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Saturday, June 6, 2009

What is Septoplasty ?

The Importance of Nasal Breathing

The importance of effective nasal airway breathing cannot be over emphasized. By the time inspired air passes through the nose and reaches the lungs, it has been properly warmed, humidified, and cleaned. The physiologic cleaning and filtering function of the nose is important for proper pulmonary function and overall good health. Absence of good nasal breathing on a continual basis or on an episodic basis gives rise to a host of medical problems and conditions. The importance of consistent nasal breathing often times is more than apparent for those individuals who have had successful corrective nasal septoplasty.

Causes of Chronic Nasal Obstruction

Nasal airway obstruction is a very common problem for many throughout the United States. There are multiple causes of chronic nasal obstruction. There are both temporary and acute causes, as well as chronic and persistent causes of obstruction. Chronic nasal obstruction can persist for weeks and months and sometimes even throughout ones lifetime. The following is a list of some of the more important causes of chronic nasal airway obstruction: nasoseptal deviation, refractory turbinate (nasal mucosa) enlargement, chronic allergic rhinitis, chronic vasomotor rhinitis, nasal polyposis, chronic sinusitis, congenital choanal atresia (congenitally obstructed nasal passage), nasal valve collapse, adenoid tonsil enlargement, chronic adenoiditis, and outer nasal deformity due to trauma or surgery.

A simple evaluation by an experienced otolaryngologist is generally satisfactory to obtain the specific cause of the nasal obstruction. Most structural abnormalities can be remedied with medical or interventional surgical treatment.

What Causes a Deviated Septum ?

Two common reasons for internal nasal obstruction due to nasoseptal deviation are nasal trauma and cartilaginous growth abnormalities. Nasal trauma is probably the most common cause for septal deviation. In the past several decades, there has been an increase of young adult participation in contact sports such as skateboarding, snowboarding, skiing, bicycling, etc. This has given rise to an increase in trauma to the nose, increase in nasal fracture, and subsequently an increase in nasoseptal deviation and crookedness. Essentially this results in nasal obstruction and turbulent nasal airflow that is of a chronic nature. Simple trauma from birth delivery can also cause internal nasoseptal airway obstruction persistent in adulthood. Since the outer portion of the nose is intimately connected with the nasal septum, simple nasal trauma and nasal fractures can cause nasoseptal deflection and nasal airway obstruction.

Secondly, a very common cause of septal deviation is unusual nasoseptal growth pattern. Sometimes the septum grows crooked due to the confined space. This overgrowth can lead toward buckling and bending of the cartilaginous and bony septum.

Manifestations of Nasoseptal Deviation

A significantly crooked nasal septum induces turbulent airflow. Sometimes, airflow is completely absent and there is no nasal airway patency. Decreased nasal breathing compromises ones sense of smell. The ability to perform the normal physiologic functions of the nose is significantly impeded, as the air flowing into the nose is “processed” so that air delivered to the lungs is humidified, warmed, and filtered and cleaned. Diminished nasal breathing compromises this process and compromises ones health.

Epistaxis (bloody nose) is a common manifestation of nasal airway compromise. The increase in air turbulence and nasal dryness lends itself more towards nasal bleeding. Correction of the septal deviation tends to decrease the epistaxis tendency. Additionally, alterations in nasal airflow currents can cause crusting, irritation, and metabolic changes to the normal mucosa, as well as normal mucosal functioning.

Nasoseptal deviation can also impinge on the sinus drainage (doorways), which can sometimes lead to sinus obstruction and/or recurrent or chronic sinusitis. By straightening the septum, improvement of nasal sinus drainage and ventilation can be achieved, which often times improves chronic sinusitis. Nonetheless, septoplasty can play an important role in the battle against chronic sinusitis.

Nasal obstruction and a deviated septum contribute to snoring and obstructive sleep apnea, as well as related sleep disordered breathing problems. With the alleviation of upper airway nasal obstruction via nasal septoplasty, snoring and sleep apnea can be significantly improved in many individuals.

The Nasal Septoplasty Procedure

Septoplasty is generally performed on an outpatient basis with IV sedation or general anesthesia. The procedure takes approximately 30 minutes. A small incision is created inside the nose and cartilage and bone is inspected and specifically treated appropriately. Bony spurs are trimmed or removed if present. The cartilage is morselized and straightened back to its original position. Bone is also manipulated to the center to achieve reasonable straightening and better nasal airflow.

Sometimes small splints are placed internally to support the septum. These are removed simply in a few days time. Packing is not required.

Concurrent Surgery

Nasal septoplasty is commonly performed with other procedures. The most common procedures include turbinate reductive surgery for additional improvement in nasal breathing; also endoscopic sinus surgery is quite common to achieve improvement for chronic sinusitis. Reconstructive or cosmetic rhinoplasty is often performed at the same time as septoplasty depending on each individual’s needs.

Nasal Septoplasty Recovery

After septoplasty individuals will go home the same day. There is mild discomfort to the nasal area for 24 to 36 hours afterward. Oral pain medications are generally effective in reducing postoperative discomfort. Ice packs are placed around the nose and cheek area for alleviation of the mild discomfort. Individuals are able to resume reasonable activities after three to four days and can go back to work after five to seven days. Nasal irrigations and nasal supplemental steroid sprays are used continuously until the healing process is complete.

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