Septoplasty and Nasal Turbinectomy
Nasal Septum
Deviated nasal septum is a common condition that creates nasal congestion and difficulty breathing through the nose. Not everyone with deviated septum requires surgery. Surgery is indicated only if it produces symptoms and is refractory to medical treatment. The goal of septoplasty is to straighten a deviated septal cartilage or bone. Septoplasty can be done under local or general anesthesia. It is accomplished through a small incision made inside the nose, and takes about an hour. At the conclusion of the procedure, packing may or may not be placed. After the surgery, nasal congestion is expected for 1-2 weeks, which should gradually improve with time. Bloody discharge is common and can last up to 1 week.
Although septoplast is generally a safe procedure, there are known complications: Infection, septal hematoma, bleeding, septal perforation, palatal and dental anesthesia, loss of smell, change in nasal appearance, and imperfect result. Fortunately, these complications are infrequent. Rarely, septoplasty may have to be repeated.
Nasal turbinate
Turbinates are bony structure located on the side wall of the nose, and covered with mucosa. In some situations, turbinates can become abnormally enlarged creating nasal congestion. An attempt should be made to identify underlying causes, and treatment instituted accordingly. Nasal steroid spray, oral decongestants, and antihistamines may be helpful and should be tried prior to considering further treatment. When the patient is refractory to medical treatment, surgical procedures may be discussed.
Cautery (burning) of enlarged turbinates can be done with an electrosurgical probe or a laser and is usually performed as an office procedure. Both electrocautery and laser surgery are performed on either the surface of the turbinate tissue or sub-mucosally. Surface cautery results in edema and crusting in the nose which can last three weeks or longer, while sub-mucosal cautery can cause swelling for up to 10 days.
Another method for improving nasal obstruction is outward fracture of the turbinate bone(s), which moves the turbinate away from its obstructive position in the airway. This approach, however, does not address the usual source of obstruction---enlarged sub-mucosal tissue, and the fractured turbinate often returns to its previous position. Turbinate resection (removal of the bone and/or soft tissue) and excision (removal of the soft tissue only) can be performed with surgical scissors or a laser. Physicians can reduce nasal obstruction by cutting away excess tissue from the surface of the turbinate with angled scissors. In Dr. Kim’s hand, turbinectomy has been the procedure of choice with long lasting result.
Complications associated with turbinectomy are crusting, dryness, scarring, and bleeding.
Post-operative Instructions:
1. Diet: No temperature hot food. Cool to room temperature before eating.
2. DO NOT blow nose, bend, lift anything more than 10 lb., or strain. Cough or sneeze with mouth open.
3. When you awaken after your surgery, remember that you will not be able to breathe through your nose. Expect some bloody drainage into your throat and out the front of the nose. This will last approximately 5-7 days after surgery.
4. If packing has been used, it will be removed, in about 4-5 days after surgery in our office. After the packing is removed, you may clear your nose by sniffing in and spitting out.
5. Expected after surgery are: a temperature as high at 100 (use Tylenol to bring this down), headache or sinus pain, sore throat (for a few days only), nausea and/or vomiting (for only 1 -2 days) and a sore neck.
6. You will receive a prescription for pain medicine before you leave the hospital.
7. You will probably feel better if you take only liquids for the first day after surgery. After that you may eat and drink as you wish.
8. You must stay away from NSAIDS, Aspirin, Motrin, or Advil for 14 days.
9. You may expect to be away from work or school for about 1 week.
