Correct nasal septum

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Surgery to correct the nasal septum

Surgery to correct the nasal septum (septoplasty) is considered the least traumatic type of surgery. It allows you to correct bone and cartilage tissue through the nostrils, without scars or scars on the face.

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The procedure quickly and effectively improves the patient’s quality of life, relieves numerous problems and restores natural breathing through the nose.

Septoplasty does not change the shape of the nose and is not a cosmetic surgery, but if necessary, it can be combined with rhinoplasty.

Causes of displacement of the nasal wall

The nasal septum is a vertical osteochondral plate that divides the nasal cavity into halves. Its defect causes a displacement of the wall relative to its axis horizontally or vertically. In this case, the deformation can be either one-sided, two-sided or S-shaped.

The reasons for the curvature of the nasal wall can be very different. They are usually divided into the following groups:

  • Physiological deformations. They occur as a result of facial presentation of the fetus, forceps delivery, or uneven development of the facial bones during adolescence. A hereditary factor can cause the defect.
  • Traumatic displacement. It is observed more often in men and adolescent boys. Occurs as a result of a blow or fall.
  • Compensatory reason. The presence of ENT diseases in a chronic form often leads to curvature of the nasal wall.

Whatever the factors and reasons this pathology is caused, its complete correction today is only possible with the help of surgery.

Who needs septoplasty

Indications for surgical intervention may include persistent difficulty breathing, chronic runny nose, nosebleeds, deterioration of hearing and vision. A deviated nasal septum is the cause of frequent and severe ENT pathologies, often becoming chronic.

Snoring in obese people can lead to stroke

The most suitable age for surgery to correct the nasal septum is 14 years and older. In children, septoplasty is performed only as a last resort, when the benefits outweigh the risk of abnormal formation of the nasal bones in the future.

Contraindications to surgery

Like any operation, septoplasty has its advantages and disadvantages. Despite the ease of execution and low invasiveness, the procedure has a number of contraindications:

  • hemophilia;
  • diabetes;
  • pathologies of the cardiovascular system;
  • severe infectious diseases;
  • cancer alert.

Manipulation is rarely carried out in the elderly and senile age and in the presence of mental illness.

Types of septoplasty

Surgery on the nasal septum in modern medicine is performed in several ways. For complex deformities that require removal of part of the lateral wall or its reconstruction, endoscopic septoplasty is indicated. For minor septal defects, you can get by with an alternative method - laser septoplasty.

The procedure does not require a long hospital stay and is performed under anesthesia. Minimal tissue damage guarantees fast and trouble-free healing.

Submucosal resection

The oldest method of correcting defects in the nasal wall. Classic surgery to straighten the nasal septum involves resection of small areas of the lateral wall that interfere with its normal functioning. In this case, the epithelium is carefully peeled off, which allows you to maintain its integrity and reduce bleeding. The procedure is performed under general anesthesia.

Submucosal resection is the most ancient and traumatic method of correcting the nasal septum.

Surgery for a deviated nasal septum at the site of injury requires elimination of the deformed areas with subsequent formation of the lateral wall anew. With appropriate preparation for the removal of defects and the right attitude, the operation is painless and with minimal damage.

Endoscopic septoplasty

This term means correction of the median wall of the nose using video equipment, which allows for precise and least traumatic manipulations.

Typically, this operation to straighten the septum lasts 20–40 minutes. Its duration depends on the degree of curvature of the plate, the presence of spines and ridges. Pain relief can be either general or local. Before the intervention, the patient is given premedication, which reduces the level of anxiety and prepares the patient for further manipulations.

Endoscopic septoplasty is a modern and low-traumatic method of correcting the nasal wall

In medical practice, the method of isolated correction of ridges and spines is sometimes used. However, this type of resection has not taken root, since it is technically complex and more often requires combined corrections.

Septoplasty with laser

Surgery to correct the nasal septum using a laser is usually performed under local anesthesia. Using a special instrument, the surgeon warms up the cartilage tissue and gives it the correct shape. If the lateral wall is pathologically overgrown, the specialist evaporates the excess tissue with a laser, leveling the septum. Then it is fixed in the desired position with silicone splints.

The operation takes 25–30 minutes and is performed on an outpatient basis. Its effectiveness and low invasiveness allows you to avoid bleeding and infection. However, laser septoplasty has a number of contraindications and is not always effective in difficult cases.

Laser septoplasty is the most modern type of surgery

Other types of septoplasty

In addition to the most common methods of straightening a curved septum discussed above, there are other ways to eliminate defects in the lateral wall:

  • Septorhinoplasty. A combined intervention that includes laser correction and plastic surgery of the appearance of the nose.
  • Ultrasonic cristotomy. It is performed with an ultrasonic knife and gives an almost bloodless result.
  • Replantation. It is a reconstruction of the septum using cartilage transplantation.

If it is necessary to correct the external shape of the nose, you can always combine rhinoplasty with any type of septoplasty.

