FAQ on Septoplasty

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					                                                 FAQ's on Septoplasty
                                                   by Dr. Richard Orlandi

    Question                                                Response

                       The septum is a wall that divides the left nasal cavity from the right. Ideally it should
                       run down the middle of the nasal cavity but often it deviates to one side or the other.
                       This condition is called a “septal deviation” and can make breathing through the
                       nose difficult, either because of actual obstruction of flow, or because of the creation
                       of turbulent airflow, which slows the air movement. In these cases, a septal repair,
                       or “septoplasty,” is indicated.

                       The procedure is typically performed through the nose. An incision is made within
                       the nose and the lining is lifted off of the crooked cartilage and bone. These
                       structural elements are then straightened in a variety of ways and the lining is then
                       returned to its original place. Dissolvable stitches are used to keep the lining in
                       place during healing. Occasionally plastic splints may need to be placed temporarily
                       within the nose following surgery.

     What is a
                       In some severe deviations, or when other surgery is to be performed on the nose at
                       the same time, a small incision between the nostrils may be necessary. If an
                       external incision is to be made, your surgeon will specifically discuss this issue with

                       In some patients, other structures in the nose may contribute to the blockage of
                       airflow and your surgeon may advise that these be addressed as well. Occasionally,
                       shelf-like structures known as “turbinates” can be enlarged and block normal air
                       movement through the nose. The function of the turbinates is to increase the
                       surface area of the nose and to act like battens to direct air through the nose.
                       Surface area within the nose is important because the nose warms and humidifies
                       air and removes small particles before the air reaches the lungs. When the
                       turbinates are too large, however, they can disrupt air movement through the nose
                       and may therefore need to be reduced in size. Your surgeon will discuss with you
                       whether this is the case in your nose.

                       The goal of the surgery is to restore normal airflow through the nose. Deviated
   What are the        portions of the nasal septum will be straightened in order to remove blockages and
benefits of surgery?   portions that cause turbulent airflow. Trimming of enlarged turbinates may also play
                       a role in achieving this goal.
                        While the risks involved in this surgery are relatively minor and uncommon, it is
                        important to remember that risks do exist, as they do in all activities in life. You
                        should be aware of the risks of the surgery in order for you to make an informed

                        All surgeries carry with them the risks of bleeding, infection, and pain. The risk of
                        bleeding is increased by certain medications so you should review all medications
                        (prescription, over-the-counter, and herbal) with your physician prior to surgery.
                        Aspirin must be stopped at least 10 days prior to surgery and other anti-
                        inflammatory medications such as ibuprofen (Motrin, Advil, etc.) must be stopped at
                        least 4 days prior to surgery. In rare cases of excessive bleeding, small sponges
                        may be placed at the conclusion of the procedure. These sponges are usually
                        removed within 1-2 days.

                        Taking antibiotics after the procedure will minimize the risk of infection. Most
                        patients’ pain is relieved by Extra Strength Tylenol or a mild narcotic and Tylenol
                        combination. You will receive a prescription for sufficient pain medicine after your

What are the risks of   Rarely, septal surgery can lead to an unexpected change in the appearance of the
     surgery?           nose or can lead to a permanent loss of the sense of smell. Another rare risk is
                        creation of a hole in the septum, connecting the right side of the nose to the left.
                        This condition, called a septal perforation, can cause accumulation of dry mucus
                        (“crusting”), bleeding, or a whistling sound in the nose. Because the nose is close to
                        the eyes and brain, it is conceivable that these structures could be injured during
                        nasal surgery as well. Such an event is extremely rare.

                        Turbinate surgery carries the additional risks of increased crusting and a condition
                        called atrophic rhinitis or ozena, in which the interior of the nose is excessively dry.
                        Atrophic rhinitis is caused by the loss of moisturizing surface area in the nose and
                        can be difficult to treat.

                        Lack of improvement or even worsening of the underlying condition and the need for
                        re-operation are other risks inherent with any surgery. Surgery also carries with it
                        the risks of anesthesia. Septoplasty can usually be performed under local or
                        general anesthesia. You should discuss your anesthesia preferences with your
                        surgeon in order to determine what is best for you. You will also have an
                        opportunity to discuss the risks and benefits of each form of anesthesia with an

                        Medications to diminish the swelling of the lining of the nose may promote airflow
    What are the        but have drawbacks that you should discuss with your physician. If turbinate surgery
   alternatives?        is recommended, there are a number of methods to perform this portion of the
                        procedure and you may wish to discuss these with your surgeon. The surgery is, of
                     course, elective so that no surgery is also an option. As with any surgery, you
                     should feel comfortable seeking a second opinion from another surgeon.

