The nasal septum is referred to in the jargon as septum nasi .
It consists of a front, cartilaginous and a posterior, bony portion. Through the nasal septum, the nasal cavity is divided into two main nasal cavities. Normally, the air flows in and out of both cavities during breathing. If the nasal septum deviates from the mid-position, the normal flow of air through the nose may be disturbed.
A curvature of the nasal septum is also called septal deviation. This can be caused by congenital deformations or external influences such as injuries.
Since the cartilaginous and bony portions of the nasal septum grow at different rates, few people have the nasal septum in the middle. Small deviations are normal and cause no impairment. However, if the curvature is more pronounced, it may affect nasal breathing.
In addition, the olfactory ability may be reduced. Due to the limited ventilation, it can lead to an increase in nasal sinus and sinusitis. Accompanying frequently recurrent headaches may occur. In some cases, patients complain of frequent nosebleeds.
A nasal passage can be laid on one side and may require treatment. In rare cases, the nasal septum may also be s-shaped and on both sides trigger a blocked nasal breathing. The treatment of choice is a surgical procedure, a nasal septum operation.
Only if the "deformed" nasal septum causes discomfort and limitations, an operative correction makes sense.
That is, if patients suffer permanent headache and / or sleep disturbances due to limited nasal breathing, a nasal septum operation should be considered.
This may be the case, with a more pronounced curvature of the nasal septum, permanent nasal swelling or bruising, abscess or hole of the septum.
In case of a nasal septum curvature requiring therapy, a so-called serum plastic is the treatment of choice.
Before the operation, a consultation and information discussion takes place with the doctor and the anesthesiologist. It is also important to inform the attending physician about medications and previous illnesses. It may be necessary to expose medicines that reduce blood clotting.
The surgery is sometimes performed under local anesthesia. In other cases, general anesthesia is recommended. According to the narcotics measure, a period of time prior to the operation for eating, drinking and smoking is set.
The operation itself starts with a cut in the front part of the nasal septum. The nasal mucosa is then released from the septum. Thereafter, the bent portions are removed. Outside the nose, these are then straightened and replaced.
In addition, if a permanently enlarged nasal mucosa leads to impairments, it is reduced using electricity or a laser. You may also misplaced or removed portions of the nasal mucosa or turbinate. In a bruise of the septum, a so-called Nasenscheidewandhämatom, a drainage is placed and the nasal septum is splinted.
For a hole in the nasal septum, the hole is surgically closed by a mucosal flap plastic. The surgery can be performed on an outpatient or inpatient basis. The medication can still work for up to 24 hours. Therefore, the patient may not drive or operate machinery after surgery. If the operation took place on an outpatient basis, the patient should be picked up. In addition, it should be avoided to make important decisions on the same day.
To avoid injury, the patient should carefully dab nasal secretions for several days instead of blowing his nose. The sneezing should be done open mouth in the first days after surgery.
Nasal septum surgery is usually not painful due to the narcosis effect. If pain occurs during surgery, the anesthetist can respond directly. In a preliminary discussion, questions about anesthesia and the development of pain can be clarified. Since everyone perceives pain differently and reacts differently to different painkillers, an exchange in advance can be helpful.
As a rule, however, even after nasal septum surgery hardly or no pain occurs. If acute pain should occur, it is possible to use analgesics at any time. In most cases this is not necessary. Instead of pain, some patients report swelling and tension in the nasal skin.
Especially in the first nights and when removing the tamponade and / or splint may short-term discomfort occur.
As a rule, operation of the nasal septum is low-risk.
However, every surgery involves certain risks, including the nasal septum surgery. There may be allergic reactions. Structures near the nasal septum can be damaged.
It can cause bleeding, bleeding, bruising, swelling and possibly pain. Moreover, especially in weakened immune systems, inflammation, wound healing problems and scars can occur.
In rare, unfavorable cases, the nose may be deformed after surgery. Moreover, a hole of the nasal septum can arise or an existing hole can enlarge. Also, adhesions of the nasal mucosa are possible, and that an opening between the nasal and oral cavity remains.
In rare exceptional cases, the skull bone can be injured. In this case, cerebral water could leak and develop meningitis. This happens very rarely. In a few cases, the nasal septum correction leads to permanent restriction of nasal breathing and odor.
