Septoplasty

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Septoplasty
Septoplasty splints.jpg
Typical flexible splints that may be used in septoplasty. They are held in place in the nose with a stitch through the hole, and are typically removed seven to 10 days after surgery.
ICD-9-CM 21.5, 21.88
MedlinePlus 003012

Septoplasty [ˈsɛp.toˌplæ.sti] (Etymology: L, saeptum, septum; Gk, πλάσσειν plassein – to shape), or alternatively submucous septal resection and septal reconstruction, [1] is a corrective surgical procedure done to straighten a deviated nasal septum – the nasal septum being the partition between the two nasal cavities. [2] Ideally, the septum should run down the center of the nose. When it deviates into one of the cavities, it narrows that cavity and impedes airflow. Deviated nasal septum or “crooked” internal nose can occur at childbirth or as the result of an injury or other trauma. If the wall that functions as a separator of both sides of the nose is tilted towards one side at a degree greater than 50%, it might cause difficulty breathing. Often the inferior turbinate on the opposite side enlarges, which is termed compensatory hypertrophy . Deviations of the septum can lead to nasal obstruction. Most surgeries are completed in 60 minutes or less, while the recovery time could be up to several weeks. Put simply, septoplasty is a surgery that helps repair the passageways in the nose making it easier to breathe. This surgery is usually performed on patients with a deviated septum, recurrent rhinitis, or ossinus issues.

Latin Indo-European language of the Italic family

Latin is a classical language belonging to the Italic branch of the Indo-European languages. The Latin alphabet is derived from the Etruscan and Greek alphabets and ultimately from the Phoenician alphabet.

Ancient Greek Version of the Greek language used from roughly the 9th century BC to the 6th century AD

The ancient Greek language includes the forms of Greek used in Ancient Greece and the ancient world from around the 9th century BC to the 6th century AD. It is often roughly divided into the Archaic period, Classical period, and Hellenistic period. It is antedated in the second millennium BC by Mycenaean Greek and succeeded by Medieval Greek.

Surgery Medical specialty

Surgery is a medical specialty that uses operative manual and instrumental techniques on a patient to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function or appearance or to repair unwanted ruptured areas.

Contents

Procedure

Pieces removed from nasal cavities during septoplasty Deviasyon ameliyati.JPG
Pieces removed from nasal cavities during septoplasty

The procedure [3] usually involves a judicious excision/realignment of a portion of the bone and/or cartilage in the nasal cavity. Under general or local anesthesia, the surgeon works through the nostrils, making an incision in the lining of the septum to reach the cartilage/bone targeted in the operation. This may be performed using an endoscope or with open techniques. Sufficient cartilage and bone is preserved for structural support. After the septum is straightened, it may then be stabilized temporarily with small plastic tubes, splints, or sutures internally.

Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with reduced pain and distress. In many situations, such as cesarean section, it is safer and therefore superior to general anesthesia. It is also used for relief of non-surgical pain and to enable diagnosis of the cause of some chronic pain conditions. Anesthetists sometimes combine both general and local anesthesia techniques.

Indications

Apart from in patients with deviated nasal septum causing airway obstruction leading to difficulty with breathing, recurrent rhinitis, or sinusitis, septoplasty is done as an approach to hypophysectomy. It is sometimes done as well to cure recurrent nosebleed (epistaxis) due to septal spur.

Hypophysectomy is the surgical removal of the hypophysis. It is most commonly performed to treat tumors, especially craniopharyngioma tumors. Sometimes it is used to treat Cushing's syndrome due to pituitary adenoma. It is also applied in neurosciences to understand the functioning of hypophysis.

Contraindications

Septoplasty should not be done in acute nasal or sinus infection. It should also be avoided if the person has untreated diabetes, severe hypertension or bleeding diathesis. [4]

Diabetes a disease characterized by long-term high blood sugar

Diabetes mellitus (DM), commonly known as diabetes, is a group of metabolic disorders characterized by a high blood sugar level over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes.

Hypertension Long term medical condition

Hypertension, also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure typically does not cause symptoms. Long-term high blood pressure, however, is a major risk factor for coronary artery disease, stroke, heart failure, atrial fibrillation, peripheral arterial disease, vision loss, chronic kidney disease, and dementia.

In medicine (hematology), bleeding diathesis is an unusual susceptibility to bleed (hemorrhage) mostly due to hypocoagulability, in turn caused by a coagulopathy. Therefore, this may result in the reduction of platelets being produced and leads to excessive bleeding. Several types of coagulopathy are distinguished, ranging from mild to lethal. Coagulopathy can be caused by thinning of the skin, such that the skin is weakened and is bruised easily and frequently without any trauma or injury to the body. Also, coagulopathy can be contributed by impaired wound healing or impaired clot formation.

