip pad in a small nose sling to keep it in place. Sleep hasn't been too bad. I do wake up a few times throughout  the night to drink a swig of water due to dry mouth. The few headaches that I had are slowly subsiding.

I do recommend someone help you with childcare the first week, stay elevated to help with swelling and drainage. I also took some arnica pills to help heal faster and I've been keeping my lips moist with a chap stick due to dryness. And lastly take your cat naps and keep yourself busy. Whether it's watching your favorite programs, reading or browsing the web it'll help pass the healing time much more quickly. Hang in there because all of this is just temporary. Keep your eye on the end results soon!!!

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by CC3233, May 26, 2012
I also wanted to add that it's best to keep up on the nausea and pain meds the first 3-4 days. That way you're ahead of the game already. And if you start
To feel light headed make sure you eat something more hardy such as scrambled eggs with a piece of buttered toast, soft veggies, cut up banana, etc. after I started
Eating more on day 2 I was no longer dizzy or light headed. It's really going to be worth it! Good Luck :)

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by kev812, Dec 15, 2012
I just had septopasty/ turbinate surgery 5 days ago. The first couple nights I could not sleep or fully empty bladder so awake every 15-20 min trying to go to bathroom. Has gotten much better over the last few days. I still am not sleeping straight through  the night but almost but it is because of major congestion in the nose. I have packing, splints in the nose and a cast on the outside just to protect the nose. I had a lot of work done as th e surgeons said it lokked like a bomb went off in my nose. I had it broken about 4 times when i was a teenager (over 20 years ago). My packing comes out in 4 more days. I cant wait.

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