Preparation for the operation and its implementation

Before surgery to straighten the nasal septum, the patient is prescribed a series of examinations, including a general blood test, MRI of the nasal plane, rhinoscopy, skull radiography, and computed tomography. You can take all tests and undergo examination at the clinic at your place of residence.

Next, the patient is admitted to the hospital, preferably one day before the operation. These hours are spent preparing for the intervention. When meeting with an anesthesiologist, you should choose the type of anesthesia (local or general anesthesia) and talk about the tolerability of various medications. If general anesthesia is prescribed, you should not eat or drink in the morning on the day of surgery.

During the procedure, septal defects are eliminated, including displacement of fragments of the lateral wall, its bending or separation. The removal of growths, spines and ridges, and the straightening of the cartilage tissue relative to the central axis. Then absorbable sutures are placed on the intervention area.

After surgery, the nose is fixed with a bandage

After the operation to straighten the septum is completed, silicone splints are inserted into the nasal cavity or the nasal passages are tamponed with turundas. With laser intervention, tamponing and suturing are not required. A plaster or gauze bandage is applied externally.

Contraindications and complications

Even though it is minimally invasive and traumatic, septoplasty, like any surgical intervention, carries its share of risks. The consequences of surgery are most often associated with the possibility of bleeding or infection of the wound.

In some cases, septoplasty can lead to changes in the shape of the nose or damage to the nerve endings of the mucous membrane. However, most often the intervention takes place without any complications.

Rehabilitation

The postoperative period is not very difficult. Usually it proceeds smoothly and almost painlessly. In the first 24 hours, the patient has tampons (silicone or gauze) in the nose, which help stop the bleeding and maintain the correct position of the nasal wall.

To relieve pain, the patient is prescribed analgesics. In addition to them, the following can be specified:

  • hemostatic agents;
  • antipyretic;
  • antimicrobial drugs.

After removing the tampons, the doctor recommends rinsing the cavities with moisturizing solutions and lubricating them with peach oil to prevent the formation of crusts. You should not blow out the contents of your nose to avoid bleeding.

After endoscopic nasal surgery, patients are discharged from the hospital after 1–3 days. Full recovery of breathing usually occurs within a few weeks. All this time, the patient should be observed by an ENT doctor and carefully follow his recommendations.

The recovery process after endoscopic septoplasty takes several days

If we talk about laser correction, then the recovery process is much easier here. After it, as a rule, there is no need to take medications or stay in the hospital.

If the patient suffers from allergic rhinitis, exacerbations may occur during the rehabilitation process, which will require additional treatment.

Sick leave after endoscopy is closed for the 10th day. By this time, swelling and external bruises, if any, disappear. With proper care of the nasal cavity, the recovery period ends quickly and does not cause any problems for the patient.

How to decide to have surgery

Of course, the most difficult thing is to overcome your fear and agree to the operation. Even patients who have suffered from nasal congestion and other complications of a deviated septum for years procrastinate until the last minute. And they can be understood. After all, any intervention in the body means pain and fear. In order to still take the decisive step, you should read reviews of people who have undergone surgery for a deviated nasal septum.

I suffered with a stuffy nose for a long time, almost all 28 years of my life. I couldn't think of anything. And low immunity, and the damp Leningrad climate, and... Yes, I thought about everything until I went to the ENT doctor. He finally said that a crooked nasal septum was to blame. He scheduled an operation. I was terribly afraid. I don't remember the process itself. Six months have passed, and what do I want to say? Yes, it’s scary, yes, it’s unpleasant, but it’s worth it. My nose breathes perfectly, I can smell all the smells, my head no longer hurts all the time. I'm happy.

I will share my observations, I hope it will help someone. I am 30 years old, young woman. After several years of suffering, I decided to have surgery. My nose stopped breathing completely, a nasty runny nose appeared, not severe, but I couldn’t go anywhere without a handkerchief. I had septoplasty on the nasal septum. Now the nose is breathing and everything is fine. And why did you suffer for so many years? Everything turned out to be not at all as scary as they told me and I imagined. Therefore, do not be afraid and make up your mind. It definitely won't be worse than it is.

For as long as I can remember, since childhood, my nose has always been covered in snot and blooms with herpes. And on the right she’s not breathing at all. I went to the ENT specialist and found out that I had a deviated septum. She agreed to the operation without hesitation. I decided to do it under local anesthesia and greatly regretted it. It was painful. Very. True, it all ended quickly, but I cried there... People walk around like cucumbers after the operation, and I am alone with a swollen face and bitten lips. Now, however, my nose is breathing, my runny nose and herpes have gone away, which I am incredibly happy about. But it’s better to do it under anesthesia. Otherwise everything is fine, it healed quickly.

As you can see, opinions are mostly positive. After the operation, your well-being changes dramatically, and new sensations appear. People get rid of rhinitis, their sense of smell returns, and their headaches go away. Therefore, do not delay with septoplasty and do not be afraid. A good attitude and strict adherence to the doctor’s recommendations will help make the intervention painless and recovery quick.

