Nasal Septum

The nasal septum is a normal anatomical structure located inside the nose. It consists partly of bone and partly of cartilage. It develops until the age of 16 for women and until the age of 18 for men. Under normal conditions it is located in the middle of the nose and divides the nasal cavity into two equal parts. It allows the smooth flow of air through the nose, its humidification and temperature regulation, as well as the normal olfactory function.

In cases where the nasal septum is not in the middle of the nose but is displaced to one side, we are talking about a crooked septum, or the common deviated septum. In fact, according to Harvard Medical School, this condition affects 80% of people and, depending on its severity, it can cause from minimal to very serious symptoms.

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Deviated Septum - Causes

The most common causes that can lead to a deviated septum are the following:

• Hereditary factors. The problem can be hereditary and is created during the development of the fetus. In this case it is present from birth.
• Pressure on the nose during childbirth. Manipulations performed by the obstetrician during labor, especially if delivery is difficult, can cause pressure on the newborn's nose and displace the septum causing deviation. In fact, as the skeleton of the nose develops, the deviation becomes more severe, making the problem even worse over time.
• Injuries during childhood or adulthood. These injuries may involve the bony part of the septum, the cartilaginous part, or both. They usually occur during a fall especially in children, during sports involving physical contact (e.g., basketball, football, boxing) or as a result of a traffic accident.
• Genetic syndromes. In rarer cases, deviated septum is associated with birth defects such as cleft palate and cleft lip, Marfan syndrome, and homocystinuria.

Deviated Septum – Symptoms

The deviated septum is a source of worry for the patient as it causes a series of symptoms:

• Difficulty in breathing through the nose during the day, which becomes more pronounced during exercise and increased physical activity.
• Difficulty in breathing through the nose during sleep. This results in the patient sleeping with the mouth open
• Snoring and pausing breathing during sleep (sleep apnea attacks) with the ultimate consequence of feeling tired during the day. In fact, it has been proven that when sleep apnea is not treated in time, it can lead to problems in the lungs and the cardiovascular system.
• Frequent sinus infections and upper respiratory tract infections, heaviness, or pain in the face.
• Dryness of the nasal mucosa predisposing to nosebleeds (epistaxis).

Deviated Septum – Diagnosis

The deviated septum is diagnosed by the otolaryngologist specialist in the office. The diagnostic approach includes the following:

• Medical History. The doctor will ask you to describe your symptoms in detail. They'll also ask you when they started, how severe they are, and whether they are on one or both sides of the nose.
• Nasal endoscopy. Endoscopy of the nose is performed using special flexible or rigid video-endoscopes and a special digital camera. The entire procedure is easily and quickly performed in the office and is recorded so that it can be used as a reference check during and after surgery. This examination enables the doctor to check in detail not only the septum itself but the entire nasal cavity, nasal sinuses, and nasopharynx. It provides a complete display of any additional factor that may contribute to the difficulty of breathing through the nose (e.g., hypertrophic nasal turbinates, nasal polyps, adenoid hypertrophy, etc.).
• Assessment of nasal breathing. The assessment of nasal breathing is done with a special device called a rheometer, which measures the volume of air that passes through the nasal cavity in one minute.

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Deviated Septum – Surgery

The surgery that will provide the complete and permanent solution to the deviated septum is the Septoplasty which, according to the prestigious medical journal The Lancet, is the most frequent otorhinolaryngological surgery performed on adults. Any conservative treatment with topical sprays and nasal irrigation provides only temporary and partial relief from symptoms and is not a reliable option. During the operation, an incision is made inside the nose therefore is not visible. Through the incision the Surgeon approaches and corrects all the cartilaginous and bony structures of the septum that are responsible for its deviation. The incision and the septal mucosa are sutured with absorbable sutures that do not require removal. At the end of the operation there is no swelling or bruising while the external shape of the nose remains unchanged. Nowadays, the simultaneous use of endoscopes (endoscopic septoplasty) offers great precision in our manipulations and, therefore, in the result.

Deviated Septum - Surgery: What is the operation procedure?

