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NASAL SURGERY
There are a number of inherited or acquired anatomic nasal problems which are amenable to surgical repair. The septum is a piece of cartilage and bone which divides the nose into two symmetric chambers. A crooked septum will cause a persistent obstruction to breathing. It will also predispose to recurrent nose bleeds, can contribute to sinusitis and often makes the symptoms of allergic rhinitis more troublesome than they might have been with a straighter septum. The septum can be straightened by surgery. This is normally performed on an outpatient basis. Some surgeons prefer local anesthesia with intravenous sedation, others prefer general anesthesia. This is ultimately a matter of personal preference. A half inch incision is made just inside the nose on the most forward edge of the septum. The mucosa is then carefully lifted off of the cartilage and bone. Fractures and convolutions are removed surgically. Concavities and convexities are straightened and then the incision closed. The septum is held in its new position while it heals. In the old days this was achieved by packing the nose with 1-2 yards of half inch gauze. Today, soft gentle packs or silicone plastic splints are placed in the nose. While there will be crusting and mild discomfort, the postoperative recovery is mild. Risks and complications do exist, but are fortunately uncommon. The biggest problem is that the septal cartilage has a memory and sometimes even though the surgery has been well performed, the cartilage will push its way back into one or the other sides of the nose and the obstruction will reoccur. This can happen as often as 10-20% of the time. If the obstructive symptoms persist and remain troublesome, revision surgery is generally successful.
I should mention that the normal nose goes through what is called a normal nasal cycle every 4-6 hours. Because the work of the nose is so intense, it cannot continue to humidify, filter and warm 24 hours a day and so it is normal for one side of the nose to congest (swell) while the other side decongests (opens up). The congested side is resting. If your nasal obstruction alternates from side to side, this is probably not caused by a septal deflection, but is just a normal nasal cycle. Septal surgery does not interrupt the normal nasal cycle and therefore will not correct these symptoms. In many, the normal nasal cycle is somewhat exaggerated, and in some it is much worse at night. When one lies on one's side, the downside will always congest and obstruct. This is normal and does not require surgical repair.
Terence Davidson, M.D., F.A.C.S.
UCSD Otolaryngology Division
200 West Arbor Drive
San Diego, CA 92103-8895
(619) 543-6631 |