ORAL SURGERY

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Nasal Airway Disorders

Deviated Septum (Crooked Septum)

The nasal septum is the center part of the nose which divides the nose into two nostrils. The septum extends about 3 inches back from the front of the nose. The septum may become crooked (deviated) by an injury to the nose as a child or an adult. Even a small injury as a child can lead to a minor curve of the septum. When the nose begins its major growth spurt during the teenage years, the minor curve of the septum can grow much worse. Sometimes the deformity of the septum can be seen or felt, but more frequently, the curvature is further back and can’t be seen by the patient. Only a complete examination of the nose after spray of a decongestant spray can determine if the septum is deviated. A very small curve of the septum can create a significant amount of nasal obstruction (Airway resistance increases by the 4th power of the radius of the airway).

A deviated septum may cause difficulty breathing through the nose on one or both sides. Frequently the obstruction will seem to alternate between sides. If the right side of the nose is blocked, the patient will usually be more comfortable sleeping on the right side. With a deviated septum, one may also experience post nasal drainage, nose bleeds, and scabbing in the nose (more commonly called boogers). People with a deviated septum may also be predisposed to recurrent sinus infections.
 

Repair of a deviated septum is called a septoplasty. The procedure typically takes about an hour and typically does not cause any bruising and does not require a cast over the nose. The surgery is usually done in an outpatient surgery center under general anesthesia and the patient goes home about an hour after the surgery. The success rate for septoplasty is very high and complications are uncommon. Most patients take several days off work or school after this surgery and avoid strenuous activity and flying for 2 weeks after the operation. Pain after this operation is usually mild.

A deviated septum is repaired through an incision inside the nose. The surgery is performed by straightening out the cartilage and bone that forms the septum. The incisions are then closed with dissolvable stitches. Nasal packing is used to prevent bleeding after surgery and keep the septum straight during healing. This packing is removed under general anesthesia one week after the septoplasty.

Turbinate Enlargement (Hypertrophy)

The nasal turbinates are structures within the nose which moisturize and warm the air as you breathe. There are three turbinates on each side of the nose (a lower, middle and upper turbinate). As the air flows past the turbinates, the air is warmed up and humidified so that once the air gets to the lungs, it is more comfortable. The turbinates may enlarge due to a deviated septum, allergies, non allergic rhinitis or sinus infections. The turbinates are made of a central flat piece of bone surrounded by blood vessels and a skin (mucosa) lining. Enlargement may be due to enlargement of the bone or skin lining or a combination of both. The middle turbinate may also enlarge due to a sinus or air pocket that can grow into the turbinate (also known as a concha bullosa).

When the turbinates enlarge, they cause nasal congestion and difficulty breathing. The patient usually describes a sense of swelling or mucous in the nose but may not be able to blow anything out. Enlarged turbinates can block the nose and cause difficulty breathing mouth breathing and snoring. If the turbinates remain enlarged, they can predispose to sinus infections due to obstruction of the sinuses. Turbinate enlargement may cause difficulty breathing through the nose on one or both sides. Frequently the obstruction will seem to alternate sides.

The turbinates can be reduced in size in the office. This procedure is performed with a radiofrequency probe (known as Somnoplasty or Coblation).  Radiofrequency reduction of the turbinates is best for turbinates that are enlarged due to soft tissue enlargement and not bony enlargement.