Post-operation

Unless there are unusual complications, there is no swelling or discoloration of the external nose or face with septoplasty alone. Packing is rare with modern surgical techniques, but splinting the inside of the nose for a few days is common; the splints are not visible externally. One percent of patients can experience excessive bleeding afterwards — the risk period lasts up to two weeks. This could require packing or cautery, but is generally handled safely and without compromise of the ultimate surgical result. Septal perforation and septal hematoma are possible, as is a decrease in the sense of smell. [5] Temporary numbness of the front upper teeth after surgery is common. [5] Sometimes the numbness extends to the upper jaw and the tip of the nose. This almost always resolves within several months.

Splint (medicine) medical restraint to keep body part in place

A splint is defined as “a rigid or flexible device that maintains in position a displaced or movable part; also used to keep in place and protect an injured part” or as “a rigid or flexible material used to protect, immobilize, or restrict motion in a part.” Splints can be used for injuries that are not severe enough to immobilize the entire injured structure of the body. For instance, a splint can be used for certain fractures, soft tissue sprains, tendon injuries, or injuries awaiting orthopedic treatment. A splint may be static, not allowing motion, or dynamic, allowing controlled motion. Splints can also be used to relieve pain in damaged joints. Splints are quick and easy to apply and do not require a plastering technique. Splints are often made out of some kind of flexible material and a firm pole-like structure for stability. They often buckle or Velcro together.

The nasal tissues should mostly stabilize within 3-6 months post-surgery, although shifting is still possible for up to and over a year afterwards. [6]

Complications of septoplasty

See also

Related Research Articles

Otorhinolaryngology study of ear, nose, and throat conditions

Otorhinolaryngology is a surgical subspecialty within medicine that deals with conditions of the ear, nose, and throat (ENT) and related structures of the head and neck. Doctors who specialize in this area are called otorhinolaryngologists, otolaryngologists, ENT doctors, ENT surgeons, or head and neck surgeons. Patients seek treatment from an otorhinolaryngologist for diseases of the ear, nose, throat, base of the skull, for the surgical management and reconstruction of cancers and benign tumors of the head and neck.

Nostril one of the two channels of the nose

A nostril is one of the two channels of the nose, from the point where they bifurcate to the external opening. In birds and mammals, they contain branched bones or cartilages called turbinates, whose function is to warm air on inhalation and remove moisture on exhalation. Fish do not breathe through their noses, but they do have two small holes used for smelling, which may, indeed, be called nostrils.

Rhinoplasty A surgical procedure to enhance or reconstruct a human nose.

Rhinoplasty, commonly known as a nose job, is a plastic surgery procedure for correcting and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that improves the appearance of the nose. Reconstructive surgery seeks to resolve nasal injuries caused by various traumas including blunt, and penetrating trauma and trauma caused by blast injury. Reconstructive surgery also treats birth defects, breathing problems, and failed primary rhinoplasties. Most patients ask to remove a bump, narrow nostril width, change the angle between the nose and the mouth, as well as correct injuries, birth defects, or other problems that affect breathing, such as deviated nasal septum or a sinus condition.

Nasal cavity

The nasal cavity is a large, air-filled space above and behind the nose in the middle of the face. The nasal septum divides the cavity into two fossae. Each fossa is the continuation of one of the two nostrils. The nasal cavity is the uppermost part of the respiratory system and provides the nasal passage for inhaled air from the nostrils to the nasopharynx and rest of the respiratory tract.

Nasal concha piece of bone in the breathing passage of humans and other animals

In anatomy, a nasal concha, plural conchae, also called a turbinate or turbinal, is a long, narrow, curled shelf of bone that protrudes into the breathing passage of the nose in humans and various animals. The conchae are shaped like an elongated seashell, which gave them their name. A concha is any of the scrolled spongy bones of the nasal passages in vertebrates.

Nosebleed bleeding from the nose

A nosebleed, also known as epistaxis, is the common occurrence of bleeding from the nose. It is usually noticed when blood drains out through the nostrils.

Nasal septum separator of the left and right airways in the nose

The nasal septum separates the left and right airways of the nasal cavity, dividing the two nostrils.

Nasal septum deviation physical disorder of the nose, involving a displacement of the nasal septum

Nasal septum deviation is a physical disorder of the nose, involving a displacement of the nasal septum. Some displacement is common, affecting 80% of people, mostly without their knowledge.

