Submucous Resection
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Septoplasty (, "septum" + , "to shape"), or alternatively submucous septal resection and septal reconstruction, is a corrective
surgical Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery ...
procedure done to straighten a deviated nasal septum – the
nasal septum The nasal septum () separates the left and right airways of the Human nose, nasal cavity, dividing the two nostrils. It is Depression (kinesiology), depressed by the depressor septi nasi muscle. Structure The fleshy external end of the nasal s ...
being the partition between the two sides of the
nasal cavity The nasal cavity is a large, air-filled space above and behind the nose in the middle of the face. The nasal septum divides the cavity into two cavities, also known as fossae. Each cavity is the continuation of one of the two nostrils. The nas ...
. Ideally, the septum should run down the center of the
nose A nose is a sensory organ and respiratory structure in vertebrates. It consists of a nasal cavity inside the head, and an external nose on the face. The external nose houses the nostrils, or nares, a pair of tubes providing airflow through the ...
. When it deviates into one of the cavities, it narrows that cavity and impedes airflow. Deviated nasal septum or “crooked” internal nose can occur at childbirth or as the result of an injury or other trauma. If the wall that functions as a separator of both sides of the nose is tilted towards one side at a degree greater than 50%, it might cause difficulty breathing. Often the inferior
turbinate In anatomy, a nasal concha (; : conchae; ; Latin for 'shell'), also called a nasal turbinate or turbinal, is a long, narrow, curled shelf of bone that protrudes into the breathing passage of the nose in humans and various other animals. The con ...
on the opposite side enlarges, which is termed '' compensatory hypertrophy''. Deviations of the septum can lead to nasal obstruction. Most surgeries are completed in 60 minutes or less, while the recovery time could be up to several weeks. Put simply, septoplasty is a surgery that helps repair the passageways in the nose making it easier to breathe. This surgery is usually performed on patients with a deviated septum, recurrent rhinitis, or sinus issues.


Procedure

The procedure usually involves a judicious excision/realignment of a portion of the bone and/or cartilage in the nasal cavity. Under
general A general officer is an Officer (armed forces), officer of high rank in the army, armies, and in some nations' air force, air and space forces, marines or naval infantry. In some usages, the term "general officer" refers to a rank above colone ...
or
local anesthesia Local anesthesia is any technique to induce the absence of sense, sensation in a specific part of the body, generally for the aim of inducing local analgesia, i.e. local insensitivity to pain, although other local senses may be affected as well. ...
, the surgeon works through the nostrils, making an incision in the lining of the septum to reach the cartilage/bone targeted in the operation. This may be performed using an endoscope or with open techniques. Sufficient cartilage and bone is preserved for structural support. After the septum is straightened, it may then be stabilized temporarily with small plastic tubes, splints, or sutures internally.
Skin graft Skin grafting, a type of graft (surgery), graft surgery, involves the organ transplant, transplantation of skin without a defined circulation. The transplanted biological tissue, tissue is called a skin graft. Surgeons may use skin grafting to ...
s can be placed internally to support the internal structures.


Indications

Apart from in patients with deviated nasal septum causing airway obstruction leading to difficulty with breathing, recurrent rhinitis, or sinusitis, septoplasty is done as an approach to
hypophysectomy Hypophysectomy is the surgical removal of the hypophysis (pituitary gland). It is most commonly performed to treat tumors, especially craniopharyngioma tumors. Sometimes it is used to treat Cushing's syndrome due to pituitary adenoma or Simmond' ...
. It is sometimes done as well to cure recurrent nosebleed (epistaxis) due to
septal spur In biology, a septum (Latin for ''something that encloses''; septa) is a wall, dividing a cavity or structure into smaller ones. A cavity or structure divided in this way may be referred to as septate. Examples Human anatomy * Interatrial sep ...
.


Contraindications

Septoplasty should not be done in acute nasal or sinus infection. It should also be avoided if the person has untreated
diabetes Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...
, severe
hypertension Hypertension, also known as high blood pressure, is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not cause symptoms i ...
or
bleeding diathesis In medicine (hematology), bleeding diathesis is an unusual susceptibility to bleed (hemorrhage) mostly due to hypocoagulability (a condition of irregular and slow blood clotting), in turn caused by a coagulopathy (a defect in the system of coagul ...
.


