Septum Surgery Melbourne
Surgery on the septum is called a septoplasty. This surgery aims to straighten the cartilage and bone which separates the nostrils. A septum that is not straight is called a deviated septum. Having a deviated septum can cause nasal obstruction and make it harder to breathe. This can affect one or both nasal passages. The surgery aims to reposition the septum to the midline. Areas of deviation such as a spur or deviated crest are removed.
When is Septum Surgery recommended
Having a deviated septum is common. However, if this deviation is contributing to nasal obstruction then surgery would be recommended. This is established on history and examination. Imaging may also be required to exclude other causes of obstruction.
Sometimes an ‘access’ septoplasty is performed. This means that the deviated septum is blocking access to the sinuses for instance. Rarely a septal biopsy is also required. Cautery can also be performed on the septum to treat bleeding.
Often the septum surgery is combined with reduction of the inferior nasal turbinates. These are nasal pads that run along the nasal cavity. This procedure is called an inferior turbinoplasty.
Preparation for Septum Surgery
Your surgeon should review all regular medications. Medication that impair bleeding, such as aspirin, should be stopped for 10 days prior to the surgery. Some herbal preparations and supplements can also promote bleeding (such as fish oil) and should also be stopped before the surgery.
Fasting times for the septum surgery will be provided. At least 6 hours of fasting is needed for solids and most liquids. However, there is an emphasis to minimise the fasting times. Usually, clear fluids (e.g clear apple juice and water) can be had up until 2 hours before the surgery.
What is Septum Surgery
The surgery is performed under general anaesthesia. A covering of the septum is raised to expose the deviated bone and cartilage. Areas of the septum are then trimmed, removed or repositioned. The covering of the septum (or mucosa) is then closed and any further nasal or sinus surgery is performed. Dissolving nasal packing is usually placed.
What happens after the Surgery
After the septum surgery, the patient is woken up in theatre recovery. An intravenous cannula (or IV) is kept in while in hospital. This allows for fluids and medications to be administered intravenously if required. This can be important if there is nausea or pain.
As soon as the patient is awake - sips of water, ice chips or an icy pole can be taken. Diet is then increased as tolerated. Hot and spicy foods are avoided. There are no other food restrictions.
The patient is transferred to the ward once fully awake. Usually, after septal surgery, an overnight stay is arranged. This ensures that pain is controlled and oral intake has been established. In some cases, a day stay may be appropriate.
Discharge medications are provided. A course of antibiotics and as-needed pain relief is prescribed. Pain is variable and can be local and also radiate to the teeth (because of common nerve supply).
What is the post-operative care following Septum Surgery
During the first week, intermittent nasal discharge is common. This can include passing clot and dissolving packing. A nasal bolster can be worn as required. It is best to avoid blowing the nose for the first week. Additionally, it is advised to avoid heavy lifting or strenuous physical activity for two weeks after surgery.
Hot and spicy foods or very hot showers should be avoided. Use of a sinus rinse such as Nasal FLO or FESS rinse is recommended in the weeks after the surgery. The rinse can be more easily used in the shower. Some blood-stained material is to be expected to discharge during the nasal wash.
At the first post-operative appointment, any remaining material is suctioned. If internal nasal splits were placed - these are also removed at the first post-operative appointment.
What to expect after Septum Surgery
There are some general and specific risks of septum surgery. General risks include bleeding, infection and an adverse reaction to the general anaesthetic. Specific risks include ongoing nasal obstruction, scar or adhesion formation, a hole developing in the septum or numbness in the nose or teeth. These risks should be discussed with your surgeon before the procedure.
Passing a small amount of bloodstained nasal discharge with crusting is normal and may persist for some weeks. The nose will continue to feel blocked until all the swelling of the nasal lining resolves. Internal nasal (septal) splints may be placed; these will be removed one week after the surgery. Mid-facial pain or toothache is normal in the first two weeks and best treated with over-the-counter paracetamol or ibuprofen. Stronger analgesics may also be prescribed. If you have a severe headache, uncontrolled bleeding or fever - seek advice.
Generally, medications that promote bleeding, such as aspirin or anticoagulants should be avoided after the surgery, for two weeks. Where such medications are normally taken regularly, a plan should be made with the surgeon.
This advice is only general in nature and may not apply to every patient. Please contact Dr. Dan Gordon’s rooms for further information.