Types Archives - Deviated Septum Surgery

Septoplasty Complications: Risk Associated with Deviated Septum Surgery

November 25, 2020 by Marc Leave a Comment

As with any surgical procedure, there are potential septoplasty complications and risks associated with deviated septum surgery.

In this article we look at the studies that examine the risks and complications, and we also answer a few frequently asked questions related to potential side effects of deviated septum surgery.

Septoplasty Complications: Evidence from Studies

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In this section, we describe the complications and risks associated with septoplasty that have been found in scientific studies: ¹Ketcham, A. S., & Han, J. K. (2010). Complications and Management of Septoplasty. Otolaryngologic Clinics of North America, 43(4), 897–904. ²Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

Bleeding: Due to the high blood supply in the inner skin of the nose, increased bleeding can be observed either during or after the septoplasty procedure. Excessive bleeding after the surgery is reported in 6-13% of patients.
Cerebrospinal fluid leak: After septoplasty, in rare instances, the patient may experience watery brain fluid discharge through the nose and sinuses, also known as a cerebrospinal fluid leak. This may be accompanied with headaches.
Infections: The rate of infection after septoplasty ranges from 0.4%-12.0%. The rate remains unchanged even after use of antibiotics.
Nasal septum perforation: Lack of blood supply at the treated site may result in perforation in the septum. The rate of nasal perforation after septoplasty ranges from 1.6%-6.7%.
Nasal deformity post-surgery: After septoplasty, an overall change in the appearance of the nose is observed in 0.4%-3.4% cases. The most common post-surgery deformities are saddle nose deformity (loss of nasal height) and supra tip depression (depression seen above the tip of the nose).
Septal hematoma: Swelling due to accumulation of blood in the septum after septoplasty is known as septal hematoma. This can impair the function of the nose.
Adhesions: Fusion between the mucosa (inner skin) of nasal septum and adjacent structures (turbinates) is seen in ~7% of the patients and can lead to postoperative nasal congestion.
Anosmia: Reduced or complete loss of smell is observed in 0.3-2.9% cases post-surgery.

Frequently Asked Questions – Septoplasty Complications, Risks & Side Effects

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Does septoplasty change appearance of nose?

The short answer is yes.

The nasal septum is a midline structure that positions the nose centrally. Any deformity in the septum causes crooked appearance of the nose. The width, height, and sharpness of the nose also depends on the dimensions (dorsal-ventral) of the septum (cartilaginous septum). So, septoplasty performed to fix the deviated septum can improve the appearance of the nose, making it more symmetrical.³Saharia PS, Deepti Sinha. Septoplasty can Change the Shape of the Nose. Indian J Otolaryngol Head Neck Surg. 2013;65(Suppl 2):220-225. doi:10.1007/s12070-011-0330-7.

Will a septoplasty straighten my nose?

Yes, the septoplasty surgery helps straighten the nose.

The nasal septum is an important structure that supports the nose. It also helps determine the appearance of the nose. The presence of septal deformity can result in a crooked appearance to the nose. Hence, undergoing septoplasty not only straightens the septum but also improves the appearance and function of the nose.⁴Sykes, J., Kim, J.-E., Shaye, D., & Boccieri, A. (2011). The Importance of the Nasal Septum in the Deviated Nose. Facial Plastic Surgery, 27(05), 413–421.

Does getting septum surgery change your voice?

Yes, undergoing septal surgery can change the voice for the better.

The presence of deviated septum causes nasal obstruction which results in hypo nasal speech. This happens when not enough air is able to move through the nasal cavity due to blocked nasal passage.

The septum surgery eliminates the nasal obstruction by straightening the nasal septum. It leads to a decrease in tissue surface area and widens the nasal passages. This results in a decrease in the nasal resonance and an increase in the quality of the voice.⁵Ozbal Koc, E. A., Koc, B., Ercan, I., Kocak, I., Tadihan, E., & Turgut, S. (2014). Effects of Septoplasty on Speech and Voice. Journal of Voice, 28(3), 393.e11–393.e15.

Is there a high risk of bleeding from septoplasty?

Excessive bleeding after the septoplasty surgery is observed in 6-12% of cases. Due to the high number of blood vessels connected to the inner skin of the nose, bleeding can be observed either during or after the septoplasty procedure. Meanwhile, mild oozing of blood is common after the surgery. In case of heavy bleeding, one should consult the surgeon.⁶Ketcham, A. S., & Han, J. K. (2010). Complications and Management of Septoplasty. Otolaryngologic Clinics of North America, 43(4), 897–904.

Sources:

1
Ketcham, A. S., & Han, J. K. (2010). Complications and Management of Septoplasty. Otolaryngologic Clinics of North America, 43(4), 897–904.
2
Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.
3
Saharia PS, Deepti Sinha. Septoplasty can Change the Shape of the Nose. Indian J Otolaryngol Head Neck Surg. 2013;65(Suppl 2):220-225. doi:10.1007/s12070-011-0330-7.
4
Sykes, J., Kim, J.-E., Shaye, D., & Boccieri, A. (2011). The Importance of the Nasal Septum in the Deviated Nose. Facial Plastic Surgery, 27(05), 413–421.
5
Ozbal Koc, E. A., Koc, B., Ercan, I., Kocak, I., Tadihan, E., & Turgut, S. (2014). Effects of Septoplasty on Speech and Voice. Journal of Voice, 28(3), 393.e11–393.e15.

Is Deviated Septum Surgery Painful? How to Manage Pain After Septoplasty Surgery

How to Fix a Deviated Septum Without Surgery: Complete Guide to Home Remedies, Devices & More

Septoplasty and Rhinoplasty Surgery: Answers to Common Questions

Nasal Septum Anatomy: A Plain English Explanation (with Diagrams!)

Deviated Septum Insurance: Everything You Need to Know

Types of Deviated Septum Surgery: Complete Guide to Septoplasty, Turbinate Reduction, Rhinoplasty & More

November 13, 2020 by Marc Leave a Comment

If you have a deviated septum and you’ve looked into the various deviated septum treatments, this question might have crossed your mind: “How to fix a deviated septum with surgery?”

In this comprehensive guide we answer that question by covering the main types of deviated septum surgery:

Septoplasty
Turbinate reduction (aka turbinoplasty)
Balloon sinuplasty
Rhinoplasty

In the sections below we describe (in plain English) what each surgical procedure is, what’s involved, and the pros and cons of each.

Table Of Contents

Septoplasty Surgery for a Deviated Septum

What is Septoplasty Surgery?

Septoplasty Procedure

Pros and Cons of Septoplasty Surgery

Turbinate Reduction (aka Turbinoplasty) for a Deviated Septum

What is Turbinate Reduction Surgery?

Turbinate Reduction Surgery Procedure Steps

Pros and Cons of Turbinate Reduction Surgery

Balloon Sinuplasty Surgery for a Deviated Septum

What is Balloon Sinuplasty Surgery?

Balloon Sinuplasty Surgery Procedure Steps

Pros and Cons of Balloon Sinuplasty Surgery

Rhinoplasty Surgery for a Deviated Septum

What is Rhinoplasty Surgery?

Rhinoplasty Surgery Procedure Steps

Pros and Cons of Rhinoplasty Surgery

Septoplasty Combined with Other Types of Surgery

1. Septoplasty and Turbinate Reduction Surgery

2. Septoplasty and Rhinoplasty Surgery

Septoplasty Surgery for a Deviated Septum

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What is Septoplasty Surgery?

Septoplasty surgery is a procedure to correct the deviated nasal septum. It is the most commonly performed surgery in the US. In individuals with obstructed nasal passage due to a deviated septum, this procedure eases breathing and improves the quality of life.¹Siegel, N. S., Gliklich, R. E., Taghizadeh, F., & Chang, Y. (2000). Outcomes of septoplasty. Otolaryngology-Head and Neck Surgery, 122(2), 228–232.

