The nasal septum (nasal septum) consists of cartilage in front and bone in the back. The nasal septum divides our nasal cavity into right and left. At the same time, the nasal septum is a structure that contributes to the support of the nose.
The main factors in etiology are major traumas to the nose and mid-face (usually), neonatal and perinatal effects, and mild traumas in childhood.
The curvature in the nasal compartment is caused by nasal septum. It is called septum deviation. The most common symptom of nasal septum deviation is nasal congestion. Nasal septum deviation may also cause bleeding, crusting, susceptibility to infection, chronic sinus infections, eustachian dysfunction, and secondary to this, middle ear infections and smell disorders.
In the diagnosis of nasal septum deviation, the first step after inspection (deformity may be observed due to deviation) is anterior rhinoscopy. Endoscopic nasal evaluation can help us evaluate the problems behind the nasal septum more clearly.
The treatment of symptomatic nasal septum deviation is surgery. Septoplasty is an effective method used in this surgery.
Septoplasty indications:
a-) Nasal congestion due to nasal septum deviation
b-) Rhinosinusitis due to nasal septum deviation
c-) Persistent or recurring nosebleeds
d-) Headache due to nasal septum deviation
e-) Presence of nasal septum deviation that prevents the application of sinus surgery
f-) Providing cartilage graft in rhinoplasty operation purposes
g-) In snoring and sleep disorders
h-) In transseptal transsphenoidal approach for pituitary surgery
i-) In case of septum separation after nasal trauma.
Attention before septoplasty Things to consider
Septoplasty is not recommended for people with bleeding disorders. Since the risk of bleeding will decrease 1 week after the use of aspirin and oral blood thinners (anticoagulant) drugs, surgery can be performed during this period. A patient with an upper respiratory tract infection should have surgery after the infection has passed because the risk of bleeding will be less. In patients with hypertension, adjusting blood pressure values to a proper level before surgery helps reduce bleeding during the operation.
3- ELEVATION:
By entering through the incision line, the mucoperichondrium (nasal mucosa and cartilage membrane) is separated from the nasal septum cartilage.
4- RELEASE:
The curve is released by the process of release. The septum cartilage is separated from the surrounding bone structures. During this procedure, care should be taken to leave sufficient cartilage tissue intact to protect the nasal support. If the septum cartilage is separated from the base, then the size of the cartilage is adjusted and released from the base to be fixed in the midline.
5- SHAPING AND PLACEMENT:
During the shaping process, a permanent repair should be aimed after the operation. Curvatures and fracture lines are removed for a smooth cartilage surface. These removed parts and shaped cartilages are placed back in a size appropriate to the area from which they were taken. It is important to adequately preserve the L-shaped structure in the upper and anterior part of the nasal septum for nasal support.
6- FIXATION (Fixation):
If the nasal septum is separated from the base of the nose, the relationship between the nasal base and the nasal septum is re-stitched. . The mucoperichondrium, separated from the nasal septum, is brought to the midline and fixed with the help of stitches and then nasal tampons. Attention should be paid to bleeding control at every stage of the surgery.
Possible complications of septoplasty
a-) Bleeding
b-) Septal hematoma :
c-) Septal abscess
d-) Saddle nose deformity
e-) Septal perforation
f-) Loss of sensation in the upper lip and teeth
g-) Intranasal synechiae
i-) CSF leak, intracranial injury, loss of smell, intracranial infection, cavernous sinus thrombosis
i-) Dropping of the nasal tip, retraction in the columella and widening of the alar base
Septoplasty Stages
1- PRE-OPERATIVE PREPARATION AND ANESTHESIA:< br /> Septoplasty operation can be performed under general anesthesia or local anesthesia. When the surgery is performed under general anesthesia, bleeding is less common when controlled hypotension is achieved. The surgeon may prefer local infiltration to the nose area at the beginning of the surgery to reduce bleeding during the surgery.
2- INCISION:
& nbsp; Depending on the location and type of curvature in the nasal septum, the surgeon may choose various incisions.
Although hemitransfixion and Killian incisions are incisions that are made through the nose and can be frequently used in closed rhinoplasty, the surgeon may prefer open technique septoplasty in noses with advanced deformities. In this case, an incision is made in the column (columella) between both nostrils and access to the nasal septum can be achieved from this area.
Read: 0
