Septoplasty

Classification according to ICD-10
J34.2	Septal deviation
ICD-10 online (WHO version 2019)

Curvature of the nasal septum on magnetic resonance imaging

The term septoplasty describes a surgical procedure to correct the curvature of the nasal septum (septum deviation).

Anatomical basics

According to the American Academy of Otolaryngology-Head and Neck Surgery , 80 percent of people have a slightly out of the median plane shifted nasal septum . This slight form of septum bending is usually symptom-free and can therefore be regarded as normal. Significant curvature, however, is often associated with breathing difficulties and is associated with hyperplasia (enlargement) of the turbinates because the turbinates compensate for asymmetries in the volume of the nasal passage. Curvature of the septum may be congenital or caused by trauma.

Symptoms and consequences of curvature of the nasal septum

Curvature of the septum and concomitant turbinate hyperplasias can lead to obstruction of nasal breathing with insomnia and snoring as well as concomitant diseases such as sinus infections and throat infections . The development of otitis media or olfactory disorders is also promoted by impaired nasal ventilation. Bending the nasal entrance area sometimes have a nosebleed result, bony outgrowths with contact to the lateral nasal wall can headaches cause.

diagnosis

An external and internal inspection of the nose is usually sufficient to diagnose a septum curvature; it is sometimes supplemented by an endoscopy . X-rays are only required if the paranasal sinuses are also to be assessed. The air flow through the nose can be objectified with rhinomanometry . An olfactory test can be carried out if there are symptoms.

History of septoplasty

From around 1900 the German doctor Gustav Killian straightened the nasal septum under cocaine anesthesia. For more than 50 years, this remained the standard surgery for nasal obstruction treatment, in which large areas of the bent nasal septum cartilage were radically removed. However, the bony nasal structures, which are usually just as responsible for respiratory problems, remained untouched. The extensive cartilage removal often led to an impairment of the nasal stability and perforations of the nasal septum - and thus again to a respiratory impairment, which should actually be treated. Because of these disadvantages, the radical surgical method according to Killian is no longer common and has been abandoned since the 1960s in favor of a tissue-sparing septal surgery.

Procedure of the procedure

Doyle Splint with Breathing Tube (used)

Modern functional nasal surgery was founded by the American Maurice H. Cottle . The principle of the operation is based on resecting bent cartilaginous parts of the nasal septum as little as possible or only sparingly, straightening them through gentle processing and leaving them in the middle of the nasal cavity for support. The bony structures of the nasal septum are also included in the correction.

The nasal septum is splinted with splints until it heals.

After the procedure, internal splinting of the nasal septum on both sides is necessary to ensure that the nasal septum grows together straight in the middle of the nasal cavity and to prevent bruising. This splint is usually made with two plastic plates ("splints") or with foils that are sewn on both sides of the corrected nasal septum and stabilize it. The splints are about 50 mm long and 15 mm high and give an idea of ​​the size of the nasal septum. Often the nasal septum is tamponated on both sides for a few days, particularly to stop bleeding from the mucous membrane. The backing sheets are removed after about 5–7 days.

Possible complications

• Rebleeding
• Cartilaginous saddle nose after extensive resection of cartilaginous nasal septum
• Relapse (renewed septal deviation)
• Septic perforation (hole in the nasal septum) with and without whistling noises when breathing through the nose

literature

• Rudolf Probst, Gerhard Grevers, Heinrich Iro: Ear, nose and throat medicine. Georg Thieme Verlag, Stuttgart 2000, ISBN 3-13-119031-0 .

Individual evidence

1. ↑ Obituary of the American Rhinological Society on Maurice Cottle ( Memento of the original of May 13, 2008 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. 
2. ↑ Ernst Kastenbauer (Ed.): Head and Neck Surgery, Volume 1. 2. Completely revised edition. Thieme, Stuttgart 1995, ISBN 3-13-485602-6 , p. 381 ff.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !