Consultant ENT, Head and Neck and Thyroid Surgeon

Septoplasty and Turbinate Surgery

What is the nasal septum?

This is the structure that separates the right and left nostrils in the nose. It is made up of
cartilage (a rubber-like firm but bendy sheet) at the front and bone further back and is
covered in mucosa (like the inner lining of your cheek). The septum is important in
maintaining the shape of your nose.
It can be bent or buckled inside the nose even though the nose itself may look straight to
an observer and may have always been bent or may have been damaged by the nose
being knocked at some stage. This can cause symptoms of blockage of one or both
nostrils and inflammation within the nose which in turn can cause mucus and nasal drip.

What are the turbinates?

The nose acts like an air-conditioner and filter providing moist, warm and clean air for
the lungs. To help do this, the side walls of the nose contain bony outgrowths lined with
mucosa (like the septum) called turbinates that form fleshy folds. If these become
enlarged they can cause a blocked nose and if inflamed they can cause mucus
production and nasal drip.

Who needs surgery?

Patients with nasal symptoms, particularly with blocked noses, who have not responded
to other forms of treatment and who have a bent or buckled septum and/or large
turbinates that may be contributing to the symptoms. The doctor assesses this and the
aim of surgery is to reduce the nasal symptoms.

What is a septoplasty?

This involves operating inside the nose to straighten the septum.
It involves cutting the covering of the septum (the mucosa) to expose the part of the
bone and cartilage that is causing the blockage. This obstruction is then removed or
straightened, with care being taken to leave enough bone and cartilage behind to
support and maintain the shape of the nose.
The mucosa is then stitched back together with dissolvable stitches (you may be able to
feel or even just see the stitch for a week or so).
Although the septum will look straight at the end of the operation, as mentioned cartilage
is a bit like rubber so can sometimes bend back into its original abnormal shape as it
heals after surgery. There are methods we use to try to avoid this happening, however it
may still occur occasionally.
The operation takes between 30 mins to an hour and most patients go home the same
day. There is no swelling or bruising of the nose and no external incisions.

What is turbinate surgery?

If the fleshy turbinates are too big we can reduce the nasal blockage by either breaking
the fleshy bones out of the way or we can shrink them with electric cautery. Occasionally
we have to remove part of the turbinates to unblock the nose.
Exactly what is required may not be obvious until during the operation.
The operation is generally quick, taking between 5 and 20 minutes.

Are there alternatives to surgery?

Yes, although usually these will have been tried before suggesting surgery and depend
on the exact symptoms and what the nose looks like on examination.
These can include:
x Saline douche (salt water nose rinse)
x Steroid nasal sprays or drops
x Decongestant nasal sprays
x Antibiotics
x Antihistamines
x Steroid tablets

What are the risks of surgery?

x Overall these operations are safe in most people. Your risk depends somewhat
on any other medical problems you may have.
x Some of these risks are very rare, but serious. Some are more common but less
troublesome.
x Firstly, you will have a general anaesthetic (you will be asleep for the operation).
You will have a chance to discuss this with the anaesthetist (the doctor who will
put you to sleep) before your surgery.

Common risks

x Nasal Obstruction:
You will probably have lots of dry blood and crusting causing a blocked nose for
the first few weeks.
x Bleeding:
A small amount of bleeding after surgery is quite common. Very occasionally
patients may need to have their nose packed during or after the operation to stop
the bleeding and it may rarely be necessary to stay overnight. You may notice
some blood when you blow your nose for a few weeks after the operation. If you
take aspirin or warfarin, or if you have a history of bleeding problems, then you
must tell your surgeon before your operation.

Occasional risks

x Discomfort:
It can sometimes be a bit uncomfortable after the operation for a few days and it
is important that you regularly douche (rinse with salty water) the nose or hard
crusts can form and it can lead to an infection.
x Infection:
Occasionally the nose can get infected after surgery which may cause, amongst
other things, a smelly discharge requiring antibiotics.
x Return of symptoms:
Although your symptoms may initially improve this may not be permanent
requiring continuing or further treatment.
x Failure of treatment:
Occasionally, nasal symptoms don’t get better after surgery.

Very rare risks

x Loss of sense of smell:
Often surgery will improve a loss of smell, but rarely it can cause a loss of sense
of smell.
x Septal perforation:
A septoplasty can very rarely leave you with a hole in your septum going from
one side of the nose to the other. This would not be visible but can cause
whistling when you breathe, crusting or nosebleeds. Usually this would cause no
trouble at all and could be left alone, but if required, the hole could be repaired by
further surgery.
x Change in nose shape:
Extremely rarely you may find that the shape of your nose has changed slightly
after a septoplasty, potentially with a dip at the front of the nose. Most people
don’t notice any change, but if you weren’t happy this could be fixed by another
operation.

After the operation

x Usually I am happy for you to go home the same day as your operation, but be
prepared to stay one night in hospital.
x Most people take 1 week off work to recover. The actual time required varies from person to person and is also dependant to an extent on what work you do (particularly if you perform heavy manual labour or work in a dusty environment).
x For the first 2 months after the operation, you should use a nasal saline douche (salt
water) to rinse your nose. Often you will also need nose sprays and sometimes
other medications.
x I will want to make an appointment to see you again in the outpatient clinic
after the operation to check how you have been.