Septoplasty Procedure

The steps that are followed during a septoplasty procedure are:²Shah J, Roxbury CR, Sindwani R. Techniques in Septoplasty: Traditional Versus Endoscopic Approaches. Otolaryngol Clin North Am. 2018;51(5):909-917.

step 1

Anesthesia is injected in the nose to create numbness.

step 2

At the lower aspect of the septum, a cut is marked using a blade on the mucosa (inner skin) of the nose through the nostril.

step 3

The skin covering the septum is raised to expose the septum.

step 4

Once the septum is exposed, bony and cartilaginous asymmetry on the septum is identified and removed with an instrument.

step 5

The soft tissue is stitched back on the septum.

Pros and Cons of Septoplasty Surgery

When deciding whether or not to have this procedure done for your deviated septum, consider these pros and cons:

Pros of Septoplasty:³Baumann I. Quality of life before and after septoplasty and rhinoplasty. GMS current topics in otorhinolaryngology, head and neck surgery. 2010;9.

This surgery improves the ease of breathing by correcting the deviated septum which causes nasal obstruction.
It reduces the incidence of sinus infections.
It improves an individual’s quality of life by correcting the other associated symptoms such as snoring, runny nose, nasal congestion, and postnasal drip (mucus entering the throat).

Cons of Septoplasty:⁴Ketcham, A. S., & Han, J. K. (2010). Complications and Management of Septoplasty. Otolaryngologic Clinics of North America, 43(4), 897–904.

Conventional surgery can cause several side effects such as infections, perforation on the septum, bleeding, and hematoma (septal swelling due to pooling of blood).
Excessive cutting of bone may cause severe pain and swelling.
In some, the nose may get overcorrected, hampering its appearance and function.

Turbinate Reduction (aka Turbinoplasty) for a Deviated Septum

What is Turbinate Reduction Surgery?

Turbinate reduction surgery is a procedure to reduce the size of the swollen turbinates to improve the patency of the nasal airway. Turbinates are small bony projections that are covered with mucous lining and seen on the side walls of the nose. In the presence of deviated nasal septum, allergies, and infections these turbinates increase in size, obstructing the airway.⁵Friedman, M., Tanyeri, H., Lim, J., Landsberg, R., & Caldarelli, D. (1999). A Safe, Alternative Technique for Inferior Turbinate Reduction. The Laryngoscope, 109(11), 1834–1837.

Turbinate Reduction Surgery Procedure Steps

The steps that are followed during a turbinate reduction surgery procedure are:⁶Galetti, G., Dallari, S., & Galetti, R. (1991). Turbinoplasty: Personal Technique and Long-Term Results. ORL, 53(2), 111–115.

step 1

Local anesthesia is injected into the nose to numb the nose.

step 2

A vertical incision is marked using a blade on the frontal part of mucosa (inner skin) of turbinates, seen on the side walls of the nose.

step 3

Following this, the swollen part of the tissue covering the turbinates is removed.

step 4

The turbinal bone is partly or completely removed and reshaped.

step 5

Temporary nasal packs and splints are inserted in the nose.

Pros and Cons of Turbinate Reduction Surgery

When deciding whether or not to have this procedure done for your deviated septum, consider these pros and cons:

Pros of Turbinate Reduction Surgery:⁷Chang, C. W. D., & Ries, W. R. (2004). Surgical treatment of the inferior turbinate: new techniques. Current Opinion in Otolaryngology & Head and Neck Surgery, 12(1), 53–57.

Turbinate surgery when performed using advanced techniques causes minimal trauma and post-surgery discomfort to the patient.
The surgery can also be performed under local anesthesia.
The surgery eases the process of breathing and improves the quality of life by eliminating additional symptoms such as snoring, sneezing, nasal discharge, and post nasal drip (mucus entering the throat).

Cons of Septoplasty:⁸Mabry, R. L. (1984). Surgery of the Inferior turbinates: How Much and When? Otolaryngology-Head and Neck Surgery, 92(5), 571–576

In a few individuals, delay in healing along with crusting (excessive accumulation of mucus) in the nose can be observed post-surgery.
It is a technique-sensitive procedure.
Multiple techniques are proposed to perform turbinate reduction surgery. So, proper assessment of the condition is required before opting any specific technique.

Balloon Sinuplasty Surgery for a Deviated Septum

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What is Balloon Sinuplasty Surgery?

Balloon sinuplasty surgery is an alternative treatment approach to treat individuals with chronic rhinosinusitis (inflammation of nose and sinuses) using a balloon catheter device. In this technique, a small, flexible balloon catheter is inserted and inflated in the clogged sinus to enlarge the sinus opening. This allows the draining of accumulated mucus in the sinus, reducing sinus congestion and associated infections.⁹Stewart, A. E., & Vaughan, W. C. (2010). Balloon Sinuplasty Versus Surgical Management of Chronic Rhinosinusitis. Current Allergy and Asthma Reports, 10(3), 181–187.

Balloon Sinuplasty Surgery Procedure Steps

The steps that are followed during a balloon sinuplasty procedure are:¹⁰Stewart, A. E., & Vaughan, W. C. (2010). Balloon Sinuplasty Versus Surgical Management of Chronic Rhinosinusitis. Current Allergy and Asthma Reports, 10(3), 181–187.

step 1

The sinus region is anesthetized and with the help of an endoscope (a thin, flexible tube with a camera), a guidewire is inserted into the sinus.

step 2

After the correct positioning of the guidewire in the sinus, a deflated balloon catheter is inserted along the guidewire towards the sinus opening (sinus ostia).

step 3

Once the position of the balloon is confirmed, it is slowly inflated at a pressure of 4-12 atmospheres.

step 4

The balloon is inflated until the sinus opening is enlarged, allowing the drainage of accumulated mucus from clogged sinus.

step 5

Following this, saline is used to flush the sinus and remove the remaining mucus and pus if any.

Pros and Cons of Balloon Sinuplasty Surgery

When deciding whether or not to have this procedure done for your deviated septum, consider these pros and cons:

Pros of Balloon Sinuplasty Surgery:¹¹Stewart, A. E., & Vaughan, W. C. (2010). Balloon Sinuplasty Versus Surgical Management of Chronic Rhinosinusitis. Current Allergy and Asthma Reports, 10(3), 181–187.

This surgical technique involves minimal intrusion without excess removal of bone or tissue.
Recovery is faster than conventional surgeries.
Postoperative complications are negligible.

Cons of Balloon Sinuplasty Surgery:¹²Levine, H., & Rabago, D. (2011). Balloon Sinuplasty: A Minimally Invasive Option for Patients with Chronic Rhinosinusitis. Postgraduate Medicine, 123(2), 112–118. doi:10.3810/pgm.2011.03.2269

The surgery is quite expensive due to the high cost of the balloon sinuplasty device.
Limited balloon sinuplasty devices are approved by the FDA.
Surgery is not recommended in individuals with nasal polyps, tumors, and fungal sinusitis.

Rhinoplasty Surgery for a Deviated Septum

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What is Rhinoplasty Surgery?

Rhinoplasty surgery is a procedure to reshape the nose to enhance its appearance and improve the function. This is also known as “nose job” and is among the most commonly-performed surgical procedures in the US.¹³Meningaud, J.-P., Lantieri, L., & Bertrand, J.-C. (2008). Rhinoplasty: An Outcome Research. Plastic and Reconstructive Surgery, 121(1), 251–257.

Rhinoplasty Surgery Procedure Steps

The steps followed during a rhinoplasty surgery procedure are:¹⁴American Society of Plastic Surgeons.

step 1

Local or general anesthesia is given to numb the nose.

step 2

Cuts are made using a blade either on the inner skin of the nose (closed procedure) or on the outer skin separating two nostrils (open procedure).

step 3

Following this, the skin covering the nasal bone and cartilage is lifted.

step 4

The nose is reshaped by removing the bone and cartilage. In some, a cartilage graft may be added to enhance the shape of the nose.

step 5

The soft tissue is again stitched back on the nose. Splints or nasal packing may be placed within the nose to give support.