Comments

My daughter is 30 years old, she has been suffering from sinusitis for 12 years, now doctors tell us that at the moment there is no sinusitis, but a deviated nasal septum (she fell on the edge of a table as a child, broke her nose, there was bleeding and a scar remained). The doctor said that an operation should be done, although many people say that the operation is of little benefit. Help me understand this situation.

Will such an operation help to restore hearing? The doctor told me that I need to do the septum first. Then your hearing will improve.

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ATTENTION! All information on the site is for informational purposes only and does not claim to be absolutely accurate from a medical point of view. Treatment must be carried out by a qualified doctor. By self-medicating you can harm yourself!

Septoplasty

Septoplasty is a surgical procedure that allows you to adjust and correct a deformed nasal septum.

Despite the fact that septoplasty is a surgical procedure, it is the least traumatic operation; in addition, in addition to eliminating the defect and problem, septoplasty allows you to preserve the bone and cartilaginous structure of the nose without changes or damage.

All surgical procedures are performed inside the nose through small incisions, thus, thanks to minor submucosal resection of the septum, its shape is corrected. Based on this, septoplasty in a short time allows:

    • quickly improve quality of life;
    • resume nasal breathing;
    • relieve the patient from numerous problems associated with chronic ENT diseases caused by a deformed nasal septum.

It should be noted that septoplasty does not change the shape of the nose and is not an aesthetic surgical intervention for its correction, but it may well be combined with rhinoplasty.

Causes of nasal septum deformation

The nasal septum is a section of osteochondral tissue that divides the nasal cavity into two parts. When it is deformed, a shift in the position of the septum from the midline is noted.

Photo: deformation of the nasal septum

Deformation of the nasal septum can cause a lot of inconvenience to a person, and even provoke a number of chronic diseases of the respiratory organs (rhinitis, tonsillitis, sinusitis, frontal sinusitis, and the like).

There are a number of reasons why the septum becomes deformed. These include physiological characteristics, as well as traumatic and compensatory causes.

The physiological factor is the most common cause of deformation of the nasal septum. This means that a person’s bone and cartilage tissues acquire uneven growth, and this happens during the development and growth of the entire organism. In the case of a physiological cause, the nasal septum is usually completely deformed, often shifted to one side, or it develops projections called ridges or spines, as well as their combinations. A less common cause of a deviated nasal septum is a traumatic factor; it is most often found in athletes, but can also be caused by other reasons (fall, bruise, blow).

Photo: deviated nasal septum after injury

Traumatic deviated septum is a mechanical defect of the nose, trauma or fracture, which entails various complications. Even a minor injury, in which the bone is not deformed, but only the cartilage, especially if it occurs in childhood (or an age concomitant with the growth of the body as a whole), leads to a disruption in the development of the osteochondral tissue of the nose, and, accordingly, to a curvature of the nasal septum. Compensatory causes of septal deformation usually include:

  • the presence of a foreign body in the nasal cavity (for example, piercing);
  • the presence of polyps, adenoids and other neoplasms in the nasal cavity;
  • the presence of vasomotor rhinitis in humans (swelling of the nasal mucosa).

In any case, no matter what factors and reasons are responsible for the deformation of the nasal septum, its correction today lies only in surgical intervention, that is, septoplasty.

Types of septoplasty

In modern medicine, septoplasty of the nasal septum is performed in several ways, in particular endoscopically (conventional surgery) and using laser technology.

In the vast majority of cases, people faced with the problem of a deviated nasal septum prefer a proven method - endoscopic septoplasty.

Laser septoplasty

Laser septoplasty is characterized by correction of the nasal septum using a laser beam. This procedure is often performed under local anesthesia; it is bloodless and practically non-traumatic. In addition, the laser beam has pronounced antiseptic properties, which significantly reduces the risk of infections and complications in the postoperative period. Rehabilitation after laser septoplasty is quick and painless. Tight tampons (turundas) are not used in the postoperative period. After the operation, the patient does not need to stay in the clinic; the operation is performed on an outpatient basis and takes minutes. However, the laser method of septoplasty has a number of contraindications and, in addition, may be ineffective in complex cases when the curvature occurs not only in the cartilage tissue. Therefore, there are reasons why it is worth operating only through classical surgical septoplasty.

Video: laser septoplasty

Endoscopic septoplasty

Endoscopic septoplasty is a gentle, low-traumatic surgical intervention. Resection is performed on the mucous membrane inside the nose, which avoids scars and traces of surgery on the face.

Modern technologies for endoscopic septoplasty not only make it possible to maintain the aesthetic effect and avoid scars, but also make the rehabilitation period much easier and shorter.