In unfavorable cases, the nasal mucosa may dry out after the operation and cause a so-called stink nose. This means that there is an unpleasant odor from the nose permanently. In rare exceptional cases structures of the eye can be damaged. In these cases, vision problems or blindness may occur. However, this happens very rarely.
If complications occur, it is the surgeon, in most cases, possible to intervene early. After the operation, about one third show anesthetic effects, such as nausea or, more rarely, vomiting. These can be uncomfortable. But they are usually harmless and will fade after a few hours.
A nasal septum surgery usually takes between 30-50 minutes. If, in addition to the correction of the nasal septum, other further measures are taken, the operating time is extended accordingly.
As a rule, the healing process of the nose starts after just a few days. Patients often report that the nose becomes freer day by day, and that breathing is easier. As a result, sleep also gets better and more enjoyable. After a few days the sense of smell completely returns.
In most cases, the nose has completely recovered within 2-3 weeks. For inpatient surgery, hospital stays usually take between 3-7 days.
As a rule, the patient is on sick leave for two weeks. Depending on the field of activity and the healing process, the sick leave can be extended for another week. If, for example, the work is accompanied by heavy exercise, an extension of the sick leave may be justified.
In many cases, nasal tamponade is introduced into the nose after surgery.
It should serve to catch bleeding and prevent adhesions between the septum and nasal turbinates. Since the septum is still unstable after surgery, it should support them. It is different how pleasant or unpleasant the wearing of the tamponade is felt. In some cases, the tamponade can trigger pressure pain in the nose and head area, as well as irritation of the neck.
The tamponade can disturb the patient at night and possibly prevent them from sleeping. Usually the tamponade is removed after 48 hours. This can also be unpleasant in the short term. If you exhale while pulling the tamponade, the procedure seems to be more comfortable.
In some cases, a tamponade is dispensed with. Due to the discomfort of patients wearing a tamponade, silicone films are increasingly being used instead. There are several scientific studies that suggest that alternatives to the tamponade can achieve the same goals and have fewer disadvantages. Further studies are planned. The abandonment of tamponades after the Nasescheidewand surgery is controversial.
After nasal septal surgery, comprehensive nasal care is very important.
The measures are shown to the patient. This person then has to carry out the care measures and instructions conscientiously at home. So that no bacterial pathogens can settle in the nose, a nasal rinse must take place at least 3 times a day.
Thereafter, the nose should always be gently rubbed with a, recommended by the doctor, nose ointment. These measures serve to prevent crust formation and promote the healing process. To keep the nasal mucosa moist, a nasal spray can be used as needed. The spray should be used sparingly and only for a short time.
The other care measures should be carried out for at least 2 weeks. After that, the flushes can be slowly reduced. If in doubt, the treating physician should be asked. In addition, it is important that the patient avoid anything in the first 2 weeks after the operation, which increases the blood pressure in the head area.
For example, to do without hot showers or hot baths. Frequent stooping or lifting of heavy loads should be avoided. Of sunbathing, sauna facilities, strong coffee and alcohol consumption, the patient should stay away at least for the first 2 weeks postoperatively. Shock, impact or pressure on the nose should be avoided. Even wearing a pair of glasses should not be done at first. On the other hand, contact lenses may normally be worn directly again.
In the first 2-3 weeks, physical strain and effort should be strictly avoided. Therefore, the patient should also take 2-3 weeks off any sports. Sport can also increase blood pressure in the head, which can affect the healing process of the nose.
If sports are restarted too soon, not only can surgical success be destroyed, but there is a risk of complications. In particular, in the first few days of a far-reaching physical rest is very important. Later, a regular exercise, in the sense of walking without effort, is allowed, as far as the patient is well. However, all sports activities should be avoided for at least 2-3 weeks. To avoid complications, the patient should follow the instructions. Before starting to practice sports again, consult with the doctor. If there are any uncertainties or complications, the doctor should be informed and consulted directly.
It is also possible to stabilize the septum after surgery, rather than using a tamponade, with a splint of silicone film for 1-2 weeks.
These rails are fixed in the nose with a small seam. The modern silicone rails have breathing tubes. Through this air can reach the nose in minimal amount. In the first hours after the operation, however, the patient has to breathe through the mouth.
A dry mouth may develop, which can be mitigated by a regular moistening of the mouth. As a rule, the silicone splints are removed after 5-10 days.