A septoplasty procedure to correct a deviated nasal septum is the most common surgical procedure that I perform. Its’ main purpose is to help people breathe better. Good nasal breathing is also important for CPAP and dental device effectiveness.
I recently made up a frequently asked questions (FAQ) information sheet for my patients. I thought it was a good idea to post the most common questions for this blog post. Please note that this information is for my patients. Other surgeons may have different routines.
Frequently Asked Questions About Septoplasty
Septoplasty is a generic description for any type of surgery to reshape the nasal septum to improve breathing. It’s also often performed along with rhinoplasty since the septum supports the nasal structures.
What’s a nasal septum?
The septum is describes the midline thin wall that separates your right and left nasal cavities. It’s mostly made of cartilage in the front and a thin plate of bone in the back, covered by a mucous membrane covering on both sides. It starts from the tip of your nose all the way back to the back of your nose, just above your soft palate.
Why is my septum deviated?
Although trauma can cause a septum to become deviated (crooked), most people with deviated septums have never suffered any trauma. During development, the upper jaw is very narrow and high, but during development during the early childhood years, your jaws widen and the roof of your mouth should drop. If the roof of your mouth (floor of your nose) doesn’t drop enough, as your nasal septum grows, it can bulge to one side or the other. Sometimes it gets wider. It’s important to remember that most people with deviated septums will also have swelling of the turbinates (see below) and flimsy nostrils, in addition to a more narrow nasal sidewalls.
When is surgery needed for a deviated septum?
Surgery is usually recommended when medical therapy doesn’t help your stuffy nose. Oftentimes, over-the-counter and prescription allergy medications are prescribed. Everyone has a slightly deviated septum. Just because it’s deviated is not a reason to undergo surgery. The only reason to consider surgery is if you’re having problems breathing though your nose, despite medical treatments.
Do you use packing?
Many surgeons use packs or splints after nasal surgery. I try to avoid nasal packs or splints, since having a stuffy nose can aggravate sleep apnea, as well as being much more uncomfortable when it has to be removed.
How much pain will I have?
Most patients either take only Aacetominophen (Tylenol) or nothing at all. However, in the small chance that you do have pain, a prescription for narcotics will be given to you after the operation. On average, if you do have pain, it will last 3-5 days.
Can I blow my nose after surgery?
Yes, very gently, after irrigating with nasal saline. Ignore what the hospital tells you.
Will my face be swollen or black and blue?
No, not from simple septoplasty and turbinoplasty. Usually, only if the nasal bones are broken for rhinoplasty or after nasal trauma will you have black and blue eyes.
Will the operation change the shape or appearance of my nose or face?
Not with septoplasty and/or turbinoplasty alone. Procedure for nostril stiffening or external cosmetic procedures may change the nose, so this possibility must be discussed with your surgeon.
When can I go back to work?
Most people can go back to work about 3 to 5 days after the procedure.
When can I exercise?
No earlier than 1 week afterwords. You can walk around and do normal activities. After a few days of healing, you can do light exercises, but no strenuous activities. Build up gradually to normal exercise activity by one week.
Can I take a shower?
Yes, as soon as you get home.
What can I eat after the operation?
Right away. In the recovery room you’ll be given liquids and soft foods. As long as you’re able to, there are no restrictions on what kind of food you can eat at home.
Will I have bleeding?
A little oozing from the nose is expected. This is why you have a small mustache dressing under your nose, which you can change as needed. This is not meant to block you nose. It can be removed after a few days if the oozing goes away.
What kind of anesthesia will I have?
Most people will undergo general anesthesia, with a tube in the throat during the procedure.
How long does the procedure take?
About 1 to 1.5 hours. Add another 30 minutes for getting to sleep and waking up after the procedure. We try to be one time, but surgery can be unpredictable, and there is always a chance that there may be delays. Plan on taking the entire day off.
Will I go home afterwards or stay overnight?
You should be able to go home.
Is it covered by insurance?
Usually it is covered, but it will be checked with your insurance company.
Do I need someone to come with me for the procedure?
Please make sure that someone is available to help you get home after surgery. You an come in by yourself. You will not be allowed to drive just a few hours after anesthesia.
When will I need follow-up after the operation?
Most patients will be given an appointment about 3 to 5 days after the procedure.
When will I begin to breathe better?
You will be able to breathe much better just after the procedure, but it will get clogged over the next few days due to mucous and blood. During your follow-up visit, your nose will be cleaned out, and you should be able to breathe much better afterwards.
What medications will be given after the procedure?
You can take Tylenol for routine pain. You will also be given a prescription for a stronger medication, like a narcotic.
Which medications should NOT be taken before the operation?