Photo: resection of the nasal mucosa

Classic endoscopic septoplasty in modern medicine involves resection of minor areas of the septum that interfere with its normal position and functioning. At the same time, the nasal mucosa is preventively exfoliated, which preserves its integrity and prevents damage. However, there are individual cases, most often these include curvatures due to a traumatic factor, where deformed areas of cartilage tissue must be removed in order to leave the supporting function of the nasal septum unchanged. Typically, endoscopic septoplasty lasts 30 to 40 minutes; Considering the patient’s preparation for surgery, all manipulations can take about an hour. Anesthesia can be either general or local, or combined (for example, local anesthesia of the nose and the introduction of fairly strong intravenous sedation to the patient).

Symptoms of a deviated septum, or who is septoplasty indicated for?

The first, and perhaps the main symptom of a deformed nasal septum is difficulty breathing through the nose, whether it is chronic congestion of one or both nostrils. Full breathing through the nose is literally necessary for a person. The inhaled air is moistened and purified precisely in the nasal passages before entering the lungs, which is why the nasal cleansing and filtering functions are so important for human health, in particular the prevention of bronchial diseases (including asthma), heart and other vital organs. A deformed nasal septum prevents normal breathing through the nose, and often makes it completely impossible. But it should be borne in mind that at a young age, even with a significant deformation of the septum, this symptom may be mild or absent, which makes it difficult for the person to diagnose his pathology, but does not at all negate the fact of its existence.

Photo: normal nasal septum

A deviated nasal septum is the cause of frequent and protracted respiratory diseases in humans, often acquiring chronic forms. People with a deformed nasal septum also often experience recurrent inflammatory diseases of the respiratory tract and paranasal sinuses. Chronic sinusitis and rhinitis develop, and sinusitis, tonsillitis and otitis are also often observed. Concomitant pathologies of the throat are a very natural process with a deviated nasal septum. This leads to diseases of the pharynx such as pharyngitis and tonsillitis, as well as diseases of the larynx such as laryngitis, which become chronic. Often people begin to self-medicate, constantly use vasoconstrictor drops and take antiviral medications, without even suspecting that the cause of their frequent illnesses and constant nasal congestion lies in another defect that can be corrected by septoplasty.

Photo: deviated nasal septum

  • dry nasal cavity;
  • allergic reactions;
  • deterioration of hearing ability.

The last symptom is due to the fact that difficulty in nasal breathing does not provide proper ventilation of the middle ear cavity (tympanic cavity). If you observe any symptom, the most reasonable decision would be to visit an otolaryngologist, who will prescribe the correct treatment or refer you for surgery. It should be remembered that for minor violations and deformations of the nasal septum, there are alternative methods of septoplasty - such as laser or radio wave.

Contraindications

As with any operation, there are a number of contraindications to septoplasty. As with any other surgical intervention, an absolute contraindication to septoplasty is impaired blood clotting. Also, contraindications include:

  • diabetes;
  • diseases of the cardiovascular system;
  • infectious diseases of various types (including syphilis, hepatitis, etc.);
  • oncological diseases;
  • In addition, septoplasty is contraindicated for persons under the age of majority, since the bone and cartilage tissues of the nose are not fully formed until this moment.

Surgery to correct the curvature of the nasal septum

The operation to correct the nasal septum is painless and fairly quick, with minimal trauma and virtually no damage to cartilage and bone tissue. Modern methods of septoplasty are minimally invasive and allow you to correct dysfunction of the nasal septum with minimal damage and resection. Endoscopic septoplasty is performed mainly endonasally (inside the nose), which guarantees the preservation of the cosmetic effect and the absence of injury to nearby tissues.

Video: modern surgery - deviated nasal septum

How is the operation performed?

Let's figure out how septoplasty is done. Before performing the operation, the doctor prescribes a list of necessary tests and examinations. In most cases, they are generally accepted for any operation. Before septoplasty of the nasal septum, the patient must undergo some examinations and pass the following tests:

  • consultation with an otolaryngologist (ENT);
  • ECG (electrocardiogram);
  • coagulogram (test for blood clotting);
  • general clinical analysis of blood and urine;
  • fluorography;
  • blood test for HIV, syphilis and hepatitis;
  • blood chemistry;

Septoplasty, like any other operation, includes several stages. First, the patient is prepared for surgery, regardless of the chosen method of anesthesia. Currently, in most cases local anesthesia is used, but some patients still prefer general anesthesia (or have indications for it). Then an endonasal incision is made on the mucous membrane.

Complications and contraindications of septoplasty

Septoplasty is an operation that almost always allows for rehabilitation without complications.

But even with a low probability of complications, it should be understood that septoplasty is still a surgical procedure, and any operation carries certain risks. Complications after septoplasty can mainly be associated with bleeding and/or infectious diseases against their background. You should be aware that some medications taken by the patient before and after surgery may increase the risk of bleeding.

Photo: consultation before surgery

Therefore, before undergoing septoplasty, it is necessary to consult with a doctor regarding medications and medications, and in some cases, discontinue them some time before surgery. Before surgery, it would be a good idea to stop taking antibiotics and use medications aimed at preventing vascular fragility. It is also necessary to quit smoking, since smoking not only complicates the operation process, but also significantly complicates the rehabilitation and healing of tissues after it.

