NASAL SEPTAL RECONSTRUCTION
General Information
The nasal septum is the partition which separates the nasal airway into two approximately equal air passages. The nasal septum is made up of cartilage in the front and thin bone in the back lined on each side by mucus membrane. Significant airway obstruction may occur if this partition is deviated or malpositioned such that air flow is impeded. This may result in relative obstruction of both nasal passages since the nasal turbinates in the opposite nasal cavity may enlarge in an attempt to humidify and warm the extra air flow going through that side. A deviated nasal septum may occur as the result of trauma either during childhood or in an adult life, but many times it is found where no history of previous trauma exists. It is felt in those instances to represent a congenital malformation. The effects of such a deviated nasal septum include airway obstruction as mentioned above, certain types of headaches, recurrent acute sinusitis or chronic sinusitis and may significantly compound the symptoms caused by underlying allergies.
Potential Benefits of Surgery:
The principal benefit of nasal septal reconstruction is an improved nasal airway. Relief of airway obstruction should also result in decreased symptoms related to allergies, potentially decrease the occurrence of sinusitis, and in certain patients, may significantly decrease the occurrence of certain types of headaches related to nasal septal deviations. Occasionally, nasal septal reconstruction is combined with other surgery within the nasal cavity or with surgery involving the paranasal sinuses.
Risks of Surgery:
The major risks encountered in nasal septal reconstruction include potential perforation of the nasal septum if the cartilage and mucous membranes do not heal appropriately, the possibility of postoperative bleeding from the nose, and possible infection within the nose after the surgery. The possibility of scar bands developing within the nose that can be usually easily handled postoperatively is also present. Temporary numbness may occur behind the central upper teeth. There is a rare chance of decreasing the sense of smell and a small chance of changing the external appearance of the nose. A functional nasal septal reconstruction is not performed in an attempt to change the external appearance of the nose and is not a cosmetic surgical procedure.
Preoperative Evaluation:
The preoperative testing necessary for this surgery includes a complete blood count and possibly electrolytes. Chest x-ray and electrocardiogram may also be ordered. Occasionally, x-rays of the sinuses may be performed to rule out the presence of sinus disease before surgery.
Anesthesia:
Nasal septal reconstruction is performed under general anesthesia in the majority of cases. This is done to make the procedure less difficult and painful for the patient. The risk of this procedure is approximately 1 chance in 10,000 of an adverse effect from anesthesia. These include the possibility of temperature elevation, cardiac or pulmonary complications, decreased blood flow to the central nervous system, etc. These risks will be explained further by the Anesthesia Department. If you have questions concerning the anesthesia, please discuss them with the Anesthesia Department.
Hospitalization:
A morning admission for surgery with either an outpatient procedure or an overnight stay in the hospital is recommended. This provides for the appropriate degree of postoperative care to be administered to you.
Postoperative Care/Instruction:
After nasal septal reconstruction, certain symptoms are to be expected. There will be some nasal discharge present for the first few days after the operation. This may be mainly mucus, but in some cases, some old blood or some small amount of fresh blood may be seen. A mild headache may be experienced for a few days after the surgery. Nasal obstruction may last for several days following your surgery, but should gradually improve with each postoperative day. The nasal obstruction should be remarkably improved after the intranasal septal splints are removed on approximately the 7th postoperative day. Some external soreness or tenderness of the nose may be expected as well. Occasionally, numbness may be noticed behind the upper front teeth which is usually transient. No blowing of the nose is recommended for the first week after your surgery. Follow-up visits will be scheduled appropriately one week after surgery and again 3 weeks later. All of the intranasal swelling may not be completely resolved until 3-4 weeks after the operation. Continuing nasal obstruction after the 4th postoperative week is generally a sign of underlying allergic problems, non-specific rhinitis, etc. which may cause swelling of the turbinates (soft tissue and mucosal structures) within the nose and is usually not related to any remaining problems with the nasal septum. Medical therapy may be required to treat these symptoms.
During your postoperative course, we recommend the use of a cool mist humidifier the first 4 weeks. Saline nasal spray is recommended, and we suggest that it be used frequently after your surgery (every 2-3 hours) to help remove secretions and prevent nasal obstruction. Antibiotics and decongestants may be prescribed as part of your postoperative medications. Pain medication will be provided for you to control any discomfort that you may have. Most patients do not require narcotics after the initial 2-3 days after surgery. During your postoperative course, we also recommend that, for the first 1-2 weeks, you sleep your head elevated on 2 pillows to help relieve nasal obstruction and swelling.
NOTIFY OUR OFFICE IF:
- YOUR TEMPERATURE BECOMES ELEVATED TO 101° OR GREATER ORALLY
- PROGRESSIVE OR PERSISTENT HEADACHES OCCURS
- PERSISTENT CLEAR WATERY NASAL DISCHARGE CONTINUES OR PROGRESSES
- IF SWELLING OF THE FACE OR NOSE OCCURS AND PERSISTS
- PROGRESSIVE AND PERSISTENT NASAL DISCOMFORT OCCURS
PLEASE ALSO CONTACT OUR OFFICE CONCERNING ANY OTHER PROBLEMS
OR QUESTIONS YOU MIGHT ENCOUNTER
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