SEPTOPLASTY TECHNIQUES
Over the years, various techniques have been developed and refined by Dr Sandeep to address simple to complex septal deviations. Here’s an overview of the primary techniques used by Dr Sandeep in septoplasty.
TRADITIONAL SEPTOPLASTY
The deviated portions of the septum are either removed, realigned, or reshaped to achieve a straight septum.
SUBMUCOUS RESECTION (SMR)
This is a traditional technique where the aim is to preserve as much of the supportive structure of the septum as possible while removing the deviated parts.
CARTILAGE SCORING
This technique involves making strategic cuts or scores in the cartilage without removing it. These scores make the cartilage more malleable, allowing it to be reshaped and straightened.
CARTILAGE GRAFTING
In cases where a significant portion of the septal cartilage needs to be removed or if there’s a septal perforation, cartilage grafts (from the ear or rib) may be used to provide structural support.
SPREADER GRAFTS
These are thin strips of cartilage placed between the septum and the upper lateral cartilages. They are often used to correct internal nasal valve collapse and dorsal septal deviations.
BATTEN GRAFTS
These are used to provide strength and support to the septum that is deviated due to an intrinsically weak cartilage which has bent under the weight of the overlying nasal structures.
SUTURING TECHNIQUES
Strategic placement of sutures can help in straightening mild deviation of the cartilaginous portion.
ENDOSCOPIC SEPTOPLASTY
Using nasal endoscopes provides better visualization, especially for posterior deviations. This approach is less invasive and allows for more precise corrections of localized deviations but may not be suitable for major deviations requiring reconstructive septoplasty.
SEPTORHINOPLASTY
Indicated when both the nasal septum and nasal bones are deviated. It addresses nasal obstruction and straightens a crooked nose effectively. It is suitable for more complex anatomical nasal deviations, where septoplasty is ineffective or likely to unsuccessful.
Traditional septoplasty may be insufficient if the deviation is:
- More pronounced towards the caudal end (closer to the tip of the nose).
- Along the dorsum (the top or bridge) of the nose.
Septorhinoplasty combines cosmetic and functional correction
EXTRACORPOREAL SEPTOPLASTY
Extracorporeal septoplasty is a specialized technique in septoplasty where the entire nasal septum is temporarily removed. Deviated portions can be removed or reshaped, and the septum is straightened. This often involves using sutures, scoring techniques, or cartilage grafts to achieve a straight, functional septum. The reconstructed septum is then re-inserted into the nose and sutured back to the remaining caudal and dorsal struts.
This approach is particularly useful for clients with complex septal deformities where traditional septoplasty techniques might not provide satisfactory results. Dr Sandeep learned this procedure during his European Academy of Facial Plastic Surgery Fellowship under Professor Wolfgang Gubisch, who first described this procedure, and has developed particular expertise in it over the years, treating many clients who had failed Septoplasty in other institutions.
THE SEPTOPLASTY PROCEDURE DETAILED
PREPARATION
Prior to the procedure, Dr Sandeep will conduct a comprehensive assessment of the septal deviation, including a meticulous review of the client’s medical history and a detailed physical examination. This evaluation typically involves the use of a nasal endoscope and diagnostic imaging techniques such as CT scans to fully understand the extent and impact of the deviation.
ANAESTHESIA
While septoplasty can be performed under local anaesthesia with sedation, general anaesthesia is often preferred to ensure the client’s comfort.
SURGICAL APPROACH
In traditional septoplasty the approach is through an incision inside the nostril, the mucosal lining covering the septal cartilage is carefully lifted. This provides direct access to the deviated cartilage and bone.
If septorhinoplasty approach is used an incision is made across the columella (the narrow strip of tissue that separates the nostrils, allowing the surgeon to lift the skin and access the nasal structures directly. This approach provides better visibility and precision, allows the surgeon to lift the skin off the nose and work on the internal structures.
CORRECTION
The deviated portions are strategically reshaped, realigned, removed, replaced, or bolstered. The goal is to straighten the septum without compromising its structural integrity so that the nasal breathing is improved, and the nose shape is maintained or enhanced.
FINISHING UP
The mucosal lining is repositioned and sutured back into place. Sutures are placed to quilt the lining to the cartilage to aid in healing and prevent complications like septal haematoma. Soft nasal packs are inserted to reduce postoperative bleeding, these are removed after a few hours. Dr Sandeep rarely uses internal splints to stabilize the septum. Any external incisions are sutured.