Rehabilitation and recovery (postoperative period)

The postoperative period (rehabilitation) after septoplasty is also almost painless and quite smooth. On the first day (or several, depending on individual characteristics), special tight tampons are placed in the patient’s nose. They are designed to reduce the postoperative risk of bleeding and stabilize the correct position of the nasal septum. Therefore, you should prepare for the fact that the nose after septoplasty will not breathe while tampons are in it.

Photo: silicone nasal swabs

Some modern clinics now use silicone tampons, which also effectively maintain shape and prevent bleeding, but due to the fact that they are empty from the inside, breathing is not difficult. Their removal from the nasal cavity does not bring any inconvenience or pain to the patient.

During the period after removing nasal tampons, you should also follow the doctor's recommendations regarding hot drinks, smoking, physical activity and water treatments.

All these simple things will have some restrictions that will have to be observed for a speedy recovery and return to functionality. To prevent infections and provide general relief, after septoplasty, various painkillers and antipyretic drugs are prescribed, and, in some cases, injections and drips of antibiotic drugs are given. After removing the tampons, the doctor often prescribes the patient special moisturizing drops for the mucous membrane, since after the operation the nasal cavity becomes quite dry, and clots of mucus and blood accumulate and dry out in it. Of course, you cannot remove them yourself with your hands, so special drops, sprays and solutions help soften this substance and “drive” it out of the nasal passages.

Photo: nasal spray to ease breathing

Most often, such preparations include drops and sprays based on saline and oil solutions. Sometimes the doctor prescribes ointments, including antibiotics, to the patient. As the nasal passages are cleansed and restored, breathing becomes easier, the mucous membrane is completely restored, and the surgical incisions heal. Completely normal breathing usually occurs in the patient within a few weeks. If we talk about laser septoplasty, here rehabilitation proceeds much faster, thanks to the bloodlessness of such an operation. The laser automatically coagulates the incision sites (seals their edges) and also disinfects them due to its strong antiseptic function. Therefore, after laser septoplasty, additional treatment is usually not required, and the introduction of tampons is not required.

If the patient has chronic and allergic rhinitis, relapses may occur during rehabilitation, which will require additional prescriptions from the attending physician and, accordingly, their implementation by the patient himself.

Performance fully returns 8-10 days after surgery. Even if a plaster fixation bandage is installed, by this time the patient is freed from it. There are practically no external bruises and swelling after septoplasty. With proper care of the nose after previous septoplasty, the postoperative period passes quickly and does not cause any discomfort to the patient.

Prices. How much does the operation cost?

The cost of correcting a nasal septum (septoplasty) varies widely in Moscow clinics, depending on the specialist who will operate, the authority of a particular clinic, as well as the chosen method of septoplasty and anesthesia. The average cost of septoplasty from a qualified specialist in a good commercial clinic is approximately 00 rubles.

This amount usually includes anesthesia, the patient’s hospital stay in the clinic (if necessary), subsequent postoperative dressings and sometimes medications (in most cases, they are purchased separately by the patient as prescribed by the doctor). In city hospitals, such an operation is performed free of charge, but the patient pays all costs for anesthesia and medications. In addition, in private clinics the patient has full guarantees that the operation will be successful and the rehabilitation period will proceed under the supervision of a doctor.