Pros and Cons of Rhinoplasty Surgery

When deciding whether or not to have this procedure done for your deviated septum, consider these pros and cons:¹⁵Lee, H. S., Yoon, H. Y., Kim, I. H., & Hwang, S. H. (2017). The effectiveness of postoperative intervention in patients after rhinoplasty: a meta-analysis. European Archives of Oto-Rhino-Laryngology, 274(7), 2685–2694

Pros of Balloon Sinuplasty Surgery:

This surgery enhances the aesthetic appearance of the nose and improves the self-esteem of the individual.
It eases the process of breathing.

Cons of Balloon Sinuplasty Surgery:

Multiple surgeries may be required to attain satisfactory aesthetic results.
The surgery is quite expensive.
Results can be unpredictable at times.

Septoplasty Combined with Other Types of Surgery

Some patients opt to have other types of surgery at the same time as septoplasty surgery. In the following sections we describe the most popular types:

1. Septoplasty and Turbinate Reduction Surgery

Turbinate reduction (also known as turbinoplasty) is a procedure that is commonly done along with septoplasty. In this section we answer common questions about having the procedures done at the same time.

What is Septoplasty and Turbinate Reduction Surgery?

Septoplasty is a procedure to correct deviated nasal septum. Meanwhile, the turbinate reduction surgery involves the reduction of enlarged turbinates (small bony projections) present on the side walls of the nose. Both of these procedures are performed to overcome the nasal obstruction.¹⁶Kim, D. H., Park, H. Y., Kim, H. S., Kang, S. O., Park, J. S., Han, N. S., & Kim, H. J. (2008). Effect of Septoplasty on Inferior Turbinate Hypertrophy. Archives of Otolaryngology–Head & Neck Surgery, 134(4), 419

Research suggests that some individuals with deviated nasal septum tend to develop overgrowth of turbinates in the side opposite to the septal deviation. Due to the deflection of the septum to one side, the area opposite to deflected septum becomes large.

This overgrowth of turbinates is a compensatory mechanism to inhibit the excess airflow through a large nasal passage. The entry of excess air causes drying and crusting (scabs) of the nasal mucosa (inner skin). So, to protect nasal mucosa it is recommended to perform septoplasty in combination with turbinate reduction surgery.¹⁷Karlsson TR, Shakeel M, Supriya M, Ram B, Ah-See KW. Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure. Rhinology. 2015 Mar;53(1):59.

Septoplasty and Turbinate Reduction Surgery – How Is It Done?

Septoplasty and turbinate reduction surgery can be performed together. Septoplasty involves the identification of specific areas of the deviation or bend on the septum. These areas are then cut and removed, resulting in the straightening of the septum. Meanwhile, on the opposite side of the deflected septum, the mucosa (inner skin) and bone of enlarged turbinates are reduced and reshaped using a blade (scalpel), laser, or radiofrequency methods.¹⁸Veit JA, Nordmann M, Dietz B, Sommer F, Lindemann J, Rotter N, Greve J, von Bomhard A, Hoffmann TK, Riepl R, Scheithauer MO. Three different turbinoplasty techniques combined with septoplasty: prospective randomized trial. The Laryngoscope. 2017 Feb;127(2):303-8.

Benefits of Septoplasty Turbinate Reduction Surgery

Performing septoplasty in combination with turbinate reduction eliminates the nasal obstruction and eases the process of breathing. These combined surgeries also help to reduce symptoms in conditions such as chronic rhinosinusitis (inflammation of nose and sinus), sleep apnea, and epistaxis (nosebleed).¹⁹Han JK, Stringer SP, Rosenfeld RM, Archer SM, Baker DP, Brown SM, et al. Clinical consensus statement: septoplasty with or without inferior turbinate reduction. Otolaryngology–Head and Neck Surgery. 2015 Nov;153(5):708-20. Research suggests that the need for revision nasal surgery was reduced in individuals who underwent combined surgeries compared to septoplasty alone.²⁰Karlsson TR, Shakeel M, Supriya M, Ram B, Ah-See KW. Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure. Rhinology. 2015 Mar;53(1):59.

2. Septoplasty and Rhinoplasty Surgery

Getting septoplasty and rhinoplasty done together is another popular surgical procedure for people with a deviated septum. In this section we answer common questions related to having the two procedures done at the same time:

What’s the Difference Between Rhinoplasty and Septoplasty?

Rhinoplasty is performed to reshape the nose for aesthetic purposes. This involves reshaping or removing the bone and cartilage present in the nose. This procedure can also improve the airflow through the nose along with its appearance.

Meanwhile, septoplasty is a procedure to correct the asymmetrical nasal septum which tends to cause nasal obstruction and affects breathing. This involves reshaping and removing the bend present on the septum, resulting in the straightening of the septum. This procedure mainly improves the function of the nose and doesn’t change its appearance.²¹Ishii LE, O’Connor SS, Strike DJ, Walsh SA. Plain Language Summary: Improving Nasal Form and Function after Rhinoplasty. Otolaryngology–Head and Neck Surgery. 2017 Feb;156(2):220-7.

Septoplasty and Rhinoplasty Together – How Is It Done?

Rhinoplasty involves the restructuring of the external appearance of the nose. It involves removing the bone and cartilage present on the outward nose. Sometimes, graft may be added to enhance the shape of the nose. Any deviation present in the septum is corrected simultaneously by a septoplasty. It involves the identification and removal of the bend present on the nasal septum, resulting in the straightening of the nasal septum.²²Geriatic Rhinities - ENT Health

Should I Get Rhinoplasty if I Get Septoplasty?

Rhinoplasty can be combined with septoplasty to achieve improvement in the appearance and function of the nose. When performed together this is known as Septorhinoplasty surgery. Performing these surgeries simultaneously saves time, money, and lessens the recovery duration for the patient.

Sources:

