The septum is the midline in the nasal cavity that divides the left and right nasal cavity.
The septum is a combination of different anatomical structures. It consists of nasal skin which
is called the nasal mucosa on the left and the right side and in the middle, we've got
cartilage and a bit of bone and together this is what we call the septum. We know that overall
about 80% of the population is having some kind of septal deviation and also from studies
we know that about 30 percent of the overall population is complaining of some forms of
nasal breathing problems. If you have excluded all the problems including rhinitis, allergies
or rhinosinusitis and if you can see in a clinical examination that the septum is the
main cause for the breathing problems which is about one to two out of four patients who
suffer from breathing problems, the treatment option is to straighten the septum and this
is what we call septoplasty.
I want to divide this answer into two parts. You can either do a septoplasty purely for
functional reasons. When we talk about functional reasons, the patients with a septal deviation
complain mainly of a unilateral obstruction of the nasal airway; which occurs mainly in
the young adult life or after trauma, but we also know that patients profit from
a septoplasty when they snore quite heavily and especially patients with a body mass index
of less than twenty eight profit from this procedure and we also perform septoplasty
for functional reasons if patients have recurrent nosebleeds and straightening of the septum
is reducing these nosebleeds. We also perform septoplasty for aesthetic reasons combined
with a septo-rhinoplasty or a rhinoplasty. There's a very famous saying from a very famous
nasal surgeon: "Where the septum goes, so goes the nose", so if it's of utmost importance
to straighten the septum within a rhinoplasty to get the best functional and aesthetic outcome
after a septo-rhinoplasty and combined aesthetic procedure.
If you come to see me as a patient in regards to a septoplasty, we will first assess your
normal medical history. We'll have to go through all possible reasons for a breathing problem
including rhinosinusitis, allergies, rhinitis. We'll have to assess if we have further symptoms
including post nasal dripping, nasal discharge, how the sense of smell is, if you have any
allergies or asthma. After assessing this, we'll go and examine the nose in detail. We'll
start with assessing the external nose: are there any deformities, for example, post trauma,
have you ever had any surgery that resulted in a deviation of the whole nose, are there
any deformities, for example, like cleft lip and palate deformities, and then moving from
the external examination we go to the internal examination and we first start with an anterior
rhinoscopy. This means we'll pop a little instrument into the nostril to the opening
of your nose to assess the front part of your nasal cavity and after the anterior report
perform the posterior rhinoscopy and this is done with a little camera which is popped
into your nasal cavity to assess if there are any polyps or other anatomical structures
that could contribute to nasal breathing problem.
If the septoplasty is performed purely for a functional reason, it is a very short and
straightforward procedure. The procedure is performed normally in general anaesthetic.
So the patient is fully asleep. Before we start with the surgery, I use in my practise
a lot of local anaesthetic and also local infinitive blocks to reduce the post-operative
pain of the patients. I then, with a tiny incision inside the nasal cavity, start to lift
off the skin from the cartilage that I can assess the cartilage properly, and after that
I'll reduce step by step the deviated parts of the cartilage and the bone until the left-over
cartilage is straight in the midline. When we perform this surgery, we have two main
goals. One goal is we want to improve the breathing, the second goal is we don't want
to change the shape of the nose and the closure of this little incision and also the stabilisation
inside the nose is purely done with resorbable sutures. I'm not placing any packets or any
silicon splints inside the nose. So the breathing after the surgery is directly very well.
The recovery after septoplasty as it's done under general anaesthetic, especially in the
first 24 hours post-surgery, you will feel a bit tired because of the general anaesthetic.
Normally, the pain after a septoplasty is really minimal. You will feel a bit of pressure,
a bit of tightness in the nose especially due to the stitches that were used during
the procedure, but this can be managed easily with paracetamol or with ibuprofen. Whenever
you operate, you get swelling. So you also will get a bit of swelling inside the nasal
cavity and this swelling can lead to an impairment of the ability to breathe properly, but I
will provide you especially during the first 72 hours with congested nasal spray to reduce
the spelling, the Saline douche to rinse out the nose and an antibiotic ointment to create
a very good wound healing environment. As I'm not using packings or any kind of splints
during a septoplasty, you don't have to go through the procedure of removing these packings
after a nasal surgery.
Managing patient expectation starts with the first consultation in the clinic. I have to
make sure that the septum is the main contributor to the nasal breathing problems. I have to
exclude anything else that can contribute to breathing problems including problems with
the inferior turbinates, for example, swelling due to allergies, I have to exclude chronic
rhinosinusitis or polyps that can contribute to nasal breathing problems. We have to make
sure that you have a free post nasal space and there for example no adenoids. We also
have to assess the nasal valve properly that you have no nasal valve collapse or a neuro
nasal valve that can contribute to breathing problems and if we excluded everything and
the septal deviation is the main contributor to your nasal breathing problems, I'm very
confident and I almost can guarantee you that with a septoplasty, with straightening the
septum and reopening your nasal breathing passages on both sides, I can improve the
breathing and improve the overall quality of life.