Nasal septum perforation nasal surgery

A nasal septum perforation is a medical condition in which the nasal septum, the bony/cartilaginous wall dividing the nasal cavities, develops a hole or fissure.

Flunisolide chemical compound

Flunisolide is a corticosteroid often prescribed as treatment for allergic rhinitis. Intranasal corticosteroids are the most effective medication for controlling symptoms.

Empty nose syndrome

Empty nose syndrome (ENS), one form of secondary atrophic rhinitis, is a clinical syndrome in which people who have clear nasal passages experience a range of symptoms, most commonly feelings of nasal obstruction, nasal dryness and crusting, and a sensation of being unable to breathe.

Chronic atrophic rhinitis, or atrophic rhinitis, is a chronic inflammation of nose characterised by atrophy of nasal mucosa, including the glands, turbinate bones and the nerve elements supplying the nose. Chronic atrophic rhinitis may be primary and secondary. Special forms of chronic atrophic rhinitis are rhinitis sicca anterior and ozaena.

Functional endoscopic sinus surgery

Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical treatment which uses nasal endoscopes to enlarge the nasal drainage pathways of the paranasal sinuses to improve sinus ventilation. This procedure is generally used to treat inflammatory and infectious sinus diseases, including chronic rhinosinusitis that doesn't respond to drugs, nasal polyps, some cancers, and decompression of eye sockets/optic nerve in Graves ophthalmopathy.

Human nose feature of the face

The human nose is the most protruding part of the face. It bears the nostrils and is the first organ of the respiratory system. It is also the principal organ in the olfactory system. The shape of the nose is determined by the nasal bones and the nasal cartilages, including the nasal septum which separates the nostrils and divides the nasal cavity into two. On average the nose of a male is larger than that of a female.

Nasal septal hematoma

Nasal septal hematoma is a condition affecting the nasal septum. It can be associated with trauma.

Concha bullosa

A concha bullosa is a pneumatized (air-filled) cavity within a nasal concha, also known as a turbinate. Bullosa refers to the air-filled cavity within the turbinate. It is a normal anatomic variant seen in up to half the population. Occasionally, a large concha bullosa may cause it to bulge sufficiently to obstruct the opening of an adjacent sinus, possibly leading to recurrent sinusitis. In such a case the turbinate can be reduced in size by endoscopic nasal surgery (turbinectomy). The presence of a concha bullosa is often associated with deviation of the nasal septum toward the opposite side of the nasal cavity. Although it is thought that sinusitis or sinus pathology has relation to concha bullosa, no strong statistical correlation has been demonstrated.

Nasal fracture

A nasal fracture, commonly referred to as a broken nose, is a fracture of one of the bones of the nose. Symptoms may include bleeding, swelling, bruising, and an inability to breathe through the nose. They may be complicated by other facial fractures or a septal hematoma.

Turbinectomy surgical procedure

Turbinectomy is a procedure in which some or all of the turbinate bones in the nasal passage are removed, generally to relieve nasal obstruction. In most cases, turbinate hypertrophy is accompanied by some septum deviation, so the surgery is done along with septoplasty.

Nasal septal abscess

Nasal septal abscess is a condition of the nasal septum in which there is a collection of pus between the mucoperichondrium and septal cartilage.

Nonallergic rhinitis is inflammation of the inner part of the nose that is not caused by an allergy. Nonallergic rhinitis involves symptoms including chronic sneezing or having a congested, drippy nose without an identified allergic reaction. Other common terms for nonallergic rhinitis are vasomotor rhinitis and perennial rhinitis. The prevalence of nonallergic rhinitis in otolaryngology is 40%. Allergic rhinitis is more common than nonallergic rhinitis; however, both conditions have similar presentation, manifestation and treatment. Nasal itching and paroxysmal sneezing are usually associated with nonallergic rhinitis in comparison to allergic rhinitis.

References

  1. "Repair of a Deviated Septum (Septoplasty) - Surgery Overview". WebMD. Retrieved 18 July 2015.
  2. Cf. "Septoplasty". Mediline Plus, U.S National Library of Medicine. Retrieved 29 June 2013.
  3. "Septoplasty". Mediline Plus, U.S National Library of Medicine. Retrieved 29 June 2013.
  4. Dhingra, P.L (2010). Diseases of the ear, nose and throat. New Delhi, India: Elsevier Publications. pp. 429–430.
  5. 1 2 "Septoplasty – Risks". Mayo Clinic. Retrieved 18 July 2015.
  6. "Septoplasty – Results". Mayo Clinic. Retrieved 18 July 2015.