Nasal septum surgery, septoplasty (septal resection)
The nasal septum is a plate of cartilage at the front and bone at the back, covered with mucous membrane. It is normally located in the midline of the nasal cavity and forms a septum between the right and left sides of the nasal cavity. It supports the nose from the inside. Opposite the nasal septum, there are 3-3 horizontally running formulas on the side wall of the nasal cavity, the so-called nasal concha. Around the age of adolescence, the nasal cavity and the nasal septum develop at different rates, which can lead to bigger or smaller curves on the nasal septum. The nasal septum can also be distorted by injury to the nose. If the deviation from the midline is significant in either direction, one half of the nose will be narrower.
There are also multi-directional S-shaped deviations that narrow both sides of the nose. We can breathe less air through the narrower half of the nose, it gets stuffy easily, and the nasal secretions are often stagnant in it. The wider side is also stuffy in many cases, as compensatory lower nasal concha enlargement develops on this side. In many cases, the deviation of the nasal septum is also associated with deviation of the nose’s shape and its axis.
Nasal congestion can be caused by the enlargement of the lower concha, adenoid, polyps, foreign bodies, and tumours.
Why is surgical correction of respiratory stenosis needed?
Surgery is recommended when a long-term nasal breathing complaint is caused by the deviation of the nasal septum alone or as part of the causes that trigger and maintain inhibited nasal breathing (e.g. enlargement of the nasal concha, nasal polyps). Surgery may be used to ensure better nasal breathing or to correct the secondary consequences of nasal breathing: prolonged upper and lower respiratory tract infections, paranasal sinus inflammation, chronic throat and pharyngeal disorders, auditory tube dysfunction, acute and chronic otitis media, headache, snoring, sleep disorder.
How is the surgery performed?
Surgery can also be performed under local anaesthesia and general anaesthesia, depending on the patient’s wishes and the opinion of the operating and aesthetic physicians. Nasal septum surgery is usually recommended under anaesthesia. In our hospital, we use two methods to correct nasal septum deviation (Kilian’s septal resection, septoplasty), and your operating surgeon will suggest the right one based on individual assessment. A common feature of both techniques is that the mucosal cartilage/periosteum is removed from the bony-cartilaginous skeleton of the nasal septum by removing the deviated bone and cartilage parts (septum resection), partially removing, and straightening it (septoplasty). The surgical incision and, if necessary, the suture are inside the nasal cavity, in an invisible place. During the operation, the appearance of the nose does not change in case of uncomplicated healing, the operation only improves the function of the nose (nasal breathing), it does not result in an aesthetic improvement. Depending on the type of anaesthesia (general anaesthesia/local anaesthesia), the degree of the nasal septum deviation and other interventions that may be needed (mucotomy, FESS), the length of the surgery is approx. 40-90 minutes. At the end of the surgery, it is necessary to tampon the nasal cavity, which in case of heavier bleeding is the classic layered tamponing, in case of minimal bleeding we use silicon septum rail. Tampon removal is performed on the second day after surgery.
What are the advantages and risks of the surgery?
The advantage of the surgery is an improvement in nasal breathing, which also has a positive effect on daytime activities and restful sleep at night. In cases where the inhibited nasal breathing already causes secondary diseases of the paranasal sinuses, ears, pharynx, larynx and lower respiratory tract, sleep disorders, the surgery also helps with these.
Nasal septum surgery is a common and safe procedure, side effects are rare. Like all surgeries, there is a risk of nasal septum surgery, primarily various infections and bleeding. It is important that in case of heavy nosebleeds, severe weakness and headache unresponsive to analgesics, high fever, an immediate examination is required at our Hospital or the regionally competent otolaryngology department. In this case, call our case manager.
Before the operation, you will receive an information sheet and a statement of consent, which contains detailed information about the nasal septum surgery, its risks, information before and after the procedure, and what to do. In all cases, it is possible to discuss the possible risks of surgery with your doctor before deciding on treatment.
There are also risk factors associated with local and general anaesthesia, for which we provide a separate information sheet and a statement of consent. Mandatory preoperative examinations ensure that the risks are minimized.
Am I fit for nose surgery?
The need for surgery is decided and recommended based on the otolaryngologic examination and anamnesis performed in our Hospital. Our otolaryngologist uses a nasal speculum and endoscope to examine your nose, check the shape of your nasal septum, the size of your nasal concha, and see if there are any other abnormalities (polyps, hypertrophic adenoid, rarely a tumour). The final diagnosis is made based on a physical examination and a CT scan of the nasal and paranasal sinuses. Allergy testing is also performed for symptoms suggestive of allergies. The suitability for surgery of general anaesthesia is decided by our anaesthesiologist and, if necessary, our internist based on a blood sample, an ECG examination and a chest X-ray.
How do I prepare for surgery?
Bring your previous final reports for pre-septoplasty examination and consultation, make a list of your regular medications, vitamins, dietary supplements, other health problems, previous illnesses, drug sensitivities and allergies, and possible diet.
You will find all the necessary information about the operation in the surgical and aesthetic patient information and consent form received in person or by e-mail before the operation, please read it, sign it with a witness and bring it to the anaesthesiologist’s examination and the operation!
What should I do after the surgery?
In the period after nasal septoplasty, usually on the day of surgery, mild or more severe nosebleeds, bloody sputum, bloody vomiting, cough stimuli, cough, and restlessness may occur in an anesthetized patient. In the days after surgery, weakness, drowsiness, dizziness, fever, headache, and nausea may occur due to varying amounts of blood loss, surgical stress, and medications used.
During the wearing of the tampon (48 hours), our patients are in our hospital, in case of a silicone septum rail, you can return home with the tampon after 1 night, you have to come back the next day to have the tampon removed. Wearing a nasal tampon is an uncomfortable feeling, similar to the feeling of a stuffy nose during a cold and is associated with mild to moderate pain that can be treated well with oral painkillers. The tampon should not be removed or handled by yourself. Removing tampons is a short, rather unpleasant procedure that takes a few seconds, which is milder when using a modern (silicon) tampon.
7-10 days after tampon removal, nasal congestion due to nasal discharge and nasal mucosal swelling may occur, and pain is not typical at all. In the days after surgery, swelling of the nose and slight numbness of the upper lip and upper teeth are normal.
In the 2 weeks after the operation, a health-conscious lifestyle and rest are recommended, it is necessary to avoid activities that raise blood pressure and cause head hyperaemia, as these can cause bleeding. During this time, the nose should not be blown hard. No dietary restriction is required, you should drink plenty of fluids but alcohol consumption is not allowed.
In the case of uncomplicated recovery, you can return to job after 14 days, the time of full recovery and the complaint-free state is approx. 3 weeks. Serious physical work and sports are allowed from the 4th week onward.
In the two weeks after surgery, we recommend that you do not travel to a place where there is no health facility nearby, and do not travel by plane.
After surgery, nasal oil/ointment should be used for 2-3 weeks, in some cases we also recommend the use of a nasal wash set.
Why is it important to have regular check-ups after surgery?
The first follow-up examination after nasal septum surgery is due one week later, when nasal cleansing treatment is needed to avoid the development of nasal infections and adhesions. In case of uncomplicated recovery, a second follow-up is usually warranted after 6 weeks.
We accommodate our clients in a modern, pleasant, air-conditioned single room. Each room has a private bathroom, fridge and TV, as well as free WIFI access. We also provide our clients with individual nurse supervision, who will help your continuous recovery during your stay.