Nasal Septum and DNS – Deviated Nasal Septum
The Nasal Septum divides the nose into the right and left nostrils.
It is made of Cartilage (malleable tissue – anteriorly), and Bone (Posteriorly).
Though ideally the Septum should be straight there is some deviation to either side in some individuals.
Causes of DNS
- The child may be born with a deviated Septum due to pressures in the womb.
- Injury- while growing up, or as a child while playing games, or sometimes after and accident.
- Pressure of swelling like large growth/ polyp on one side of the nose can push the septum to the other side.
INDICATIONS OF SEPTOPLASTY
1. Nasal Blockage
2. Recurrent Nasal bleeding
3. Snoring and sleep Apnoea
4. As an approach or access to Nasal Surgery like FESS or skull base surgery
5. To repair a nasal septal deviation
Anaesthesia for Septoplasty
1. Local Anaesthesia – after discussing with the patient – only Local Anaesthetic is used along with some sedation
2. MAC- Monitored Anaesthesia Care- the anaesthetist gives pain reliving drugs intravenously, along with sedation
3. General Anaesthesia – Full General Anaesthesia where the patient is completely unconscious.
The decision regarding the type of anaesthesia to be used is taken following a discussion between the ENT surgeon and the patient.
METHOD OF SEPTOPLASTY
Septoplasty is a very commonly performed surgical procedure.
In the Operation Theatre, after cleaning and draping the patient 2 % Xylocaine with adrenaline is injected into the septum so as to lift a submucosal flap. Cotton patties with 4 % Xylocaine and adrenaline are sometimes placed in the nasal passage as well to help shrink the mucosal swellings.
Depending upon the nature of the deviation an incision is made on the Septum and mucosal flaps are lifted and joined together – the septum is now standing freely and unattached.
The Septum is then brought to the midline using various techniques, including thinning out duplicated parts, straightening and morselization as well as using a hammer and gouge to remove bony spurs.
Once the septum is brought to the midline parts may be sutured – either at the caudal (lower) end or sutures to approximate septal flaps together so as to prevent haematoma formation.
Nasal packs are placed in the nose which are kept in situ for a day or sometimes longer.
POST OPERATIVE PERIOD
1. The post operative period is usually uneventful – the patient takes rest for a day or two.
We recommend to work from home for about 5-7 days or till the wound has healed.
2. Normal diet is recommended- simple regular home food.
3. Lying propped up in bed is usually helpful
4. There may be some pink/ blood soaked discharge from the nose for a few days
5. Do not blow nose
6. No steam inhalation in the immediate post operative period
7. Must come for regular follow up visits as asked for
COMPLICATIONS
Though a safe and well tolerated surgical procedure, Septoplasty can lead to some complications
1. Bleeding – in the immediate post operative period, or sometimes after a week to 10 days- a well known complication called Secondary Haemorrhage. Treatment is usually simple.
2. Infection – every surgical procedure can be followed by a local infection in the affected area- a good antibiotic is usually enough to treat this.
3. Nasal Septal Perforation- in spite of all precautions sometimes there can be a septal perforation due to flap necrosis.
4. External nasal deformity- sometimes, if excessive supportive tissue is sacrificed the nasal pyramid may be affected – usually in the form of a supra tip depression.
5. Recurrence- though airway improvement is predictable sometimes the septal deviation may spring back either as a result of fresh trauma or due to strong tissue memory.
ENDOSCOPIC SEPTOPLASTY
With the advent of the endoscope ENT Surgeons are now performing minimal access Endoscopic guided Septoplasty surgery. You must discuss this with your surgeon- not all septal deviations can be corrected by endoscopic septoplasty.
POINTS TO NOTE
- Septoplasty is quite often combined with other procedures like Inferior Turbinate reduction- a procedure broadly known as ‘Airway correction surgery’. It can also be combined with an Endoscopic Sinus Surgery, done for concomitant sinus disease.
- Septoplasty will not cure you of your allergies. Symptoms of Nasal Allergy will be managed with medication and Immunotherapy if indicated. These include sneezing, clear nasal discharge, nasal itching, watery eyes etc.
To summarize, Septoplasty is a simple and safe surgical procedure and in properly indicated cases it offers great relief from long standing nasal blockage.
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Disclaimer: The contents of this video, including any information, products, or services offered, are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, or treatment.