No Aspirin, Ibuprofen or blood thinning medications. If you are on blood thinning medications, please let your doctor know.
Please pick up a few bottles of nasal saline and squirt it up both your nostrils every 3-4 hours during the day. This should be continued for 7 days after the procedure.
Will septoplasty cure my snoring or sleep apnea?
In general, no. The main reason to undergo a septoplasty is to improve your nasal breathing. In theory, you should be able to better tolerate and benefit from CPAP or dental devices.
Can I use CPAP after the operation?
Yes, but the pressure needs may be off. If it’s too uncomfortable, then hold off until after the first post-op visit.
Can I use my oral appliance?
Yes. However, you may have some problems if you nose is stuffy.
What can I do if my nose is stuffy after the procedure?
Use lots of nasal saline, using a spray or squirt bottle, aerosol can, or a Neti-Pot container.
You can also make your own isotonic saline solution (0.9%). Boil (or microwave) 1/2 teaspoon of sea salt or Kosher salt (not iodized) and 1 cup of water for a few minutes. Cool to room temperature and store in a clean jar. For larger quantities, use the same proportions. If it’s too irritating, you can also add 1/4 teaspoon of baking soda. Use at room temperature or preferably, close to body temperature. You can use an old Nedi-Pot container, a large syringe, or even a turkey basting syringe. Make sure it’s cleaned between each use.
What do I do if there’s excessive bleeding?
Call your surgeon or go to the nearly emergency room.
Why does my throat hurt?
The tube that was temporarily placed can cause throat soreness for 1-2 days.
What time do I show up for the surgery?
The hospital will tell you what time to come. You’ll get a phone call the day before, since the OR schedule can change up to the last day. Usually, you’ll have to come in about 2 hours before your scheduled time.
When should I stop eating before surgery?
Nothing to eat (except water) after midnight.
Do I need to use ice on my face?
No, not for routine septoplasty. For any external procedures, your surgeon will let you know.
Do I need to sleep upright after the operation?
You can sleep in whatever position is most comfortable for you.
Why am I still stuffy, even though it’s been 6 months after the operation?
A very small percentage of patients will have persistent or recurrent nasal congestion months or years later. An office exam is needed to see what’s causing the blockage. The two most common reasons for recurrent nasal congestion are enlarged turbinates or flimsy nostrils.
When should I call the doctor?
For heavy bleeding or severe anesthesia side effects (severe nausea, vomiting, etc.)
What additional procedures are commonly done with septoplasty?
Oftentimes, the nasal turbinates (wing-like structures with bone on the inside), need to be shrunk, trimmed, or cauterized. Sometimes, flimsy nostrils need to be stiffened.
Is septoplasty the same thing as rhinoplasty?
Rhinoplasty describes surgery of the external nose, either for structural deformities or for cosmetic reasons. Septoplasty is a completely different procedure. Oftentimes, it’s done together.
What are the different types of septoplasty operations?
Surgeons have various preferences for technique when it comes to the septoplasty procedure. In general, a cut is made inside the nose on the septum, thought the mucous membrane, and the cartilage is freed up on both sides. The crooked parts of cartilage or bone is then removed using appropriate instruments. Some surgeons weaken the cartilage and place it back. The incision is closed using stitches, which dissolves in a few weeks. Other surgeons will use plastic sheets with or without cloth, paper or an tampon-like packing to keep the mucous membranes pressed together on both sides of the nose, to prevent blood from building up. Packs and splints, if placed, are usually removed in the office a few days after.
My preference is to avoid packs or splints altogether.
Do you use a laser?
Not usually. Rarely, I will use a laser for specific reasons, such as for cutting through scar tissue. Surgeons now rarely use lasers for septoplasty.
Do I need to have stitches taken out?
No, since the stitches dissolve within a few weeks.
Why do my front teeth hurt?
During the procedure, the nerves that go to the front teeth can be bruised from electrocautery or chiseling. This usually goes away after a few days. Rarely it can take weeks.
Do you use cameras (an endoscope) for septoplasties?
Not usually. I have done it both ways and find that the traditional way is much faster, and you can use both eyes to see in 3-D, where the endoscope can give you only a 2 dimensional view. Sometimes I will use the camera for teaching purposes or for special situations.
Do I need blood tests or medical clearance from my doctor for the surgical procedure?
If you are healthy, then no. But each patient has to be addressed on a case by case basis. You will be notified if you need any tests or medical clearance at the time of scheduling. If a medical clearance is needed, you must be seen within 30 days of the date of the procedure.
What is your success rate?
In my experience, about 90% of patients are happy with the results. About 5% say it helped somewhat and 5% need further surgery, which usually takes care of the problem.