The straightening of the deviated septum is performed under general anesthesia and usually lasts 30 to 60 minutes, depending on the severity of the problem. Before the operation, a pre-operative check-up (blood tests, evaluation by a cardiologist and anesthesiologist) is necessary, which, in most cases, is done on the day of the surgery. The patient is then transferred to the operating room where the septoplasty takes place. After the procedure is over, the patient is taken to their room where they stay for at least 6 hours. After this period of time and depending on their wish they can return to their home or alternatively they can spend the night in the clinic and be discharged the next day.

Deviated Septum - Surgery: Which other operations can Septoplasty be combined with?

Sometimes, difficulty in breathing through the nose is not only due to a deviated septum. Other conditions that can co-exist are:

• • Hypertrophy of the inferior turbinates
  • Nasal polyps
  • Formations or nose tumors
  • Adenoid hypertrophy

In these cases, septoplasty should be combined with:

• Conchoplasty (Turbinoplasty)
• Endoscopic sinus surgery
• Adenotomy
• Rhinoplasty in cases of severe deviations or in cases of additional aesthetic problems in the nose

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Deviated Septum and Rhinoplasty

In some cases, the nasal septum can be extremely deviated, parts of it may be missing or ossified due to a violent injury, while deviation may also drag the nasal bones along creating the so-called 'crooked nose'. In these cases, the classic straightening of the nasal septum is not sufficient. To achieve the desired result, we must combine the septoplasty with open or closed rhinoplasty. Thus, we can reconstruct a straight septum using cartilage grafts from the auricle or ribs, and also realign the nasal bones. Moreover, in cases where, as along with the breathing problem, there are aesthetic issues that worry the patient, e.g., a hump or a thick or droopy tip can be corrected in the same surgical time as the rhinoplasty procedure.

In several cases, the straightening of the nasal septum can be combined with rhinoplasty, so as to restore both the function and the aesthetics of the nose simultaneously.

Deviated Septum – Septoplasty: What Happens After Surgery?

6 to 8 hours after the surgery or the next day the patient is discharged. They receive a short antibiotic treatment while nasal irrigation with a special solution and the use of a special healing ointment for a few days are recommended. As mentioned above, all sutures are absorbable and do not need to be removed. The post-operative check-up takes place at regularly scheduled appointments at the clinic.

Deviated Septum – Septoplasty: Is it painful?

Septoplasty is a painless surgical procedure. General anesthesia ensures the absence of pain during the operation, while little or no painkillers are usually required afterwards. Also, there is no external swelling, no bruising, and no change in the external appearance of the nose.

Deviated Septum – Septoplasty: Will it hurt when the nasal packing is removed?

You may have heard descriptions from people who have undergone nasal septum straightening surgery who report how much pain or discomfort they felt when the nasal packing was removed. It is true that in the past the materials used for this purpose were very bulky and remained in the nose for a long time, making their removal a traumatic experience.

In our practice, we either do not use any tamponade at all, replacing it with special absorbable sutures on nasal mucosa, or we place a very light tamponade which we remove shortly before the patient is discharged. In this way, we minimize or even eliminate any discomfort that could be caused, so you no longer need to worry about this (previously) unpleasant experience.

Deviated Septum: What is the right age for surgery?

A necessary precondition before someone undergoes Septoplasty is that the formation of the septum, nose and facial features in general has been completed. In women this happens at the age of 16-17 years and in men at the age of 17-18 years. As for older ages, there is no upper limit. So, any person who has difficulty in breathing, snores, or has sleep apnea due to a deviated septum, can undergo septoplasty.

Deviated Septum - Operation: Will it be done with Laser or Ultrasound?

Lately, there is a lot of talk about the use of Laser or Ultrasound in straightening the deviated septum. These are two technologically advanced methods that offer very good results when used in the right cases, that is, in cases with mild and moderate deviation of the septum. In contrast, in more severe cases, the use of the classic surgical method of straightening the nasal septum is the only option. And this, because it is the only technique that enables the treatment of even the most demanding cases and ensures an excellent result that will last over time. In addition, it is the most technically demanding method for the surgeon and for this reason the latter must have appropriate training and experience. It should be noted that Lasers, Ultrasound and Radio Frequencies are routinely used and are very effective in shrinking Hypertrophic Nasal Turbinates. It is considered necessary that the patient be properly informed and discuss with their doctor how the surgery will be done.

