Deviated Septum

Repair of a deviated septum is called a septoplasty. The procedure typically takes less than 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 and the patient goes home about an hour after the surgery. While the surgery can be done either under general anesthesia (asleep for the surgery) or local anesthesia (awake for the surgery), most patients prefer to be under general anesthesia. 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. Historically, nasal packing was used to prevent bleeding after surgery and keep the septum straight during healing. Now, we almost never use packing. Sometimes a thin piece of plastic called a splint (the thickness of a business card) will be placed on each side of the septum in order to keep the septum straight during the healing process. The splint is slid out of the nose about a week after surgery.

Turbinate Enlargement (Hypertrophy)

If the turbinates are too large, we will usually reduce the lower or middle ones.

The size of the turbinates may be reduced in the operating room by trimming part of the surface lining or the underlying boney structure. Sometimes the lining is too bulky and other times the bone is too large and sometimes both may be contributing to the problem. An operation called submucous resection of the turbinates achieves a reduction of both soft tissue and boney portions of the turbinate. This surgery caused minimal discomfort. Most patients are able to return to school or work after just a few days and return to normal activity in a few weeks.

In some people, the turbinates can be reduced in size in the office. This procedure is performed with a radiofrequency probe (known as Somnoplasty or Coblation) and is performed under local anesthesia (with you awake and numbed up) in the office. Radiofrequency reduction of the turbinates is best for turbinates that are enlarged due to soft tissue enlargement and not boney enlargement.

Nasal Valve Collapse or Stenosis

There are many surgical approaches to repair the nasal valve and prevent collapse of the valve. The best approach depends on your anatomy and the exact site and degree of collapse.

A J flap approach involves a small incision in the inside of the nose, and a rotation of skin tissue in order to tighten the valve. The procedure can be done under local or general anesthesia.

The valves can be repaired with a permanent suture placed over the bridge of the nose, attached to the valve cartilages. This procedure is performed through an external incision at the bottom of the nostrils (External rhinoplasty incision).

The valves can be repaired with a cartilage graft (a spreader graft) placed on each side of the septum, in order to widen the valves, which prevents collapse.

The valves can be repaired with a suture from the valve area to the bone just under the eye. When the suture is tied, it stretches the valve open.

Nasal Polyps

Nasal polyps are removed endoscopically in the operating room, in order to remove the polyps from their sites of origin (usually the sinuses). The surgery is the same as endoscopic sinus surgery. The operation is performed with angled endoscopes to allow a magnified view of the sinus openings. A miniature camera is attached to the scope and projects the magnified view of the inside of your nose and sinuses onto a TV monitor. The operation is performed through the nostrils, typically without any external incisions. The sinus openings are enlarged, thereby eliminating blockages, removing the polyps and allowing the sinuses to drain properly. The majority of sinus surgeries are performed as an outpatient (you go home the same day). New advances in sinus surgery have allowed us to avoid nasal packing in virtually all patients and most patients have relatively little discomfort.

Time off work is usually several days and most patients are asked to avoid strenuous physical activity for 2 weeks. Sinus surgery heals over several weeks. Frequent use of saline sprays and saline nebulizers aids in the healing process.

Nasal Deformities

Rhinoplasty (a "nose job") is the operation to correct a nasal deformity, either one that is acquired from an injury or one that you are born with. Many patients elect to improve their appearance with a Rhinoplasty, while they are undergoing nasal or sinus surgery to improve breathing. Rhinoplasty may actually be required in order to improve the nasal breathing.

Rhinoplasty may be performed through internal or external incisions or a combination of the two. During a Rhinoplasty, the nasal bones and nasal cartilages are altered to straighten any curvature and improve appearance. Rhinoplasty can typically achieve a reduction of a nasal hump, thinning a wide nose, reducing the size of the nose and defining the nasal tip.

Following surgery, there is usually a cast placed on the outside of the nose for a week, while any bruising clears up. Nasal packing is usually avoided, though there may be splints placed on the septum similar to a septoplasty procedure. Time off work is usually less than a week and most patients are asked to avoid strenuous physical activity for 2 weeks.

Nasal Fractures

The surgery to correct a nasal fracture is similar to a Rhinoplasty. In some cases, the procedure is performed with internal nasal incisions, and other times, the procedure can be done without any incisions at all. This decision will be made by your surgeon after reviewing the severity of your injury.

Nose bleeds (Epistaxis)

In most cases, nose bleeds can be controlled in the office with a chemical cautery (Silver Nitrate). The nose is sprayed with oxymetazoline (Afrin) and lidocaine in order to shrink the blood vessels and numb the surface of the nose. The lining of the nose is then thoroughly dried and silver nitrate is applied to the blood vessel which has been bleeding. This chemical causes the blood vessel to be sealed off and leads to scar formation over the surface of the vessel, in order to prevent future bleeding.

When bleeding is more severe, a nasal packing can be placed into the nose, in order to put pressure on the bleeding blood vessel. The packing is left in place for several days until all bleeding has stopped and the surface over the blood vessel start to heal.

In severe cases of nasal bleeding, electrocautery is performed in the office or in the operating room. Electrocautery is able to seal off larger blood vessels that with chemical cautery.