FAQ's on Septoplasty
by Dr. Richard Orlandi
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
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
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
• 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)