The nasal septum is inside the nose, it consists of cartilage at the front and bone at the back and divides the nose in two areas. If it is excessively off-center, broken or slanted, it makes breathing very difficult.
Many people present an asymmetry in the nasal ways and it is estimated that 80% have a deviated badly placed septum without knowing it.
Only the most serious cases create a significant breathing difficulty and demand treatment like surgery.
The most frequent symptom of a scoliotic septum is nasal congestion, usually one side is more blocked than the other.
Recurring sinusitis are another sign, as are:
- Facial pain.
- Postnasal drip.
- Loud breathing.
- Intense snoring.
- Apnea syndrome.
Α) Classical Septoplasty
Through a small incision in the inside of the nose the nasal mucous membrane is dislodged on both sides and leaves in the middle purely the deviated nasal septum. By a special tunnel its bone basis is also revealed.
Then the surgeon removes at will vertically and horizontally pieces of cartilage so they do not protrude.
The bone basis is removed with a thin osteotome because it usually bothers the air passage. The bone protrusions behind the cartilage septum are also removed.
However, in very difficult cases, if many slanted pieces must be removed, they leave almost nothing behind.
If 1 cm of cartilage remains at the front and 1 cm under the nose bridge it is very difficult to sustain the support and therefore the shape of the nose for long!!!!
So in such cases with severe septal deviation or post traumatic septal deformities, if we just remove the broken parts in order to operative airway, serious consequences will occur. The shape of the nose will eventually change, the nasal tip will lost its height, the colunella will recede, the nose will look more flat and droopy.
It is useful in cases with folds in the posterior part of the septum and not in the anterior part!!
Using a rigid 0o degree endoscope parts of cartilage and bone are removed from the posterior part of the septum.
It is sometimes used together with endoscopic surgery of the paranasal sinuses (the sinuses). No cartilage formation takes place, however.
Only removal or protruding cartilage and bones.
It is used in selected incidents with a small problem, small to medium deviation of the cartilage septum.
Technically, vaporization takes place, shaving of the protruding nasal spine, together with the mucous membrane surrounding it.
This creates a burn in a 2-3 mm-high strip of mucous membrane, cartilage and perichondrium together.
The procedure lasts for 5 minutes with local anesthesia. No tampon is needed, naturally. No cartilage formation takes place and no bone protrusions are removed.
The removal of nasal mucous membrane presents the risk of chronic rhinitis.
The method is not safe for cartilage deviations in both nostrils, as the septum may be perforated.
Β) Nasal Septum Plastic with Cartilage Relocation & Restructure
Nasal septum plastic is the most modern approach for treating both simple and more complex cases.
It is carried out by a specially trained rhinosurgeon with flexibility in the use of grafts.
It is the most advanced method and is used in the best rhinosurgery centers internationally.
The operation aims to modify all deviations, anterior and posterior, in the nasal septum cartilage without removing anything in the end. What will be removed will be only the protruding parts of the bones.
For this purpose, there will be relocations of parts of cartilage, their transfer to another position after abrading them, so that no gaps remain inside the nose.
This technique is invaluable when there is tilted anterior septum. The fold of the septum in the anterior part is very difficult indeed to handle.
It may be scratched in order to weaken its tendency or be treated with seams or finally removed, something that affects the shape of the nose (the tip falls downwards).
On the other hand, with the relocation technique, the tilted anterior septum will be replaced by a strong and straight septum part taken from another position.
This technique also helps treat permanently and effectively a post-traumatic and very deviated septum.
The same is true for corrective and restorative nasal septum operations with or without rhinoplasty. The composition will be carried out with whatever remains from the old septum, while “construction” will continue with ear or rib cartilage of the same patient.
C) Extracorporeal – Open Nasal Septum Alignment Method
If all the cartilage septum presents serious deviation touching the opposite nasal wall and often makes the whole nose slant, the only effective operation is the extracorporeal one.
In this case because an extremely tilted septum cannot be reconstructed from the inside, it must be wholly removed out of the nose.
Then the reconstruction techniques will take place of the operation table and a new, completely straight septum will be put together. Sometimes it is good to have an absorbable PDS sheet to help the technique. The new cartilage septum will be replaced in the nose and supported in fixed points.
Only in this way do we have flawless, permanent results of a completely straight and whole septum ensuring stable height and shape for the nose.
All the above modern techniques of nasal septum reconstruction are very often combined with a rhinoplasty.
The new rhinoplasty is always combined with the new nasal septum techniques carried out by the same surgeon, thus increasing the flexibility and success of the operation.
In this way we can treat even more difficult cases with great assurance and predictable results.
It is inside the nose and divides it in two parts. It consists of cartilage at the front and bone at the back. It develops over age and acquires its final shape at age 16-18.
When you have a constantly congested nose, when there are chronically secretions and mucus, intense headaches, heavy head, frequent sinusitis, otitis. Also, many patients have become dependent from nasal sprays which they buy without a doctor’s prescription, for many years without control and end up with reduced sense of smell, dry nose, nose bleeds.
The tilted nasal septum which may close one or both nasal passages. Swollen nasal conches, stenosis of the sides of the nose, in the area of nasal valves and nasal polyps.
In the nasal septum operation, we use an invisible incision in the interior of the nose. From there we create tunnels with the help of special thin instruments for the removal of cartilage and bone protrusions that block breathing. The new details in this operation is the art in septum cartilage formation in order to maintain their biggest part and obtain good support for the nose. No laser is used in any international rhinosurgery center, as it shows no success in the formation of cartilage and bones. The initial incision will be closed with 1 – 2 absorbable sutures. No tampons or gauzes are used in the nose.
We are going to need two different operations in order to align a tilted nose: septum and rhinoplasty. Just the operation in the nasal septum may result in a small difference in the lower part of a mildly tilted nose.
Nasal septum surgery is not painful and often includes an operation in nasal conches and perhaps sinuses. There are no swelling and bruises. On the following day the patient can return to work, if it is not manual. It is recommended to avoid sun exposure and aerobic exercise during the first 15 days. One can travel by airplane after 3 -5 days depending on the case.