Post-operation

Unless there are unusual complications, there is no swelling or discoloration of the external nose or face with septoplasty alone. Packing is rare with modern surgical techniques, but splinting the inside of the nose for a few days is common; the splints are not visible externally. Patients who have nasal splints should receive prophylactic antibiotics against gram positive organisms to prevent possible toxic shock syndrome. One percent of patients can experience excessive bleeding afterwards — the risk period lasts up to two weeks. This could require packing or
cautery Cauterization (or cauterisation, or cautery) is a medical practice or technique of burning a part of a body to remove or close off a part of it. It destroys some tissue in an attempt to mitigate bleeding and damage, remove an undesired growth, or ...
, but is generally handled safely and without compromise of the ultimate surgical result. Septal perforation and septal hematoma are possible, as is a decrease in the sense of smell. Temporary numbness of the front upper teeth after surgery is common. Sometimes the numbness extends to the upper jaw and the tip of the nose. This almost always resolves within several months. The nasal tissues should mostly stabilize within 3-6 months post-surgery, although shifting is still possible for up to and over a year afterwards. A randomised controlled trial found that people who had septoplasty had a greater improvement in their symptoms and quality of life after 6 months than people who managed their nasal airway obstruction with nasal sprays.


Complications of septoplasty

*Dropped nasal tip due to resection of the caudal margin. *
Empty nose syndrome Empty nose syndrome (ENS) is a Syndrome, clinical syndrome in which there is a sensation of Asphyxia, suffocation despite a clear airway. This syndrome is often referred to as a form of secondary atrophic rhinitis. ENS is a potential complicatio ...
due to resection or removal of the
turbinates In anatomy, a nasal concha (; : conchae; ; Latin for 'shell'), also called a nasal turbinate or turbinal, is a long, narrow, curled shelf of bone that protrudes into the breathing passage of the nose in humans and various other animals. The conc ...
. *
Nasal septum perforation A nasal septum perforation is a medical condition in which the nasal septum, the bony/cartilaginous wall dividing the nasal cavities, develops a hole or fissure. This may be brought on directly, as in the case of nasal piercings, or indirect ...
due to the bilateral trauma of the mucoperichondrial flaps opposite each other. *Septal
hematoma A hematoma, also spelled haematoma, or blood suffusion is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. A hematoma is ...
and septal
abscess An abscess is a collection of pus that has built up within the tissue of the body, usually caused by bacterial infection. Signs and symptoms of abscesses include redness, pain, warmth, and swelling. The swelling may feel fluid-filled when pre ...
. *Adhesions and synechiae between septal mucosa and lateral nasal wall. *
Saddle nose Saddle nose is a condition associated with nasal trauma, congenital syphilis, relapsing polychondritis, granulomatosis with polyangiitis, cocaine abuse, and leprosy, among other conditions. The most common cause is nasal trauma. It is character ...
due to over-resection of the dorsal wall of the septal cartilage.


See also

*
Rhinoplasty Rhinoplasty (, nose + , to shape), commonly called nose job, medically called nasal reconstruction, is a plastic surgery procedure for altering and reconstructing the human nose, nose. There are two types of plastic surgery used – plastic sur ...
, surgery involving the entire nose *
Turbinectomy A turbinectomy or turbinoplasty (preserving the mucosal layer) is a surgical procedure, that removes tissue, and sometimes bone, of the turbinates in the nasal passage, particularly the inferior nasal concha. The procedure is usually performed t ...
*
Empty nose syndrome Empty nose syndrome (ENS) is a Syndrome, clinical syndrome in which there is a sensation of Asphyxia, suffocation despite a clear airway. This syndrome is often referred to as a form of secondary atrophic rhinitis. ENS is a potential complicatio ...
*
Nose A nose is a sensory organ and respiratory structure in vertebrates. It consists of a nasal cavity inside the head, and an external nose on the face. The external nose houses the nostrils, or nares, a pair of tubes providing airflow through the ...


References


External links

* A brief and concis
Septoplasty entry
on
MedlinePlus MedlinePlus is an online information service produced by the United States National Library of Medicine. The service provides curated consumer health information in English and Spanish with select content in additional languages. The site brings ...
, a public health encyclopedia * A more in dept
Septoplasty and accompanying ''Turbinates'' entry
on the American Rhinologic Society's website {{Respiratory system procedures Nose surgery Otorhinolaryngology Rhinology