This is an operation designed to straighten the septum (the midline partition of the nose) to improve the breathing through the nose in people who have nasal obstruction symptoms. The procedure is performed under a general anaesthetic and typically requires a one-night stay in hospital. Most patients are able to return to work after 10-14 days. The procedure is performed through a small incision made inside the nostril with elevation of the lining of the septum and removal of the portions of the septum that are deviated or holding it out of place. Care must be taken not to remove too much septum as this may result in an external change in the appearance of the nose with sagging of the tip of the nose, due to loss of support to the nasal skeleton.
Often, at the same time, surgery is performed on the inferior turbinates. These are swellings found on the side wall of the nose which help control air flow through the nose. When enlarged these will impede air flow and give a sensation of nasal obstruction. Surgery to these structures usually takes the form of cautery or surgical trimming of the turbinates. At the end of the surgery the lining of the septum is re-approximated with an internal absorbable suture. The small incision inside the nostril is also closed with an absorbable stitch. Generally nasal packing is not used unless there is heavy bleeding at the end of the procedure. A nasal bolster, a piece of rolled up gauze, is taped under the nose to patch any bloodstained discharge initially. After surgery, patients should rest in bed, except for the toilet, on the day of surgery; but can be gently mobilised the following morning. They shouldn’t partake in any vigorous physical exertion for at least 10 days, preferably 14.
In the initial postoperative period, the nose may feel fairly clear but within hours of surgery will invariably become completely obstructed due to swelling of the nasal lining. After approximately one week the nose begins to clear and by two weeks is usually back to its pre-operative state. Typically, it is 6-8 weeks before the final improvement in breathing occurs. Pain is usually not a significant procedure of this operation, although some patients may have a moderate midline forehead headache for some hours. All patients’ experience bloodstained discharge for some hours after surgery and this usually continues to a lesser degree for a few days. Occasionally bleeding may be heavy and require packing of the nose. External nasal splints are not worn after this type of surgery and patients should not expect any bruising around the eyes although there may be a minor degree of soft tissue swelling around the lower part of the nose.
Infection is rare and usually takes the form of fever and increasing nasal pain in the days following surgery. If this occurs you should contact me for acute review in my rooms. Occasionally patients experience transient numbness of the upper teeth due to bruising of the nerve, which supplies the upper jaw and which passes through the floor of the nose. The majority of patients’ experience a significant improvement in the breathing through the nose but in some, revision surgery may be required due to a shift in the position of the septum in the postoperative period.
If you experience any significant problems in the early postoperative period please
contact me.