FAQ

Among the frequently asked questions about septoplasty by potential patients, the most common are the following: 1. Does septoplasty change the shape of the nose? Of course, with a traumatic curvature of the septum, when the deformation is severe, the shape of the nose acquires normal features, the septum becomes horizontal and even, not displaced to one side. If the curvature is purely on the inside, the shape of the nose remains completely the same. In general, septoplasty refers to ENT operations and has nothing to do with plastic surgery and aesthetic medicine. However, very often septoplasty (correction of the nasal septum) is combined with aesthetic rhinoplasty to completely change the shape of the nose, its aesthetic correction and eliminate problems with a deviated septum. 2. Does a deviated nasal septum pose a threat to health and life? A deformed nasal septum, of course, does not pose a direct threat to life. But it causes a number of health problems that can end very badly and at least pose a threat to the quality of life (ranging from hearing impairment, problems with the cardiovascular system, and ending with chronic diseases of the respiratory tract and organs). In addition, frequent diseases can develop into chronic and severe forms; insufficient air purification through the nasal passages and its direct entry into the lungs can lead to the development of asthma and heart disease, which, in turn, can pose a threat to life and normal functioning. 3. Is it possible to correct a septum without resorting to surgery? Today, septoplasty is the only way to effectively cope with the problem of a deformed nasal septum. If the deformity is not too complex, it is possible to avoid direct surgical intervention (endoscopic septoplasty) and use the most minimally invasive techniques - laser and radio wave septoplasty. However, even if the case is quite complex, and the curvature affects not only areas of cartilage tissue, modern medicine allows the use of classical endoscopic septoplasty with minimal trauma and health risks, and also maintains a cosmetic effect (no traces or scars of surgical intervention on the face). 4. Are there any scars after endoscopic septoplasty? All manipulations during endoscopic septoplasty are performed endonasally (inside the nose), including incisions that are made on the mucous membrane. This ensures that there are no scars on the nose after septoplasty. In rare cases, the skin is involved, but this is the exception rather than the rule. If we are talking about septoplasty combined with rhinoplasty (aesthetic correction of the shape of the nose), there are scars if the surgeon performs rhinoplasty in an open way. Septoplasty itself does not involve skin incisions, and no technique (endoscopic, laser or radio wave) requires that any traces remain after the operation. 5. What is the optimal age for septoplasty, and is there an age limit for it? There is no optimal age for nasal septum correction, because... problems can develop at any age, for example, due to trauma, polyps, tumors and other factors. Some people turn to septoplasty in adulthood, and often this can also happen because the symptoms of such a deviation as a deviated nasal septum may not be felt at a young age. As for age restrictions, the operation is not recommended for persons under age, since the anatomy of the face is such that by this age the osteochondral skeleton of the nose is not fully formed, and surgical intervention may not lead to the elimination of the problem, but to its aggravation. 6. Will surgery help if I have been using vasoconstrictor drops for a long time and my normal breathing is impossible without them? It is likely that the curvature of the nasal septum forced me to start using vasoconstrictor drops to ease nasal breathing. However, it should be understood that regular, and even more so constant, use of such drugs often leads to irreversible consequences (the mucous membrane atrophies), and there is little that can help here.

Photo: nose rhinoplasty

In the case of combining septoplasty and rhinoplasty, both a full version of plastic surgery is possible (with intervention in the bone section and elimination of aesthetic defects in it), as well as manipulations aimed at the aesthetics of the tip (its reduction, narrowing, elevation). Even if the bone part is not involved, any plastic surgery on the nose is called “rhinoplasty,” while septoplasty can get rid of breathing problems, chronic respiratory diseases and other problems caused by a deviated nasal septum.

Source: http://plastgid.ru/plasticheskaja-hirurgija/plastika-lica/septoplastika/

Operations to correct the nasal septum: surgical, laser

The nasal septum is a plate that divides the nasal cavity into 2 halves. It has two components - bone and cartilage.

Man, like any living creature, is symmetrical only at first glance. Upon closer examination, we will see various kinds of deviations from strict symmetry. The same goes for the nasal septum. Only 5% of the population have an ideal partition, located strictly in the middle.

Why then is surgery to straighten it one of the most frequently performed surgical interventions in ENT hospitals?

Causes of a deviated nasal septum

There are several reasons for this anomaly. This:

  • Physiological reasons: Curvature occurs as the body grows. Different parts have different growth rates. For example, the cartilaginous part grows faster than the bone part, due to lack of space it bends in one direction or another, and processes - ridges and spines - grow at the border of the bone part and cartilage.
  • Compensatory reasons. The septum moves due to something pressing on it from the side. These may be polyps or hypertrophied nasal turbinates.
  • Nose injury. And not only a fracture, but also a severe bruise (especially if received in childhood or adolescence). For obvious reasons, it occurs more often in males.

Types of curvature

  1. Actually curvature, that is, deviation from the midline, which can be C-shaped or S-shaped, in different planes, in the front or back.

When does the nasal septum need to be corrected?

The main pathophysiological component of a deviated nasal septum is a decrease in the lumen of the nasal passage on one or both sides, impaired air circulation, and the occurrence of pathological turbulence, which leads to excessive drying of the mucous membrane and atrophy of the ciliated epithelium. Sometimes a curved septum covers the openings of the anastomosis of the paranasal sinuses or the openings of the auditory tube, which leads to disruption of aeration and prevents the outflow of secretions from the sinuses or from the tympanic cavity.

There is no division of deviated septum into stages according to the severity of the anatomical defect, since this has no clinical significance. Indications for treatment are only clinical manifestations. Moreover, there is no direct correlation of complaints with the degree of curvature. There are cases where significant deformations did not affect nasal breathing in any way, and, on the contrary, even a slight curvature was the cause of many unpleasant symptoms.

It is believed that the indications for straightening the nasal septum are:

The most difficult point in this case is to be sure that these complaints and diseases are related specifically to the deformation of the nasal septum. As a rule, in addition to a deviated nasal septum, such patients also experience other pathologies (vasomotor rhinitis, polyps, hypertrophied nasal turbinates, allergies, etc.). Therefore, surgery to correct the nasal septum is usually offered after unsuccessful long-term treatment for other causes.