1
Siegel, N. S., Gliklich, R. E., Taghizadeh, F., & Chang, Y. (2000). Outcomes of septoplasty. Otolaryngology-Head and Neck Surgery, 122(2), 228–232.
2
Shah J, Roxbury CR, Sindwani R. Techniques in Septoplasty: Traditional Versus Endoscopic Approaches. Otolaryngol Clin North Am. 2018;51(5):909-917.
3
Baumann I. Quality of life before and after septoplasty and rhinoplasty. GMS current topics in otorhinolaryngology, head and neck surgery. 2010;9.
4
Ketcham, A. S., & Han, J. K. (2010). Complications and Management of Septoplasty. Otolaryngologic Clinics of North America, 43(4), 897–904.
5
Friedman, M., Tanyeri, H., Lim, J., Landsberg, R., & Caldarelli, D. (1999). A Safe, Alternative Technique for Inferior Turbinate Reduction. The Laryngoscope, 109(11), 1834–1837.
6
Galetti, G., Dallari, S., & Galetti, R. (1991). Turbinoplasty: Personal Technique and Long-Term Results. ORL, 53(2), 111–115.
7
Chang, C. W. D., & Ries, W. R. (2004). Surgical treatment of the inferior turbinate: new techniques. Current Opinion in Otolaryngology & Head and Neck Surgery, 12(1), 53–57.
8
Mabry, R. L. (1984). Surgery of the Inferior turbinates: How Much and When? Otolaryngology-Head and Neck Surgery, 92(5), 571–576
9
Stewart, A. E., & Vaughan, W. C. (2010). Balloon Sinuplasty Versus Surgical Management of Chronic Rhinosinusitis. Current Allergy and Asthma Reports, 10(3), 181–187.
10
Levine, H., & Rabago, D. (2011). Balloon Sinuplasty: A Minimally Invasive Option for Patients with Chronic Rhinosinusitis. Postgraduate Medicine, 123(2), 112–118. doi:10.3810/pgm.2011.03.2269
11
Meningaud, J.-P., Lantieri, L., & Bertrand, J.-C. (2008). Rhinoplasty: An Outcome Research. Plastic and Reconstructive Surgery, 121(1), 251–257.
12
American Society of Plastic Surgeons.
13
Lee, H. S., Yoon, H. Y., Kim, I. H., & Hwang, S. H. (2017). The effectiveness of postoperative intervention in patients after rhinoplasty: a meta-analysis. European Archives of Oto-Rhino-Laryngology, 274(7), 2685–2694
14
Kim, D. H., Park, H. Y., Kim, H. S., Kang, S. O., Park, J. S., Han, N. S., & Kim, H. J. (2008). Effect of Septoplasty on Inferior Turbinate Hypertrophy. Archives of Otolaryngology–Head & Neck Surgery, 134(4), 419
15
Karlsson TR, Shakeel M, Supriya M, Ram B, Ah-See KW. Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure. Rhinology. 2015 Mar;53(1):59.
16
Veit JA, Nordmann M, Dietz B, Sommer F, Lindemann J, Rotter N, Greve J, von Bomhard A, Hoffmann TK, Riepl R, Scheithauer MO. Three different turbinoplasty techniques combined with septoplasty: prospective randomized trial. The Laryngoscope. 2017 Feb;127(2):303-8.
17
Han JK, Stringer SP, Rosenfeld RM, Archer SM, Baker DP, Brown SM, et al. Clinical consensus statement: septoplasty with or without inferior turbinate reduction. Otolaryngology–Head and Neck Surgery. 2015 Nov;153(5):708-20.
18
Karlsson TR, Shakeel M, Supriya M, Ram B, Ah-See KW. Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure. Rhinology. 2015 Mar;53(1):59.
19
Ishii LE, O’Connor SS, Strike DJ, Walsh SA. Plain Language Summary: Improving Nasal Form and Function after Rhinoplasty. Otolaryngology–Head and Neck Surgery. 2017 Feb;156(2):220-7.
20
Geriatic Rhinities - ENT Health

Medication for a Deviated Septum: Do You Know the Three Major Types?

Medication for a Deviated Septum: Do You Know the Three Major Types?

Septoplasty Surgery for a Deviated Septum: Plain English Guide for Patients

Septoplasty Surgery for a Deviated Septum: Plain English Guide for Patients

What is Deviated Septum Surgery? A Quick & Simple Explanation

What is Deviated Septum Surgery? A Quick & Simple Explanation

Deviated Septum Sinus Infections: How Does a Deviated Septum Cause Sinus Infections?

Deviated Septum Sinus Infections: How Does a Deviated Septum Cause Sinus Infections?

Rhinoplasty Surgery for a Deviated Septum: Plain English Guide for Patients

November 6, 2020 by Marc Leave a Comment

In this plain English guide to rhinoplasty surgery for a deviated septum, we cover everything you need to know about this common surgical procedure:

What is rhinoplasty surgery?
What happens during a rhinoplasty surgery?
What should I expect after rhinoplasty surgery?
What are the risks of rhinoplasty surgery?
What are the pros & cons of rhinoplasty surgery?

And much more. Let’s get started:

Table Of Contents

What is Rhinoplasty Surgery?

Rhinoplasty Surgery Procedure Steps

Effectiveness of Rhinoplasty Surgery

What to Expect After Rhinoplasty Surgery?

Rhinoplasty Surgery Recovery

Precautions After Rhinoplasty Surgery

Rhinoplasty Pain After Surgery

Rhinoplasty Surgery Side Effects

Pros and Cons of Rhinoplasty Surgery

Rhinoplasty Surgery Pictures

Rhinoplasty Surgery Videos

Frequently Asked Questions – Rhinoplasty Surgery

What is Rhinoplasty Surgery?

Rhinoplasty surgery is a procedure that reshapes the nose or enhances the appearance of the nose while restoring or improving its function. It is one of the most commonly-performed surgical procedure in the US. This procedure is also known as “nose job” or nose reshaping.¹Sean T. Massa MD, Scott G. Walen MD. Evidence-Based Clinical Practice in Otolaryngology, 2018, 59-71.

Rhinoplasty Surgery Procedure Steps

The steps that are followed during a rhinoplasty surgery procedure are:²American Society of Plastic Surgeons.

step 1

Based on the patient’s preference and complexity of the case, local or general anesthesia is given to the patient to numb the nose.

step 2

Using a blade, incisions are marked either internally on the inner skin of the nose (closed procedure) or externally on the skin separating two nostrils (open procedure).

step 3

Following this, skin covering the nasal bone and cartilage is lifted.

step 4

The nose is reshaped by removing bone and cartilage. Occasionally, cartilage graft is added to enhance the shape of the nose.

step 5

Any deviation present in the septum is corrected simultaneously.

step 6

The soft tissue is again stitched back on the nose. Splints or nasal packing may be placed within the nose to give support.

Effectiveness of Rhinoplasty Surgery

Studies show there is significant improvement in the appearance and function of the nose after rhinoplasty. Individuals reported improvement in the quality of life and satisfaction with the results of rhinoplasty upon evaluation at the end of 3 and 6 months.³Esteves SS, Gonçalves Ferreira M, Almeida JC, Abrunhosa J. Evaluation of aesthetic and functional outcomes in rhinoplasty surgery: a prospective study. Brazilian Journal of Otorhinolaryngology. 2017 Oct;83(5):552-7

What to Expect After Rhinoplasty Surgery?

After the rhinoplasty procedure, patients can expect the following:⁴Cochran, C. S., Ducic, Y., & DeFatta, R. J. (2008). Current Concepts in the Postoperative Care of the Rhinoplasty Patient. Southern Medical Journal, 101(9), 935–939.

Post-surgery, the patient may have discomfort or congestion in the nose due to the presence of nasal splint or packing. The nasal packing is given to stop post-surgery bleeding, while nasal splints help to stabilize the septum and prevent adhesions (fusion between septum and adjacent structures in the nose).
Post-surgery dressing will be placed over the nose. This provides comfort to the patient as it allows only a partial view of the post-operative changes and prevents anxiousness or depression that may be caused by looking at the nose.
Mild bleeding from the nose can be expected for a very short duration.
Pain or tenderness will be present for up to 48 hours. In case of severe pain contact the doctor.
Swelling at the operated site can be seen for 2-3 days which subsides gradually.
The doctor will document the patient’s satisfaction with the appearance and function of the nose for at least a year.

Rhinoplasty Surgery Recovery

To recover from a rhinoplasty surgery, patients are advised to:⁵Lee, H. S., Yoon, H. Y., Kim, I. H., & Hwang, S. H. (2017). The effectiveness of postoperative intervention in patients after rhinoplasty: a meta-analysis. European Archives of Oto-Rhino-Laryngology, 274(7), 2685–2694

Apply cold pack or ice intermittently for 20 minutes for 3 post-operative days to reduce pain, swelling, and discoloration of skin.
Use medications (antibiotic and painkillers), as prescribed.
Perform nasal saline irrigation once or twice daily for 1-2 weeks after the surgery as it helps in clearing the accumulated mucus and reducing the patient’s discomfort.
Use Arnica montana, an herbal supplement that helps in treating the postoperative swelling and discoloration, and fastens the recovery.
Use cotton buds or Q-tips with antibiotic ointment to gently clean scabs in the nostrils.
Visit the doctor for regular follow ups and assessment of the symptoms.

Precautions After Rhinoplasty Surgery

After the rhinoplasty procedure, patients should follow these precautions:⁶Simpson JC. Postoperative Care of The Patient After Nasal Surgery

Avoid blowing of nose at least for a week post surgery.
Avoid lifting weights or performing vigorous workout.
While sleeping, keep the head elevated (by ~30 degrees) by using 2-3 pillows.
Avoid sneezing with the mouth closed. Keep the mouth open while sneezing.
Avoid smoking tobacco and drinking alcohol.
Avoid biting on hard food for 1 week after surgery.
Avoid visiting crowded places.

