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Nasal septal correction

 Pic.1 - Anatomical specimen of nasal septum with its components

Pic. 2 - Nasal septal deviation - bony spur (coronal view)

Schemat skrzywienia przegrody nosa - kolec

Pic. 3 - Nasal septal deviation - cartilaginous and bony basal ridge

(coronal view)

Schemat skrzywienia przegrody nosa - listwa

Septoplasty is a surgical procedure with two main stages:

1. deformation resection

2. reconstruction

Only performing both leads to success and Patient's satisfaction.

 

Two main mechanisms produce nasal septal deviation - spontaneous, where septal skeleton continuous development after the nasal vault growth is completed and traumatic.

Below are most frequent deformation variants:

 

1. Nasal septal spur

2. Nasal septal basal ridge

3. "C" or "S" deformation

4. Coronal traumatic transposition of septal cartilage

 

Below are the major stages of nasal septal correction surgery:

 

1. Lignocaine and epinephrine solution septal injection - decreases swelling, bleeding and pain.

2. Nasal vestibule skin and perichondrium cut on the left side (for left-handed)

3. Bilateral elevation of skin, perichondrium and periosteum flaps with creating lower and upper tunnels.

4. Resection of deviated cartilaginous and bony parts of the septal skeleton.

5. Reshaping of the septal cartilage.

6. Reconstruction of the septal skeleton

7. Resorbable sutures nasal vestibule wound closure.

8. Nasal pack (if needed)

 

Postoperative care after septoplasty:

Good and quick healing of the septum is accomplished by proper closure with absorbable sutures of the surgical cut and any major mucous tears. Adequate adaptation of the mucoperichondrial flaps can be done with transseptal adapting suture, silastic intransal plates or anterior nasal pack. First two methods may be more comfortable for the Patient (nasal breathing immediately after the procedure) but they increase the risk of septal haematoma. One day nasal pack better supports the flaps, though blocks the nasal breathing. Silastic plates are removed week after the septoplasty and the suture reabsorbs spontaneously in 2 to 3 weeks.

 

I recommend antibiotic prophylaxis - first dose 30 minutes prior to skin cut and second and third in 12 hrs. intervals.

 

At home I recommend nasal douching and some ointment on the surgical cut site twice a day.

 

Antibiotics are prolonged only if the healing is adequate.

 

Postoperative frequent follow-up visits with nasal decongestion is strongly advised.

Pic. 4 - Nasal septal deviation - "S" shaped deformation (coronal view)

Schemat skrzywienia przegrody nosa - wygięcie esowate

Pic. 5 - Nasal septal deviation - most frequent deviation localizations (sagittal view); blue (1) - "C" or "S" shaped cartilaginous deformation, green (2) - deviation along the sphenoid process of the septal cartilage (i.e. spur), red (3) - basal deformation (ridge)

Schemat najczęstszych miejsc skrzywień przegrody nosa
Rafał Chmielewski - ZnanyLekarz.pl