Treatment of nasal septum deformities

A deviated nasal septum is an anatomical defect and its treatment is mainly surgical. Basic principles of surgical treatment:

  1. The operation is planned, carried out after a thorough examination and preparation. It is necessary to identify all contraindications for surgery. Absolute contraindications:
    1. Acute infectious diseases.
    2. Decompensation of chronic diseases (diabetes mellitus, heart failure, hypertension, cancer, liver cirrhosis).
    3. Mental illnesses.
    4. Bleeding, slow blood clotting.
  2. There are also relative contraindications (that is, conditions under which the operation is possible, but undesirable):
    1. Children under 18 years of age. Septoplasty is very rarely performed on children over 6 years of age.
    2. Senile age.
    3. Menstruation period in women. It is advisable to have surgery 2 weeks after menstruation.
    4. Sinusitis, pharyngitis, tonsillitis during exacerbation. The operation is performed no earlier than 2 weeks after treatment. In exceptional cases, under the cover of powerful antibiotics, septoplasty is performed simultaneously with endoscopic sanitation of the sinuses for chronic sinusitis.
  3. Before the operation, an examination is carried out: general blood and urine tests, biochemical analysis, determination of blood clotting, ECG, examination by a dentist, therapist.
  4. Before surgery, it is necessary to discontinue medications that increase blood clotting time (aspirin, warfarin, anti-inflammatory drugs such as diclofenac, indomethacin, ketoprofen).
  5. The operation is performed in a hospital by a qualified ENT surgeon. There is a separate specialization in specialized clinics - rhinosurgeon, that is, a surgeon who deals exclusively with nasal pathology.
  6. The operation is usually performed under local anesthesia. If the patient wishes, general anesthesia is possible. The surgical approach is through the nasal cavity, that is, no external incisions are required.
  7. The duration of the operation is from 30 minutes to 1.5 hours.
  8. After surgery, tampons are inserted into the nose, which will cause some discomfort. Tampons are removed after 1-2 days.
  9. After removal of the tampons, in the absence of complications, the patient can be discharged from the hospital under outpatient supervision by an ENT doctor. It will be necessary to toilet and irrigate the nasal cavity with special solutions to disinfect the postoperative field and remove crusts.
  10. After the operation, swelling occurs, so immediate relief is not felt. Complete restoration of normal nasal breathing is possible in 1-4 weeks (time frames vary from person to person and depend on the type and extent of the operation).
  11. For 3-4 weeks after surgery, it is necessary to avoid physical overexertion and sports.

Basic operations for straightening a crooked nasal septum

Basically, two types of operations are used to correct deviated septum - submucosal resection and gentle minimally invasive endoscopic septoplasty.

Submucosal resection is the oldest method of surgical intervention on the septum. The operation was first performed more than two centuries ago and is still used today. The essence of the method: an arcuate incision is made in the mucous membrane in the anterior part of the septum, the cartilage is cut through its entire thickness, separated from the perichondrium and mucous membrane and removed almost completely. Only the upper part of the cartilage, 1-1.5 cm wide, is left. Then, using a hammer and chisel, the bony septum is removed. What remains of the septum - 2 layers of the mucous membrane, perichondrium, periosteum - is brought together and fixed with tampons for fusion. Sutures are usually not required.

Disadvantages of this operation:

  • The operation is quite traumatic and recovery after it takes up to 2-3 weeks.
  • Since the hard base of the nasal septum is almost completely removed, postoperative complications such as perforation and saddle-shaped retraction of the nasal dorsum are possible.
  • After such an operation, the septum is, in fact, scar tissue; because of this, the trophism of the mucous membrane is disrupted, it cannot fulfill its protective function, and there is a feeling of constant dryness in the nose and the formation of crusts.
  • The septum becomes quite mobile and displaced, which can also lead to problems with nasal breathing in the future.

The main advantage of this operation is that it does not require expensive equipment, so it is performed free of charge in any budget hospital.

Gentle endoscopic septoplasty is a more modern type of surgical intervention on the nasal septum. Under the control of an intranasal endoscope, a thorough inspection of the nasal cavity is carried out, areas of deformation are identified, and only curved areas are removed through small incisions of the mucous membrane. Gentle modern microsurgical instruments are used. The surgeon observes the entire surgical field on the monitor screen in a greatly enlarged form.

This operation is less traumatic compared to standard classical resection, it avoids complications such as perforation of the nasal septum, saddle-shaped retraction of the nasal dorsum, complications such as bleeding and suppuration develop less frequently, and rehabilitation is faster. However, for complex curvatures its use is limited.

In fact, the division of these operations into two types is very arbitrary. In practice, submucosal resection is almost never performed in its pure form, and with endoscopic septoplasty, resection is also performed, although to a lesser extent. In fact, both operations have no fundamental differences, and recently they are increasingly called by the same term - septoplasty.

There is also an improved technique for this operation, in which curved sections of cartilage are not removed, but are modeled in a special way using a scalpel or a special flattener and returned to their place, that is, they are installed between the sheets of mucosa to fill the defect. Subsequently, such cartilage occupies a normal physiological position. This operation is called resection-reimplantation.