Rhinoplasty Pain After Surgery

Most patients report minimal to moderate pain for 36-72 hours after rhinoplasty surgery. Patients rarely complain of severe pain. However, the nose may remain sensitive to touch until 3 months. The pain can be managed using painkillers, cold packs, herbal supplement Arnica montana, or by keeping the head elevated while sleeping using pillows. In case of severe pain even 48 hours after the surgery, the patient should contact the doctor.⁷Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR,et al.Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngol Head Neck Surg. 2017 Feb;156(2_suppl):S1-S30.

Rhinoplasty Surgery Side Effects

Complications are observed in 1.7-18% of rhinoplasty surgeries. The most common side effects of the surgery include presence of infection (~15%), delayed wound healing (~5%), and postoperative bleeding (~2%).

Other complications include septal hematoma (collection of blood between nostrils), numbness in skin of the nose, over correction of the nose, perforation of the nasal septum, nasal obstruction, and requirement of revisional surgery.⁸Layliev J, Gupta V, Kaoutzanis C, Ganesh Kumar N, Winocour J, Grotting JC, Higdon KK. Incidence and preoperative risk factors for major complications in aesthetic rhinoplasty: analysis of 4978 patients. Aesthetic surgery journal. 2017 Jul 1;37(7):757-67.

Pros and Cons of Rhinoplasty Surgery

When deciding whether or not to have this procedure done for your deviated septum, consider these pros and cons:⁹Lee, H. S., Yoon, H. Y., Kim, I. H., & Hwang, S. H. (2017). The effectiveness of postoperative intervention in patients after rhinoplasty: a meta-analysis. European Archives of Oto-Rhino-Laryngology, 274(7), 2685–2694

Pros of Rhinoplasty Surgery:

It restores aesthetics and the function of the nose.
Enhanced aesthetics improve the confidence and self-esteem of the patient.

Cons of Rhinoplasty Surgery:

The results of the surgery can be unpredictable at times.
It is a technique-sensitive procedure due to high aesthetic demands of the patient.
The surgery is quite expensive. The patient may require to undergo multiple surgeries to achieve satisfactory results.

Rhinoplasty Surgery Pictures

Here are some excellent photos that show the rhinoplasty procedure:

source

Rhinoplasty Surgery Videos

Here are some excellent videos that show the rhinoplasty procedure:

Frequently Asked Questions – Rhinoplasty Surgery

Here are answers to the most commonly asked questions related to rhinoplasty surgery:

Is rhinoplasty a major surgery?

The short answer is yes.

Rhinoplasty involves intricate procedures which can impact the overall facial balance. As a result, the surgery is artistically most challenging of all aesthetic surgeries.¹⁰Daniel RK, Pálházi P. Rhinoplasty: an anatomical and clinical atlas. Springer; 2018 Mar 6.

How long does rhinoplasty surgery take?

Rhinoplasty surgery takes an average time of 1.45- 2.15 hours.¹¹ Foda, H. M. T. (2003). External rhinoplasty: a critical analysis of 500 cases. The Journal of Laryngology & Otology, 117(06)

What is the recovery time for rhinoplasty surgery?

The swelling after rhinoplasty surgery subsides within a few weeks. While it may take a year for permanent changes in the nasal contour to become evident.¹²American Society of Plastic Surgeons.

What is the cost of rhinoplasty surgery in the USA?

The average rhinoplasty procedure typically exceeds $4,000, excluding cost incurred for anesthesia, operating room facilities, and other expenses.¹³Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR,et al.Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngol Head Neck Surg. 2017 Feb;156(2_suppl):S1-S30.

Sources:

1
Sean T. Massa MD, Scott G. Walen MD. Evidence-Based Clinical Practice in Otolaryngology, 2018, 59-71.
2
American Society of Plastic Surgeons.
3
Esteves SS, Gonçalves Ferreira M, Almeida JC, Abrunhosa J. Evaluation of aesthetic and functional outcomes in rhinoplasty surgery: a prospective study. Brazilian Journal of Otorhinolaryngology. 2017 Oct;83(5):552-7
4
Cochran, C. S., Ducic, Y., & DeFatta, R. J. (2008). Current Concepts in the Postoperative Care of the Rhinoplasty Patient. Southern Medical Journal, 101(9), 935–939.
5
Lee, H. S., Yoon, H. Y., Kim, I. H., & Hwang, S. H. (2017). The effectiveness of postoperative intervention in patients after rhinoplasty: a meta-analysis. European Archives of Oto-Rhino-Laryngology, 274(7), 2685–2694
6
Simpson JC. Postoperative Care of The Patient After Nasal Surgery
7
Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR,et al.Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngol Head Neck Surg. 2017 Feb;156(2_suppl):S1-S30.
8
Layliev J, Gupta V, Kaoutzanis C, Ganesh Kumar N, Winocour J, Grotting JC, Higdon KK. Incidence and preoperative risk factors for major complications in aesthetic rhinoplasty: analysis of 4978 patients. Aesthetic surgery journal. 2017 Jul 1;37(7):757-67.
9
Daniel RK, Pálházi P. Rhinoplasty: an anatomical and clinical atlas. Springer; 2018 Mar 6.
10
Foda, H. M. T. (2003). External rhinoplasty: a critical analysis of 500 cases. The Journal of Laryngology & Otology, 117(06)

Deviated Septum Surgery: How to Know When It’s Time to Do It

Deviated Septum Surgery: How to Know When It’s Time to Do It

Deviated Septum Self-Test: How to Test Yourself for a Deviated Septum

Deviated Septum Self-Test: How to Test Yourself for a Deviated Septum

Buteyko Breathing for a Deviated Septum: Everything You Need to Know

Buteyko Breathing for a Deviated Septum: Everything You Need to Know

Deviated Septum Pain: Your Complete Guide to Managing Pain

Deviated Septum Pain: Your Complete Guide to Managing Pain

Septoplasty Surgery for a Deviated Septum: Plain English Guide for Patients

October 29, 2020 by Marc Leave a Comment

In this plain English guide to septoplasty surgery for a deviated septum, we cover everything you need to know about this common surgical procedure:

What is septoplasty surgery?
What happens during septoplasty surgery?
What should I expect after septoplasty surgery?
What are the risks of septoplasty surgery?
What are the pros & cons of septoplasty surgery?

Let’s get into it!

Table Of Contents

What is Septoplasty Surgery?

Septoplasty Procedure Steps

Effectiveness of Septoplasty

What to Expect After Septoplasty Surgery?

Septoplasty Surgery Recovery

Precautions After Septoplasty Surgery

Septoplasty Pain After Surgery

Septoplasty Surgery Side Effects

Septoplasty Surgery Pictures

Septoplasty Surgery Videos

Frequently Asked Questions – Septoplasty Surgery

Frequently Asked Questions – Septoplasty Splints

What is Septoplasty Surgery?

source

Septoplasty surgery is the most-commonly performed surgical procedure to improve the nasal airway. It may be required in individuals with deviated nasal septum as a result of trauma, deformation from birth, or severe nasal infections.¹Gandomi B, Bayat A, Kazemei T. Outcomes of septoplasty in young adults: the Nasal Obstruction Septoplasty Effectiveness study. American journal of otolaryngology. 2010 May 1;31(3):189-92.

Septoplasty Procedure Steps

step 1

The anesthesia is injected into the nose to numb the area.

step 2

Using a blade, an incision (cut) is made on the mucosa (inner skin) of the nose through the nostril at the lower portion of the septum.

step 3

Following this, skin covering the septum is lifted and septum is exposed.

step 4

Cartilaginous and bony bents on the septum are identified and cut using an instrument.

step 5

The soft tissue is stitched back on the septum.