POSTOPERATIVE JOURNEY
IMMEDIATE RECOVERY
Clients might feel groggy as the anaesthesia wears off. Breathing might feel obstructed due to internal swelling and any packing or splints.
MANAGING DISCOMFORT
Mild to moderate pain, swelling, and nasal congestion are common. Pain medications and cold compresses can help manage these symptoms.
ACTIVITY RESTRICTIONS
Clients are advised to avoid strenuous activities, nose blowing, contact sports and wearing glasses directly on the nasal bridge for a few weeks.
NASAL DOUCHE
Helps to clear the nose of any secretions, blood clots and crusts, aids in healing, while minimizing the risk of infection.
FOLLOW-UP VISITS
These are crucial to monitor healing, address any concerns, and remove sutures or splints.
POTENTIAL COMPLICATIONS
As with any surgical intervention, septoplasty carries potential risks and complications. Here’s a detailed look at the complications associated with septoplasty:
- Immediate Bleeding: Some postoperative bleeding is expected, but excessive bleeding can be a concern and may require intervention, including readmission.
- Septal Hematoma Formation: A collection of blood, known as a hematoma, can form between the septal cartilage and its overlying lining, the mucoperichondrium. This can compromise the blood supply to the cartilage, leading to cartilage death, if not promptly drained.
- Infection: Infections after septoplasty are rare but can be serious. Symptoms might include increased pain, swelling, fever, and discharge from the nose.
- Septal Abscess: A collection of pus between the septal cartilage and its mucosal covering. It requires drainage and antibiotics.
- Septal Perforation: A hole can develop in the septum postoperatively. This can lead to symptoms like nasal crusting, whistling sounds during breathing, or even recurrent nosebleeds. If symptomatic this may require further surgery to correct.
- Adhesions and Synechiae: Scar bands can form between the septum and the lateral nasal wall, potentially obstructing the nasal passages.
- Persistent Nasal Obstruction: Despite surgery, some clients might still experience nasal obstruction due to unaddressed issues like turbinate hypertrophy or nasal valve collapse.
- Altered Nasal Shape: Especially if extensive corrections are made or if osteotomies (controlled bone fractures) are performed, there might be subtle changes to the external appearance of the nose.
- Saddle Nose Deformity: A rare complication where there’s a loss of dorsal nasal height. It can occur if too much septal cartilage is removed or if there’s a loss of septal support.
- Cerebrospinal Fluid (CSF) Leak: Extremely rare, but a breach in the cribriform plate (bone of the floor of the skull attached to the upper part of nasal septum) during surgery can lead to a leak of CSF (fluid around the brain). Symptoms might include a clear fluid nasal discharge and a salty taste. Rarely meningitis may occur. Should this extremely rare event happen it may require surgery to plug the leak.
- Anesthesia-related Complications: As with any procedure requiring anaesthesia, there’s a risk of complications such as allergic reactions, respiratory difficulties, or cardiovascular issues.
- Numbness or Altered Sensation: Some clients might experience temporary numbness or altered sensation in the upper incisor teeth (upper central front teeth) or the tip of the nose. Rarely this may be permanent.
- Pain: While some postoperative pain is expected, persistent or severe pain is extremely rare, and should be evaluated.
- Altered smell and taste: There is a risk of the sense of smell and consequently taste being altered or lost with any nasal surgery.
CONCLUSION
While septoplasty is generally a safe procedure with a high success rate in Dr Sandeep’s hands, it’s essential for clients to be aware of potential complications. Proper surgical technique, thorough pre-operative assessment, and diligent post-operative care provided by Dr Sandeep and his team can minimize these risks. We encourage you to maintain open communication with Dr Sandeep, promptly reporting any concerning symptoms postoperatively to achieve the best results possible.
IMPROVE YOUR BREATHING PATHWAYS: SCHEDULE YOUR SEPTOPLASTY CONSULTATION TODAY!
Revitalize your daily life with a Septoplasty procedure. Struggles with obstructed breathing, persistent snoring, or ongoing sinus complications due to a deviated septum can be addressed with a personalized consultation by Dr Sandeep. Embarking on this path with us could be the key to enhancing your overall health and comfort. Our Septoplasty procedure aims to alleviate blockages in the nasal passages and refine the structural function of the nose.
Experience the transformative effects of Septoplasty on your breathing, quality of sleep, and general health. Make the decision for a brighter, clearer tomorrow and book your consultation now.