Understanding the Nasal Septum & When to Consider Septoplasty

When the nasal septum becomes deviated it can lead to complications such as nasal obstruction, facial pain, snoring, and other issues that make nasal breathing difficult.
This video is a deep dive into understanding the nasal septum and the common issue of septal deviation. Learn how a deviated septum affects nasal breathing and when it's time to consider septoplasty surgery. In this comprehensive video, I'll go over:
The anatomy of the nasal septum
Causes and effects of septal deviation
Symptoms and impact on nasal breathing
Diagnostic methods for nasal obstruction
Detailed overview of septoplasty surgery and recovery
Potential risks and complications
Whether you're considering septoplasty or just curious about nasal anatomy, this video provides valuable insights. Have questions? Leave a comment below!
For consultations, visit www.premiersinus.com or call My Houston Surgeons at [phone].
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[@Bunzur1]

Enjoyed the video production which led to a relaxing presentation of information!

[@allysonfarmer83]

Amazing doctor.

[@richardw1043]

What is your opinion on new techniques that reduce a septoplasty to a 20 minute in-office visit or the use of balloons? Why do some ENT doctors opt not to use nasal support strips at all post-op?

[@snotdoctx8742]

I’ve seen septoplasty balloons a few times and attempted to use them a few years ago in simple cases. I wasn’t a fan because without an incision you’re just fracturing bone and/or cartilage and hoping they heal in a good position and don’t have any access to remove bulky spurs, apply support sutures, etc. I’m sure fracturing over a deviation will help some patients, but it’s the lack of control over the eventual outcome I didn’t view as acceptable. If a patient only has a posterior septal problem such as a spur and the front of the septum is relatively straight, a limited incision just large enough to remove the spur or posterior deviation can be done in 5-10 min using the endoscopic equipment. The length of a septoplasty procedure depends on how challenging the front of the septum is (where structural support is needed) and how easy it is to raise the skin off the bone or cartilage (can be stuck down after trauma, prior surgery, etc).
I use splints applied to the septum for 1-2 weeks when the front portion of the septum is worked on and needs help staying midline while initially healing, but only 20-30% of my patients end up needing those splints. The rest without splints have a slightly easier recovery as the splints can cause pressure and discomfort while in place.
Nasal support strips (I’m guessing you’re referring to Breath-right strips on the outside of the nose) might open the nostrils better while the nose is swollen and improve airflow temporarily, but they’re completely optional and would not be advised if a Rhinoplasty was performed and the nasal bones are covered with tape/support already.

[@user-jk5cl2oi1m]

Nice video with helpful info. My question if one needs a septoplasty and also has turbinate hypotrophy can just performing the septoplasty alone without turbinate reduction will this bring the turbinates back to normal size over time after the surgery. I am afraid of ENS and don't want to touch the turbinates'. Would appreciate your feedback.

[@snotdoctx8742]

@@user-jk5cl2oi1m This really depends on the specific nature of your septal and turbinate abnormalities. If you have overgrowth of bone in either (I.e. large septal bone spur or thick turbinate bone that is rigid) then addressing both would likely be needed to provide meaningful relief. If you straighten the septum and only soft tissue of the turbinates remains a problem, you might get relief over time with topical steroid sprays or rinses and sleeping at an incline to reduce vascular swelling that occurs in turbinates while lying flat.
I’m very comfortable with turbinate surgery and usually recommend it as a path to lasting improvement in nasal breathing because it makes more room than just correcting a septum. And I haven’t seen any cases of ENS that I’m aware of after my procedures, as it is extremely rare with modern techniques.
The safety of turbinate reduction comes down to technique - all surgeons will claim to be good. The best way to tell as an outsider is to ask how they do it and how long it takes, if they’ve had patients with ENS, and if they know how to treat ENS (if they can treat it, chances are they’re not causing it because they understand it).
If they use a microdebrider or cautery probe (RFA) and spend 2 minutes per turbinate, it’s less likely to be permanent but in general is safe if done properly. If they trim with scissors and remove a large portion of the turbinates in less than 2 minutes, this is more concerning and may risk ENS. If they meticulously remove the turbinate bone through an incision but don’t remove much if any soft tissue/outer lining, this in my opinion is the best for lasting great results with demonstrated safety.
There are many patients using steroid sprays, rinses, allergy meds, etc and still miserably congested with impact on their sleep, exercise, etc. If you’re in that category, then trusting a good surgeon to perform turbinoplasty can drastically improve breathing, sleep, and restfulness. You just have to decide if it’s impacting you enough to warrant it.

[@user-jk5cl2oi1m]

@@snotdoctx8742 Wow thank you for such comprehensive reply. I don't have any issues with obstruction during the daytime only when I lay down to sleep my left side turbinate swells up blocking the nose completely causing me to wake up every few hours during my sleep cycle and my septum is deviated to the right side. Is submucosal resection with microdebrider safe against ENS? Once again thank and wish you success for your youtube channel.

[@snotdoctx8742]

@@user-jk5cl2oi1m Often the turbinate opposite the septal deviation grows larger than the turbinate on the side of the deviation. Having not seen your images it’s difficult to give specific advice, but in general it’s better to get both problems corrected if you want better chances of a successful breathing outcome. The risk of ENS with microdebrider or any technique is very low as long as the surgeon knows what they’re doing when it comes to turbinoplasty. I wouldn’t hesitate to have my own turbinates reduced by a surgeon I trust, and wouldn’t be concerned about ENS in their hands.

[@user-jk5cl2oi1m]

@@snotdoctx8742 Thanks for the reply Doc. I would suggest if you can do a comprehensive video on ENS it would really help people who are the fence about the surgery. There are some people with scary stories online warning about ENS even with these modern techniques for turbinate reduction. I actually saw one story on yotube who recently had a septoplasty and turbinate reduction done and after 3 months started to show symptoms of ENS which subsided after a few weeks. The person mentioned how those continuous symptoms of suffocation were almost suicidal. link of the video ua-cam.com/video/EiFKbpjWG8M/v-deo.html. Hope people can have a better understanding about this condition.