Septoplasty surgery is usually done after 16 to 18 years of age, when the facial structures are fully grown. It is a surgery to correct the central nose bone structure that divides the 2 halves of the nose. The internal deviations of the nasal bone may or may not be accompanied by external deviations of the nose, so a flexible nasoendoscopy is usually needed to properly evaluate this nose bone.
Many people may have slightly crooked nasal bones, but surgery is only needed if that obstructs the breathing, predispose to recurrent sinus infections or nasal polyps, then surgery will not be needed.
The nose bone, also known as septum, inside the centre of the nose, is actually made up of a larger piece of softer cartilage and 3 other bony structures, and not the single piece of bone many think of it as. These four structures need to be fully aligned for the internal nose bone to be straight. The surgery usually takes less than an hour, depending on the complexity of individual cases. It can be done as a day surgery or with an overnight hosptialisation. After general anesthesia is administered, the nose is decongested and topical medications injected to control bleeding. The skin overlying the septum on both sides is lifted off the septum carefully, to expose fully the different septal cartilage and bones.
Only the deviated aspects of the septum are trimmed, straightened, chiseled out, or scored to reduce the strong memory of curvature that some cartilage may have. The shape of the nose is not changed as the front and top struts of nose cartilage are fully preserved. The skin is replaced and sutured back into position. Some more sutures may be placed to further strengthen or straighten the remnant septum. Occasionally, the cartilage that has been removed is used to further straighten or strengthen the remnant septum.
Some surgeons may advise nasal packing overnight. In Septoplasty, there is no change to the external shape of the nose. Postoperatively, there is little pain and risk of bleeding, but the patients usually need to rinse the nose twice a day for 1 to 2 weeks, and antibiotics may be added for a week usually.
Yet other patients have crooked nasal bones that also affect the shape of the external nose, making the nose appear twisted. In such cases, instead of a septoplasty, an open septorhinoplasty surgery is needed. In Open Septorhinoplasty, a small 3- 4 mm incision is made on the inferior aspect of the nose so that access to the entire structure of the nose bone is facilitated, allowing correction of both the external shape of the nose by addressing the side and middle nasal cartilages and bones. This surgery needsabout 2 to 3 hours depending on the complexity of each case, and a longer recovery time of 2 weeks, and may have bruises on the external nose if the nasal bones at the top of the nose needs to be reset.
Postoperatively, there is not much pain and the incision usually heals well and is not much visible. Besides functional improvement of the breathing, it also has the potential to improve the appearance of the external nose. Expectations have to be clarified pre-op about what the patient can and cannot accept with respect to the external nasal appearance.
For both surgeries, it is important not to have trauma to the nose for especially the first 2 months as the nose septum and bones heal. Prior to any surgery, the patient must discuss the surgery with their respective doctors as doctors can do the surgeries differently. There are many ways to do a surgery, and the outcomes and risks will thus need to be counselled differently, with patient factors also considered.
