Why does a bent partition in the nose cause problems?

In most people the partition in the nose is slightly bent to one side or the other, but not enough so that one would notice . Some people do have a significant bend in the partition and still don't notice anything different. However, a bend in the partition whether large or small does cause problems of nasal obstruction in some. There may also be associated problems with headache, facial pain and snoring. The bend may touch the side walls of the nose and the natural shelves which arise from these walls. This is important because the sinuses open out here, and the openings may be blocked causing pressure problems and pain. Operations on the partition of the nose are sometimes combined with sinus operations.

What is the partition made of?

Cartilage in the front and bone at the back sandwiched by a mucous membrane.

How can we straighten the partition or improve the nasal obstruction?

Well, some people just live with their symptoms without needing any treatment. If treatment is needed we try to start simple using medication. Nasal obstruction is sometimes due to allergy that makes the lining of the nose swollen. Using an allergy test, we may find out what you are allergic to, and avoiding this may cure the problem. Otherwise, we can use antihistamines and steroids to shrink the lining of the nose and improve the airflow. The steroid sprays must be used everyday for a couple of months to make any difference. The new generation of steroid sprays have very little absorption into the bloodstream and so don’t affect other parts of the body and may be safely used in children. These sprays can be used for long periods, but can cause dryness and bleeding in the nose occasionally.

If none of these conservative measures work, and there is a structural bend which we think is causing your symptoms we will recommend surgery. This operation is a septoplasty.

How do we do a septoplasty?

You need to come into hospital. This operation is normally done with a general anaesthetic, so the anaesthetist and surgeon will see you on the day of the operation. Once you have been wheeled to the anaesthetic room and put to sleep then you will be wheeled into the operating theatre.

An incision is made inside the nose at the front end of the partition. This incision won’t be visible from the outside once healed. Then, we separate the cartilage and bone in the partition from their mucous membrane coverings. This allows us to separate the cartilage in front from the bone behind and the bone it rests on in the floor of the nose. We then cut out some bone to allow the cartilage to swing back to the middle of the nose. Sometimes we will have to cut out a bend from the cartilage and either remove it or replace it inside the partition.

Once the partition is straight, we stitch up the partition to close up the mucous membrane coverings over the remaining bone and cartilage. Then, depending on your surgeon, you may have plastic sheets stitched inside the nose (which are removed at one or two weeks post surgery), and/or packs which are designed to stop bleeding. Some surgeons don’t place anything in the nose after surgery.

You are then woken up, and taken to a recovery area until fully awake. Then you return to the ward.

Recovery

Once on the ward, patients normally stay overnight, especially if packs have been used. You can eat and drink as normal. The next morning, if packs have been inserted these are removed. You can expect a bloodstained ooze to continue from some days, but this is normal and will settle. As with any operation, it is normally better to stay at home for a couple of weeks to allow complete recovery.

We tend to give patients a variety of medications after the operations: these may include steroid nasal drops, douches for the nose to clear it of clots and scabs, and painkillers. Sterimar is seawater in a canister which has a useful spray nozzle to allow the nose to be conveniently washed. This is something you can buy over the counter in a chemists, but is not on prescription.

Follow up

We do arrange for you to come back to clinic. If splints have been inserted, you will need to come to have them removed one or two weeks after the operation. Otherwise, some surgeons make an appointment for you to be seen at 2-3 months after the operation. It will probably take this long for your nose to settle down and to benefit from the operation to the maximum extent.

Complications

Most of the time the operation and post operative period pass without any problems, but as with any operation there are risks involved. Pain does not tend to be too bad and the painkillers we describe will help.

Bleeding is an important complication to be aware of. If it does happen whilst you must ring the ward and come back into hospital. If the bleeding has been significant, you will have a tube inserted into your vein and a blood test taken to check the amount of bleeding you have had, as well as to check your blood group. If the bleeding is not stopping using an ice pack wrapped in a towel and placed over the nose, you will need insertion of packs into the nose. These come in a variety of guises, but they all aim to put pressure onto the bleeding vessels inside the nose. Once these are inserted, you will have to stay in hospital overnight at least. We tend to remove the packs at 24 or 48 hours after insertion, once the bleeding has settled, then we can send you home. It is uncommon to get bleeding which cannot be controlled and requires a transfusion.

Infections can occur. If the nose starts to get smelly, or there is an increase of pain in the tip of the nose, it is possible that you may have developed an infection in the nose. You must seek medical attention sooner rather than later if this occurs.

Sometimes, a collection of pus can form in the partition of the nose. If this does happen, you may need a further operation under general anaesthetic, to allow us to reopen the partition and remove the pus (a relatively simple and short operation.)

Uncommonly, the shape of the nose from the outside may be altered, and a saddle deformity may occur with a collapse of the nose. A perforation of the partition may also occur. This may cause no problems or go unnoticed, but may cause the nose to whistle or collect crust and debris. If it does cause problems there are operations which can be done to fix it.