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Septoplasty Surgery

It is uncommon for a patient to notice a slight nasal bend when looking in a mirror. Photographs and the image-reversing mirror will reveal the deviation. That is why many of us do not like to have photographs taken. A person with a more severely bent nose may complain of blockage of the airway.

Illustration of baby's head in birth canal with the nose pressed against the sacrum Nasal deviation is commonly due to trauma before birth . One instance of trauma is due to humans having large heads. There is a lot of pressure applied to a baby's nose up to 4 weeks before birth (less time for second and subsequent children). The baby is born with a bent nose but this deviation corrects itself over a few days because the skeleton in the front of the nose is cartilage and it is flexible. Photo of a newborn with temporary nasal deviation
20% of people have permanent deviation of the septum caused by dislocation of the septal cartilage (1) from the vomer bone (2). The cartilage dislocates where the red dotted line is seen in the figure that illustrates the midline structures of the nose.
Nasal septum
This form of nasal deviation is thought to be due to pressure on the cheek bones that occurs earlier in pregnancy. The Braxton Hicks contractions, also known as false labour, may be the cause. The pressure produces compression of the upper jaw and the roof of the mouth moves higher. The roof of the mouth is also the floor of the nose so the vomer pushes upwards and the septal cartilage is forced off it. The scene is now set for nasal problems that include excessive growth of the nose at puberty.
Damage to the vomer (2) during the dislocation produces a thickening of the bone called a spur (3). Deviation of the septal cartilage (1) produces a widening of one nasal passage and the turbinate (4) on that side enlarges. Paradoxically, it is on this wide side that the nose often feels blocked. The large turbinate causes the problem.
Illustration of turbinate hypertrophy
Illustration of a conservative septoplasty SEPTOPLASTY and S.M.R. (submucous resection) are names for operations that improve the midline structures inside the nose. We often do them with rhinoplasties particularly if the nose is bent to one side. Straightening a septum can help a blocked airway. The straightening is partial as not all bends and thickenings will be corrected.

Paul O'Keeffe modified the septoplasty technique at the beginning of 2001 to include a safe chondrotomy (cartilage cut) shown as yellow lines on the figure. This has greatly improved the septum-straightening results without the previously feared septal collapse that might occur after a different chondrotomy.

Septal bone is often thickened where coloured green in the figure. It is called a spur and would be removed at septoplasty. (NB the caudal end of the septal cartilage is broken away in the figure to show its dislocation off the vomer bone.)

Septal reconstruction by suturing a bone graft to the septal cartilage and setting it on one side of the vomer produces additional stability of the structures. This is another innovation by Paul O'Keeffe. Illustration of a bone graft sutured to septal cartilage in septoplasty
TURBINATES (superior, middle and inferior) are structures deep in the nose that look like swellings attached to the side walls. They secrete mucus and can swell or shrink to affect the size of the nasal passages. When the septum is deviated to one side the inferior turbinate (4) on the opposite side will often become too large and frequently block the passage. The turbinate is commonly reduced in size by a turbinectomy operation. As with any operation, this can be done simply and quickly or carefully and in a more conservative way. Simply cutting the inferior turbinate off might remove too much tissue and lead to a dry nose. It is better to remove a small amount of mucous membrane and then reduce the the thick part of the bone underneath the membrane. Photo of a skull showing the turbinate bone in the nasal cavity

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