Deviated Septum – Septoplasty: Can the deviated septum relapse after the operation?

If the operation is done properly, as mentioned above, the septum will remain straight forever, allowing free breathing for the rest of the patient's life.

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Deviated Nasal Septum - Septoplasty: Is it true that I will be able to breathe perfectly immediately after surgery?

Again, this is a myth that is unfortunately reproduced very often as this only applies to the mildest nasal septum deviations that are treated with Laser or Ultrasound. In all other cases, which are treated with the classic surgical method, the nasal mucosa inevitably swells due to the manipulations that have been done. Thus, immediately after the operation or immediately after the removal of the very light packing that may have been placed, the patient can breathe perfectly, but this only lasts for a few hours. Subsequently, the swelling of the nasal mucosa makes nasal breathing difficult. So, for the first week the breathing through the nose is moderate and the patient breathes roughly like when they have a cold/sinusitis. Nasal rinse, a special nasal gel as well as the cleaning that will be done in the doctor's office will help to improve the flow of air through the nose. From the 8th postoperative day onwards, the swelling decreases significantly and gradually subsides completely. The patient breathes better and better, while the final result is noticeable in about 6 weeks after the operation. In the meantime, the nasal breathing is already very good.

Deviated Septum – Septoplasty: What should I watch out for after surgery?

Immediately after Septoplasty and for a few days, the patient should follow some simple post-operative instructions. Specifically, the following are recommended:

• Avoid vigorous physical activity (e.g., sports, gym) for about 3 to 4 weeks. 15 to 20 days after the operation you can start mild aerobic exercise, e.g. light running.
• For the first week after your surgery, do not eat very hot or spicy foods and avoid hot drinks.
• Do not blow your nose intensely for 2 weeks. In case you want to sneeze, open your mouth so that the air is released from there and the pressure in the nasal cavity does not increase.
• For the first days after surgery, sleep with your head slightly higher than the rest of your body.
• In the first few days, it is more comfortable to wear clothes that button up at the front (e.g., shirt, cardigan) so that you do not press your nose with the clothes as you get dressed.
• Avoid alcohol and, if possible, smoking for at least one week.
• Do not stay under the sun and do not remain for a long time in very high temperatures for 3-4 weeks after the operation.

Deviated Septum – Septoplasty: When can I go back to work?

Septoplasty has a short recovery and the patient's return to work is rapid. Thus, if it is an office job, it is possible to return to it as early as the third day after surgery. In the case of heavy manual work that includes weightlifting or sudden changes in the ambient temperature it is good to let a period of 10 to 15 days pass before you resume work.

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210 69 90 484 & 6940 804 000 & 6944 221 223

Deviated Septum: Surgery Cost

The cost of Septoplasty includes the following:

• Surgeon's fee
• Anesthesiologist fee
• Pre-operational check
• Operating room cost
• Cost of materials used during the operation
• Hospital room cost
• Follow-up visits to the doctor's office

The final cost of the Septoplasty depends on the following parameters:

• The hospital you will choose to undergo the operation.
• Your insurance company.
• Whether you have private insurance. In many cases, private insurance fully covers the costs of your surgery.
• Whether it is a simple straightening of the septum or it will be combined with a functional rhinoplasty.
• Whether it is the first operation you undergo or whether it is a revision operation.
• Whether special materials are to be used.

In any case, you should discuss the exact cost of the operation with your doctor so that you are informed in advance. It remains a fact that with the right choice of surgeon you can get an excellent result at a very reasonable price.

Deviated septum is a pathological condition that affects many people. Its consequences make their presence felt daily and affect their quality of life negatively. However, there is a definite solution given by Septoplasty. With this operation, every anatomical defect of the area is restored, and the patient acquires a normal breath that gives him energy and well- being.