Effectiveness of Septoplasty

Studies show that septoplasty results in significant improvement in the symptoms associated with deviated septum, and within 3 months of the surgery, leads to a reduction in the use of medication to overcome the symptoms.³Stewart MG, Smith TL, Weaver EM, Witsell DL, Yueh B, Hannley MT, Johnson JT. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg. 2004 Mar;130(3):283-90.

This leads to overall improvement in the quality of life and higher satisfaction levels.

Research suggests that the success rate of the septoplasty varies from 65-83%. Younger individuals with a complain of nasal obstruction are more likely to benefit from the surgery.⁴Siegel, N. S., Gliklich, R. E., Taghizadeh, F., & Chang, Y. (2000). Outcomes of septoplasty. Otolaryngology-Head and Neck Surgery, 122(2), 228–232.

What to Expect After Septoplasty Surgery?

After the septoplasty procedure, patients can expect the following symptoms:⁵Bernardo MT, Alves S, Lima NB, Helena D, Condé A. Septoplasty with or without postoperative nasal packing? Prospective study. Braz J Otorhinolaryngol. 2013 Aug;79(4):471-4. English, Portuguese.

Post-surgery, the patient may feel uneasy due to the dressing and packing in nostrils. This packing is to stop post-surgery bleeding. The patient needs to breathe through the mouth until it is removed.
Mild oozing of blood can be expected from the nose after the surgery. A drip pad is placed underneath the nose to absorb bloody discharge from nose. In case of heavy bleeding one can immediately contact the surgeon.
Nasal pain can be experienced by patients in the first 48 hrs.
Mild to moderate swelling, bruising, and discoloration can be seen in nasal and adjacent areas, which subsides gradually.
If the surgeon has placed splints in the nose, the patient needs to visit the doctor in a week’s time to remove it.
Headaches, watering of eyes (epiphora), dryness of mouth, discomfort while swallowing, and sleep disturbances can be experienced by patients with nasal packing.
Mild pain and discomfort may be present during removal of nasal packing or nasal splint.

Septoplasty Surgery Recovery

To recover from septoplasty surgery, patients are advised to follow these instructions:⁶Simpson JC. Postoperative Care of The Patient After Nasal Surgery

Keep an ice or gel pack over the nose for 20 minutes intermittently for the next 36-48 hours post-surgery to reduce swelling and bruising.
Take medications on time for a specified duration.
Use a saline nasal spray (after the packing is removed) or saline irrigation for several weeks to keep the nose moist.
Use clean cotton swabs with antibiotic ointment or hydrogen peroxide to gently clean nostrils and the surrounding areas to prevent infections.
Visit the doctor for follow up visits as recommended after the surgery.

Precautions After Septoplasty Surgery

After the septoplasty procedure, patients should follow these precautions:⁷Simpson JC. Postoperative Care of The Patient After Nasal Surgery

Do not blow nose for at least a week. Post one week, try to blow nose gently, without any excessive pressure.
Avoid sneezing with mouth closed. Keep mouth open while sneezing.
Due to nasal packing, breathing through the mouth is recommended.
Keep head elevated, use 2-3 pillows while sleeping.
Avoid any vigorous exercise or lifting heavy objects, or bending forward.
Avoid hot steam baths and showers.
Avoid Smoking and drinking alcohol.
Avoid going to public places.

Septoplasty Pain After Surgery

Most patients report feeling moderate pain after the septoplasty surgery. The patient may complain of pain in the nose and the surrounding facial areas. Intake of analgesics (pain killers) and avoiding straining of nose, application of cold packs, and keeping head in elevated position can reduce the discomfort.⁸Ketcham, A. S., & Han, J. K. (2010). Complications and Management of Septoplasty. Otolaryngologic Clinics of North America, 43(4), 897–904.

Septoplasty Surgery Side Effects

Potential side effects of septoplasty surgery include….⁹Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

Hemorrhage: Excessive bleeding after the surgery is reported in 6-13% of patients. Mild oozing of blood from nose is common after the surgery. In case of excessive bleeding, the patient should contact the surgeon.
Infections: Some patients may develop infections at the site of surgery.
Septal hematoma: Individuals may develop swelling due to accumulation of blood in the septal region. If left untreated, this may turn into an infection.
Overcorrected septum: In ~2% of patients, septum is overcorrected which hinders both shape and functioning of the nose.
Septal perforation: It is a late complication, seen in 1-6% of patients. Presence of small perforations may hinder the humidification of nose while large ones may cause structural deformities.
Adhesions: It is caused due to fusion between the mucosa (inner skin) of nasal septum with adjacent structures. This can lead to postoperative nasal congestion.
Cerebrospinal fluid leak: This is a rare case, where the patient experiences watery brain fluid discharge from nose and sinuses, and also experiences headaches.

When deciding whether or not to have this procedure done for your deviated septum, consider these pros and cons:

Pros of Septoplasty:¹⁰Baumann I. Quality of life before and after septoplasty and rhinoplasty. GMS current topics in otorhinolaryngology, head and neck surgery. 2010;9.

Eases the process of breathing by eliminating the obstruction present due to deviated septum.
Improves symptoms associated with deviated septum such as snoring, runny nose, nasal congestion, post nasal drip (mucus entering the throat), and reduced sense of smell.
Decreases the incidence of sinonasal infections.

Cons of Septoplasty:¹¹Ketcham, A. S., & Han, J. K. (2010). Complications and Management of Septoplasty. Otolaryngologic Clinics of North America, 43(4), 897–904.

Conventional septoplasty is associated with several side effects such as infections, perforation on septum, excessive bleeding, and hematoma (septal swelling due to pooling of blood).
In few patients, the nose gets overcorrected after the surgery which affects the appearance and functions of the nose.
Excess trimming of bone or removal of tissue can affect the postoperative discomfort.

Septoplasty Surgery Pictures

Here are some excellent photos that show the septoplasty procedure:

source

Septoplasty Surgery Videos

Here are some excellent videos that show the septoplasty procedure:

Frequently Asked Questions – Septoplasty Surgery

Here are answers to the most commonly asked questions related to septoplasty surgery:

Is septoplasty a major surgery?

It is the most-commonly performed nasal surgery with minor procedures compared to other surgeries. Considering its risk factors, we can label it as a major surgery.

How long does septoplasty surgery take?

Depending on the complexity of the condition, it takes 1- 1.5 hours to complete a septoplasty surgery.

What is the recovery time for septoplasty surgery?

Complete recovery from septoplasty may take about 6 weeks. Patients can resume their work within 7-10 days.¹²Baumann I. Quality of life before and after septoplasty and rhinoplasty. GMS current topics in otorhinolaryngology, head and neck surgery. 2010;9.

What is the cost of septoplasty in the USA?

The average cost of the conventional septoplasty procedure ranges between USD 6,000-30,000. The cost varies according to local standards, complexity of the nose to be operated, surgeon’s expertise, reputation, clinical experience, and operating room’s fees.¹³Cost of Septoplasty - 2020 Healthcare Costs

What are signs of infection after septoplasty surgery?

Infection is common in septoplasty and the signs can include systemic changes such as change in blood pressure and heart rate, vomiting, diarrhea, skin discoloration, and multiple systemic complaints.¹⁴Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

Frequently Asked Questions – Septoplasty Splints

Nasal splints are commonly placed in the nose after septoplasty surgery in order to stabilize the healing septum. As a result, many people have questions about splints. We answer the most common questions below:

What do nasal splints look like?

source

Nose splints are small plastic or silicone devices used to stabilize the nose after nasal surgery.¹⁵Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

Do you need splints after septoplasty?

After the septoplasty, internal splints are placed along the septum in each nostril for 1-2 weeks after the surgery. The splints help stabilize the treated septum and compress the septum to help reduce bleeding related complications.¹⁶Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

How long do splints stay in after septoplasty?

