Not every crooked septum requires repair. Some people have only a mild deviation but complain of a large degree of nasal obstruction. Others may have a significant deviation but have no problems. Interestingly, the direction and amount of deviation do not always correlate with the subjective complaint of nasal obstruction. For example, let us take ten patients with a septum that is really pushed over to the right side. Most people will complain of trouble with right nasal breathing.
However, some may have no complaints. Others yet may complain of difficulty breathing through both sides of the nose, and a few might even complain of more trouble breathing through the left side even though there is more space. From this example it is apparent there are no steadfast rules.
A septoplasty or sometimes referred to as a “submucosal resection” or “SMR” refers to straightening out the septum. This requires lifting the lining of the nose off the septum and removing or carving the underlying cartilage and/or bone. A light nasal dressing is placed in the nostrils and is removed the following day. Sometimes, a septoplasty may be performed to obtain cartilage for grafts if a rhinoplasty is performed. If only a septoplasty is performed,there is no external evidence that surgery has been done.
There is no external bruising or swelling. All incisions are inside the nose, and dissolvable sutures are used so none have to be removed. There is typically very little pain involved. There is more discomfort for the first week since there is swelling inside the nose. Sometimes one may experience temporary numbness of the upper teeth.
The turbinates are finger like structures that line the sides of the nose. There are three on each side – the inferior (largest), middle and superior. These structures warm and humidify the air we breathe in. The inferior turbinate (sometimes referred to as “concha”) may be enlarged and cause breathing problems by narrowing the nasal passageway.
The middle turbinate is sometimes enlarged and can block the sinuses on that side of the nose. Most sinuses drain into the nose underneath the middle turbinate. The turbinates can be reduced in size by numerous surgical methods. They should not be removed entirely since they serve important functions mentioned above. Turbinectomy is commonly performed as a combined procedure with a septoplasty or with sinus surgery.
There are numerous ways to reduce the size of the turbinates. Dr. Liu has been using recent technology involving radiofrequency to shrink them – this results in less pain, less crusting in the nose, and faster recovery.
SEPTAL PERFORATION REPAIR
A septal perforation refers to a hole that occurs in the septum, thus causing an abnormal communication between the left and right sides of the nose. These holes may be small or large, in the front or in the back of the nose.
There are numerous causes including previous nasal surgery, nasal trauma, nasal infection, chronic use of certain over the counter nasal medications, use of cocaine, certain systemic diseases, and others. Only those perforations that cause symptoms require repair. Symptoms include nasal obstruction, whistling noises when one breathes in, dryness, frequent nasal crusting, nosebleeds,and recurrent infections.
For additional information Click Here
for an online article on septal perforation authored by Dr. Liu. Repair can range from placement of a prosthesis in the nose to close the hole to complicated surgery requiring placements of grafts. A detailed examination will determine which procedure is best for you.