If there are indications, other manipulations in the nasal cavity are performed simultaneously with septoplasty. This includes trimming a thickened nasal concha, removal of polyps and adenoids, endoscopic surgery on the paranasal sinuses, and vasotomy.

The cost of septoplasty in private clinics ranges from 25 to 90 thousand rubles. The price depends on the complexity of the operation, the category of the clinic, the qualifications of the surgeon, the type of anesthesia, and the length of stay in the hospital.

Complications of septoplasty

The following complications are possible after septoplasty surgery:

  1. Nosebleeds.
  2. Suppuration, abscess of the nasal cavity.
  3. Hematomas (accumulation of blood under the mucous membrane).
  4. Perforation (formation of a through hole) of the septum.
  5. Sinusitis.
  6. Adhesions, adhesions in the nasal cavity.
  7. Recession of the nasal bridge.

Postoperative period

Immediately after surgery, tampons are placed in the nose. This is necessary to keep the nasal septum in the correct position and prevent bleeding. Tampons are impregnated with an emulsion containing antibiotics and hemostatic agents. There are also special gel tampons with tubes inside for breathing. Tampons are installed for 1 day, if necessary, after 24 hours they are replaced with new ones for another 1 day. You need to prepare for the fact that during this time you will have to breathe through your mouth all the time, which, of course, causes discomfort. Sometimes a fixing plaster bandage is also applied to the nose.

Due to the fact that you have to breathe through your mouth, the mucous membrane of the oral cavity and lips dries out, and you constantly want to drink.

There may be a headache, the upper jaw often hurts, and there may be an increase in body temperature. If the operation was performed under general anesthesia, there are also symptoms of the aftereffects of narcotic drugs - weakness, drowsiness, dizziness, nausea. Medicines usually prescribed include painkillers, hemostatic agents and antibiotics.

In the first days after surgery, it is not recommended to blow your nose too much, drink hot drinks, or take a hot shower or bath. It is better to drink through a straw.

After removing the tampons, there is still swelling in the nose, so nasal breathing is not restored immediately. The timing of full recovery varies from person to person. According to reviews of people who have undergone surgery, most begin to breathe fully through their nose and smell smells after a week; for some, this period extends to a month.

After the tampons are removed, daily nasal toilet is necessary to remove crusts, rinse the nose with saline solutions and antiseptics. They are usually discharged from the hospital on the 5-6th day, but they can be released on the 2nd after removal of the turundas with daily visits to the ENT doctor. Complete healing of the nasal septum occurs 7–10 days after surgery.

For a month, it is not recommended to engage in heavy physical labor, sports, visit the bathhouse, or drink alcohol.

Alternative to septoplasty

Currently, in addition to traditional surgical methods, other methods for straightening a crooked nasal septum are being widely developed. The most well-known alternative method is laser septoplasty. It is possible with minor deformations only in the cartilaginous part of the septum.

The essence of the method is that with the help of a laser beam the place of deformation of the cartilage is heated, it is given the desired shape and fixed with a tampon inserted into one half of the nose. The operation takes about minutes and is performed on an outpatient basis under local anesthesia.

Main advantages: the operation is non-traumatic, practically painless, there is no bleeding after it, the swelling is insignificant, hospital treatment and long-term observation are not required.

However, despite all the advantages, laser correction of deviated septum has not become widespread due to the fact that isolated curvatures of only the cartilaginous part of the septum are quite rare.

In addition to laser treatment, there is also a method of ultrasonic cristotomy - removal of the ridges and spines of the septum using a special ultrasonic saw.

Osteopathic doctors try to correct small defects of the nasal septum with good results.

Video: laser septoplasty

How to decide to have surgery?

The worst thing is to agree to surgery to correct a crooked nasal septum. Even patients who cannot fully breathe through their nose for a long time and cannot live without vasoconstrictor drops are delaying the decisive moment. They can be understood, because any operation is stressful for the body, it is painful, scary, it means 2-3 weeks of incapacity for work.

However, it is worth reading the reviews of people who have decided to take this step. For the most part, these are positive, life-changing sensations. In addition to restoring nasal breathing, straightening the nasal septum allows you to get rid of chronic sinusitis and chronic otitis media. A person begins to hear better, smell better, constant snoring disappears, and headaches disappear. In addition to all this, septoplasty often also provides a cosmetic effect in the form of correcting the shape of the nose.

I am undergoing surgery for a bent nose in America. Now I have had a second operation. The first was - they cleaned the sinusitis and the septum was cracked and curved. The second operation straightened the nose. Right now, 5 days have passed and I’m taking pills. There are no washing procedures. There are silicone tampons. The first postoperative visit to the doctor is after 8 days. By the way, after general anesthesia, go straight home)) America))

They did no worse in St. Petersburg, Russia))

Source: http://uhonos.ru/nos/lechenie-nosa/ispravlenie-peregorodki/