Intranasal splints may be placed for 1-15 days after the septoplasty surgery.¹⁷Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

How long does it take for dissolvable septoplasty splint to dissolve?

It takes 15-25 weeks for the splint to dissolve.¹⁸Lau, J., Elhassan, H. A., & Singh, N. (2018). History of intranasal splints. The Journal of Laryngology & Otology, 132(03), 198–201.

Can nasal splints fall out?

Yes, they can fall out. If the patient sneezes vigorously within 1-2 days of the surgery then there are chances of the splint falling out

Septoplasty splints clogged – what can I do to unclog them?

It is common for the splints to get clogged with dried blood shortly after surgery which can create significant congestion and pressure.

To relieve congestion, hydrogen peroxide can be used with a Q tip to clean both sides of the splint. The use of saline sprays may also help loosen up blockage. In case of excessive discomfort, the patient should consult a doctor.¹⁹Simpson JC. Postoperative Care of The Patient After Nasal Surgery

Septoplasty splint removal pain – how painful is it?

Removal of internal nasal splints can cause discomfort and pain. Research suggests that removal of internal nasal splints within 24 hours are less painful.²⁰Simpson JC. Postoperative Care of The Patient After Nasal Surgery

What to expect after nasal splints are removed?

There will be a slight discomfort or bleeding while removing the nasal splints.²¹Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

Sources:

1
Gandomi B, Bayat A, Kazemei T. Outcomes of septoplasty in young adults: the Nasal Obstruction Septoplasty Effectiveness study. American journal of otolaryngology. 2010 May 1;31(3):189-92.
2
Shah J, Roxbury CR, Sindwani R. Techniques in Septoplasty: Traditional Versus Endoscopic Approaches. Otolaryngol Clin North Am. 2018;51(5):909-917.
3
Stewart MG, Smith TL, Weaver EM, Witsell DL, Yueh B, Hannley MT, Johnson JT. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg. 2004 Mar;130(3):283-90.
4
Siegel, N. S., Gliklich, R. E., Taghizadeh, F., & Chang, Y. (2000). Outcomes of septoplasty. Otolaryngology-Head and Neck Surgery, 122(2), 228–232.
5
Bernardo MT, Alves S, Lima NB, Helena D, Condé A. Septoplasty with or without postoperative nasal packing? Prospective study. Braz J Otorhinolaryngol. 2013 Aug;79(4):471-4. English, Portuguese.
6
Simpson JC. Postoperative Care of The Patient After Nasal Surgery
7
Ketcham, A. S., & Han, J. K. (2010). Complications and Management of Septoplasty. Otolaryngologic Clinics of North America, 43(4), 897–904.
8
Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.
9
Baumann I. Quality of life before and after septoplasty and rhinoplasty. GMS current topics in otorhinolaryngology, head and neck surgery. 2010;9.
10
Cost of Septoplasty - 2020 Healthcare Costs - CostHelper
11
Lau, J., Elhassan, H. A., & Singh, N. (2018). History of intranasal splints. The Journal of Laryngology & Otology, 132(03), 198–201.

How to Fix a Deviated Septum Without Surgery: Complete Guide to Home Remedies, Devices & More

How to Fix a Deviated Septum Without Surgery: Complete Guide to Home Remedies, Devices & More

Deviated Septum Surgery Success Rate: A Look at the Evidence

Deviated Septum Surgery Success Rate: A Look at the Evidence

Buteyko Breathing for a Deviated Septum: Everything You Need to Know

Buteyko Breathing for a Deviated Septum: Everything You Need to Know

What is Rhinitis Medicamentosa?

What is Rhinitis Medicamentosa?

Deviated Septum Symptoms: 5 Signs to Look Out For

Deviated Septum Symptoms: 5 Signs to Look Out For

Balloon Sinuplasty Surgery for a Deviated Septum: Plain English Guide for Patients

October 29, 2020 by Marc Leave a Comment

In this plain English guide to balloon sinuplasty surgery for a deviated septum, we cover everything you need to know about this common surgical procedure:

What is balloon sinuplasty surgery?
What happens during balloon sinuplasty surgery?
Balloon sinuplasty approach utilizes balloon
What should I expect after balloon sinuplasty surgery?
What are the risks of balloon sinuplasty surgery?
What are the pros & cons of balloon sinuplasty surgery?

And much more. Let’s get started:

Table Of Contents

What is Balloon Sinuplasty Surgery?

Balloon Sinuplasty Surgery Procedure Steps

Effectiveness of Balloon Sinuplasty Surgery

What to Expect After Balloon Sinuplasty Surgery?

Balloon Sinuplasty Surgery Recovery

Precautions After Balloon Sinuplasty Surgery

Balloon Sinuplasty Pain After Surgery

Balloon Sinuplasty Surgery Side Effects

Pros and Cons of Balloon Sinuplasty Surgery

Balloon Sinuplasty Surgery Pictures

Balloon Sinuplasty Surgery Videos

Frequently Asked Questions – Balloon Sinuplasty Surgery

What is Balloon Sinuplasty Surgery?

Balloon sinuplasty surgery is an alternative approach to treat chronic rhinosinusitis (inflammation of nose and sinuses) due to blockage of sinus opening. It uses a small, flexible balloon catheter which when inserted into the sinus and inflated, enlarges the sinus opening. This allows draining of the accumulated mucus (slimy substance) in the sinus, relieving from sinus congestion and associated infections.¹Lofgren DH, Shermetaro C. Balloon Sinuplasty. [Updated 2020 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan

Balloon Sinuplasty Surgery Procedure Steps

The steps that followed during a balloon sinuplasty procedure are²Stewart, A. E., & Vaughan, W. C. (2010). Balloon Sinuplasty Versus Surgical Management of Chronic Rhinosinusitis. Current Allergy and Asthma Reports, 10(3), 181–187.

step 1

The sinus region is anesthetized and a guidewire is inserted into the sinus with the help of an endoscope (a thin, flexible tube with a camera).

step 2

The correct positioning of the guide wire in the sinus is confirmed. A deflated balloon catheter is inserted along the guide wire into the sinus opening (sinus ostia).

step 3

After confirming the position, the balloon is slowly inflated.

step 4

The balloon is inflated until the sinus opening is enlarged, permitting draining of accumulated mucus from clogged sinus. Saline is injected through the catheter to flush the sinus and remove the remaining mucus and pus.

step 5

The device is then removed.

Effectiveness of Balloon Sinuplasty Surgery

Studies of balloon sinuplasty surgery show that the surgery is effective in enlarging the sinus opening without excessive removal of soft tissue or bone, or even injuring the surrounding structures. With this technique, individuals experience minimal trauma, pain, and bleeding, and tend to recover faster when compared to conventional procedures.

Research suggests that reduction in the symptoms were observed in ~95% of individuals and ~73% of individuals were symptom free.³Taghi, A. S., Khalil, S. S., Mace, A. D., & Saleh, H. A. (2009). Balloon Sinuplasty™: balloon-catheter dilation of paranasal sinus ostia for chronic rhinosinusitis. Expert Review of Medical Devices, 6(4), 377–382.

What to Expect After Balloon Sinuplasty Surgery?

After the balloon sinuplasty procedure, patients can expect⁴Hur K, Ge M, Kim J, Ference EH. Adverse Events Associated with Balloon Sinuplasty: A MAUDE Database Analysis. Otolaryngol Head Neck Surg. 2020 Jan;162(1):137-141.

Mild bleeding (largely oozing type) from the nose for the first few days.
Small swelling and tenderness in the region of cheeks, beneath the eyes and the nose in the first few days, which will subside gradually.
Nasal and sinus congestion or feeling of fullness may be present in the first week after the surgery.
Tiredness and weakness may be experienced in the initial days.