                     HEALING        The majority of the healing in your nose will take place over the course
                     of 4-6 weeks. In patients with allergies or over-reactive nasal and sinus lining, the
                     process can take much longer. During this time, you will want to keep your nose out
                     of dusty or smoky environments. This includes tobacco smoke.

                     MEDICATIONS          Following your surgery you will receive prescriptions for a number
                     of medications. Typically these include pain medicine and antibiotics. It is essential
                     that the prescriptions be filled promptly and the medications taken as directed.

                     Crusting of blood and mucus can slow the healing process. In order to keep your
                     nose moist and prevent the crusting, you should use saline (salt-water) nasal spray
                     for at least two weeks following surgery. These sprays can be purchased “over the
                     counter” at your pharmacy. For the first five days following surgery, you should use
                     the spray at least once an hour while you are awake. Thereafter, you can reduce
                     use to four or five times a day. However, you cannot “over-do it” with the salt water,
                     so use it more frequently if you wish	
  What should I
   expect after
                     FATIGUE       Fatigue for two or three days following the surgery is common. Patients
                     who have general anesthesia often find the fatigue can hang on for an extra day or
                     two. You will want to take it easy for a few days following surgery. You should also
                     avoid strenuous physical activity for a few days. Moderate activity (like going for a
                     walk) is acceptable.

                     WORK        Most individuals return to work within 4-7 days following surgery. Some
                     return earlier, some later. Plan to be out for a week and return as soon as you feel
                     up to it.

                     TRAVEL       Many of our patients come from some distance. We prefer you stay in
                     the local area overnight following the surgery. If necessary, you may travel by air
                     after the surgery.

                     POST-OPERATIVE VISITS             Depending on the extent of your septal surgery,
                     expect to see your doctor within the first three weeks after surgery and, if necessary,
                     another visit 4 to 6 weeks later.

                     BLEEDING        Oozing from the nose is common for 24-48 hours following surgery.
 What are a few
                     You should probably put an old pillow case on your pillow or put a towel over it.
things to be aware
                     Additionally, you may want to sleep with your head elevated on an extra pillow to
                     minimize the oozing. After a couple of days, the discharge from your nose may turn
                      maroon or dark brown. This change is due to old blood and is normal. It does not
                      mean that the nose or sinuses are infected.

                      Occasionally, persistent bleeding from the nose can develop. If this occurs, sit
                      upright and breathe through your nose for 5-10 minutes. This should relieve most
                      bleeding. If it does not, or if the bleeding is heavy, contact our office at the numbers

                      NAUSEA Nausea and even vomiting following general anesthesia are not
                      uncommon. They can also occur after local anesthesia, but less often. The nausea
                      usually fades after about 12-24 hours. Try to sip liquids to avoid dehydration during
                      these periods. If the nausea is severe notify our office.

                      CRUSTING During septal surgery, incisions are made inside the nose. Like
                      incisions on the external skin, scabs will form as these heal. Mucus may also
                      accumulate on these “crusts” and block breathing through your nose. Do not
                      attempt to remove these, but instead continue to use the saltwater nasal spray to
                      soften the crusts. If the problem is severe, your physician may prescribe other

                      PAIN     Some discomfort following the procedure is to be expected but usually is not
                      especially severe. Use the pain medicine as needed. As soon as you feel ready, try
                      to switch to an over the counter pain medicine like extra-strength Tylenol. For the
                      first two to three weeks after surgery, do not use medications which contain aspirin,
                      ibuprofen, or other “anti-inflammatory” compounds, as these promote bleeding.

                      Sometimes after anesthesia, your muscles may ache all over like you have lifted
                      weights or strained muscles, particularly in the first day or two after surgery. Take
                      Tylenol for this and stretch your muscles—it will subside.

                      NOSE BLOWING          You may sniff (even vigorously) if you feel you need to clear
                      your nose. Realize that the interior of the nose will be swollen for 4-7 days and may
                      not clear - even with the most forceful attempts. Blowing your nose too early in the
                      healing process can cause bleeding. You may begin to blow your nose lightly 3
   What are the       days after surgery.
                      BENDING, LIFTING, STRAINING           Placing your head below your waist (e.g., to tie
                      your shoes), lifting anything over 10 pounds (including children) and straining will all
                      increase the risk of bleeding. You should avoid these activities for one full week
                      following surgery.

Promptly report the       •    Fever (100.6 or higher)
       following symptoms    •   Any symptom of infection: marked swelling of the tip of the nose, or
        to your doctor…          redness with increasing tenderness at the tip of the nose
                             •   Severe headache accompanied by nausea, vomiting, or unusual change in
                                 your behavior.
                             •   New rashes
                             •   Swelling or bruising around the eyes.

       How to get in touch                    Phone: 801-587-UENT (801-587-8368)
            with us.         •   After hours: 801-581-2121 (page operator – ask for ENT doctor on call)


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