Balloon Sinuplasty Surgery Recovery

To recover from balloon sinuplasty surgery, patients are advised to⁵Lofgren DH, Shermetaro C. Balloon Sinuplasty. [Updated 2020 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan

Take medications as prescribed.
Apply ice/gel pack over eyes and upper cheeks as much as possible for the next 48 hours for 20 minutes intermittently post-surgery (this helps reduce swelling).
Perform nasal rinsing with saline as per the instructions.
Visit doctor for follow up visits after 1 week, 3 months, and a year after the surgery.
Take up follow up CT (computed tomography) scans as advised by the doctor.
Visit the doctor for assessment of vision and mental heath status in the following weeks after the surgery.
Visit the doctor for evaluation of the quality of life before and after the surgery using several assessment tools (e.g. Sino-nasal outcome tests, Wong-Baker Faces Pain Scale).

Precautions After Balloon Sinuplasty Surgery

After the balloon sinuplasty procedure, patients should follow these precautions for 7-10 days after the surgery:⁶Endoscopic Sinus Surgery - CSOHNS

Avoid blowing of nose to allow the clot to form for an uneventful healing. The patient can sneeze keeping the mouth open.
Avoid performing any vigorous activity and lifting heavy objects after the surgery.
Take antibiotics and painkillers on time as prescribed (based on the requirement).
Visit the doctor for cleaning (debridement) of blood clots and crusts in the nose (as advised).
Avoid smoking or taking alcohol.
Avoid use of hot water or steam on the face.

Balloon Sinuplasty Pain After Surgery

Research suggests that after balloon sinuplasty surgery the level of pain that patients feel is less in comparison to conventional surgeries. Balloon sinuplasty causes minimal intrusion to the bone and mucosa while enlarging the sinus opening. As a result, reduced postoperative pain and morbidities are observed.⁷Catalano, P. J. (2013). Balloon Dilation Technology: Let the Truth Be Told. Current Allergy and Asthma Reports, 13(2), 250–254.

Balloon Sinuplasty Surgery Side Effects

Potential side effects of the balloon sinuplasty surgery include pain, and redness and bruising of skin beneath the eyes for short duration. In rare cases, a leak of cerebrospinal fluid (the liquid surrounding the brain and spinal cord) is observed.⁸Taghi, A. S., Khalil, S. S., Mace, A. D., & Saleh, H. A. (2009). Balloon Sinuplasty™: balloon-catheter dilation of paranasal sinus ostia for chronic rhinosinusitis. Expert Review of Medical Devices, 6(4), 377–382. Its occurrence is very rare and observed in 0.01% patients.⁹Cingi, C., Bayar Muluk, N., & Lee, J. T. (2018). Current indications for balloon sinuplasty. Current Opinion in Otolaryngology & Head and Neck Surgery

Pros and Cons of Balloon Sinuplasty Surgery

When deciding whether or not to have this procedure done for your deviated septum, consider these pros and cons:

Pros of Balloon Sinuplasty Surgery:¹⁰Stewart AE, Vaughan WC. Balloon sinuplasty versus surgical management of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2010 May;10(3):181-7.

Minimal intrusion without excessive removal of bone or tissue.
Reduced pain, bleeding, postoperative discomfort, and postoperative medications.
Faster recovery than the conventional procedures.
Can be performed under local anesthesia. General anesthesia is not required.

Cons of Balloon Sinuplasty Surgery:¹¹Levine, H., & Rabago, D. (2011). Balloon Sinuplasty: A Minimally Invasive Option for Patients with Chronic Rhinosinusitis. Postgraduate Medicine, 123(2), 112–118. doi:10.3810/pgm.2011.03.2269

High cost of the device (The balloon sinuplasty device (Acclarent, Menlo Park, CA costs ~$1,200 for the single-use device system).
Not recommended for individuals with nasal polyps, fungal sinusitis, or neoplasm (cancer).
Fewer devices approved by FDA.

Balloon Sinuplasty Surgery Pictures

Here are some excellent photos that show the balloon sinuplasty procedure:

source

Balloon Sinuplasty Surgery Videos

Here are some excellent videos that show the balloon sinuplasty procedure:

Frequently Asked Questions – Balloon Sinuplasty Surgery

Here are answers to the most commonly asked questions related to balloon sinuplasty surgery:

Is balloon sinuplasty a major surgery?

The short answer is No.

The balloon sinuplasty surgery can be performed in office settings under local anesthesia and doesn’t require any hospitalization. Patients are treated under “Day care” and discharged with oral antibiotics and postoperative instructions.¹²Raghunandhan, S., Bansal, T., Natarajan, K., & Kameswaran, M. (2012). Efficacy & Outcomes of Balloon Sinuplasty in Chronic Rhinosinusitis: A Prospective Study. Indian Journal of Otolaryngology and Head & Neck Surgery, 65(S2), 314–319.

How long does balloon sinuplasty surgery take?

Research suggests the average time taken to perform balloon sinuplasty surgery is ~75 minutes.¹³Levine HL, Sertich AP, Hoisington D et al (2008) A multi-center registry of balloon catheter sinusotomy outcomes for 1,036 patients. Ann Otol Rhinol Laryngol 117:263–270.

What is the recovery time for balloon sinuplasty surgery?

Research suggests that ~85-90% of the patients got relief from symptoms in the first week after the surgery. Most patients resume work within 24 hours after the surgery.¹⁴Catalano, P. J. (2013). Balloon Dilation Technology: Let the Truth Be Told. Current Allergy and Asthma Reports, 13(2), 250–254.

What is the cost of balloon sinuplasty surgery in the USA?

The cost of balloon sinuplasty surgery is ~$10,000 in the USA.¹⁵Levine, H., & Rabago, D. (2011). Balloon Sinuplasty: A Minimally Invasive Option for Patients with Chronic Rhinosinusitis. Postgraduate Medicine, 123(2), 112–118. doi:10.3810/pgm.2011.03.2269

1
Lofgren DH, Shermetaro C. Balloon Sinuplasty. [Updated 2020 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan
2
Stewart, A. E., & Vaughan, W. C. (2010). Balloon Sinuplasty Versus Surgical Management of Chronic Rhinosinusitis. Current Allergy and Asthma Reports, 10(3), 181–187.
3
Taghi, A. S., Khalil, S. S., Mace, A. D., & Saleh, H. A. (2009). Balloon Sinuplasty™: balloon-catheter dilation of paranasal sinus ostia for chronic rhinosinusitis. Expert Review of Medical Devices, 6(4), 377–382.
4
Hur K, Ge M, Kim J, Ference EH. Adverse Events Associated with Balloon Sinuplasty: A MAUDE Database Analysis. Otolaryngol Head Neck Surg. 2020 Jan;162(1):137-141.
5
Endoscopic Sinus Surgery - CSOHNS
6
Catalano, P. J. (2013). Balloon Dilation Technology: Let the Truth Be Told. Current Allergy and Asthma Reports, 13(2), 250–254.
7
Cingi, C., Bayar Muluk, N., & Lee, J. T. (2018). Current indications for balloon sinuplasty. Current Opinion in Otolaryngology & Head and Neck Surgery
8
Stewart AE, Vaughan WC. Balloon sinuplasty versus surgical management of chronic rhinosinusitis. Curr Allergy Asthma Rep. 2010 May;10(3):181-7.
9
Levine, H., & Rabago, D. (2011). Balloon Sinuplasty: A Minimally Invasive Option for Patients with Chronic Rhinosinusitis. Postgraduate Medicine, 123(2), 112–118. doi:10.3810/pgm.2011.03.2269
10
Raghunandhan, S., Bansal, T., Natarajan, K., & Kameswaran, M. (2012). Efficacy & Outcomes of Balloon Sinuplasty in Chronic Rhinosinusitis: A Prospective Study. Indian Journal of Otolaryngology and Head & Neck Surgery, 65(S2), 314–319.
11
Levine HL, Sertich AP, Hoisington D et al (2008) A multi-center registry of balloon catheter sinusotomy outcomes for 1,036 patients. Ann Otol Rhinol Laryngol 117:263–270.