FUNCTIONAL SURGERIES
Difficulty breathing through the nasal airway may be due to a deviated septum, enlarged turbinates, a broken nose, septal perforation, or a weak structure of the nose causing collapse of the “valve”.
These can lead to snoring, morning headaches, fatigue during the day, nasal obstruction, congestion due to insufficient sinus drainage, and even deformity of the nose.
Since Dr. Shaer is also a certified Otorhinolaryngologist, he has the skillset and in-depth understanding of the facial, head, ears, nose, and throat structures to correct virtually all functional issues.
A large percentage of the population suffering from this can improve their daily life functions just by a short surgery under general anesthesia to establish good airflow through their nose.
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These functional surgeries last approximately an hour
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The patient is closely monitored because they usually will be under general anesthesia.
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Complications rarely occur, and the patient usually can go home the same day as the surgery.
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After surgery, the patient will need someone to transport them home.
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To avoid nose bleeding, it is important for the patient to keep their head elevated, and to avoid any straining or exercise for 3 weeks.
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Following the doctor’s instructions in regard to surgery after-care is very important
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If a patient experiences a sudden increase in nose bleeding, or a fever higher than 38.6 C, or persistent sharp pain, they should contact their surgeon immediately.
SEPTOPLASTY
Not every crooked septum requires repair. Some people have only a mild deviation but complain of a large degree of nasal obstruction. Others may have a significant deviation but have no problems. Most people will complain of trouble with one-sided nasal breathing. However, some may have no complaints. Others yet may complain of difficulty breathing through both sides of the nose.
A septoplasty, sometimes referred to as a “submucosal resection” or “SMR“, refers to straightening out the septum. This requires lifting the lining of the nose off the septum and removing or carving the underlying cartilage and/or bone.
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Preferably done under general anesthesia
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A light nasal packing is placed in the nostrils and is removed the following day.
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There is no external bruising or swelling.
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All incisions are inside the nose, and dissolvable sutures are used so none have to be removed.
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There is typically very little pain involved.
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There is more discomfort for the first week since the nose will still feel congested and will require cleaning with irrigation prescribed to you.
TURBINECTOMY
The turbinates are finger-like structures that line the sides of the nose. There are three on each side – the inferior (largest), middle and superior. These structures warm and humidify the air we breathe in. The inferior turbinate may be enlarged and cause breathing problems by narrowing the nasal passageway. The middle turbinate is sometimes enlarged and can block the sinuses on that side of the nose. Most sinuses drain into the nose underneath the middle turbinate. The turbinates can be reduced in size by numerous surgical methods. They should not be removed entirely since they serve important functions mentioned above. Turbinectomy is commonly performed as a combined procedure with a septoplasty or with sinus surgery.
There are numerous ways to reduce the size of the turbinates. Dr. Shaer has been using recent technology involving radiofrequency to shrink them, and if necessary, partially cutting part of them out – this results in less pain, less crusting in the nose, and faster recovery.
SEPTAL PERFORATION REPAIR
A septal perforation refers to a hole that occurs in the septum, thus causing an abnormal communication between the left and right sides of the nose. These holes may be small or large, in the front or in the back of the nose. There are numerous causes including previous nasal surgery, nasal trauma, nasal infection, continuous use of over the counter nasal medications, use of cocaine, certain systemic diseases, and others. Only those perforations that cause symptoms require repair. Symptoms include nasal obstruction, whistling noises when one breathes in, dryness, frequent nasal crusting, nosebleeds, and recurrent infections.
Repair can range from placement of a prosthesis in the nose to close the hole, or complicated surgery requiring placements of grafts. A detailed examination will determine which procedure is best for you.
NASAL FRACTURES
A broken nose is one of the most common injuries of facial trauma. This section will only discuss isolated fractures of the nose. For the most part, nasal fractures only need to be repaired if there is an obvious cosmetic deformity or worsening nasal breathing.
Evaluation is primarily made by physical examination. X rays may show a nasal bone fracture, but often this does not change the management. Most fractures that are not “displaced” (pushed from the normal position) do not require any special treatment. Immediately, ice should always be placed to reduce swelling. Bleeding often occurs but resolves on its own within a short time.
There are two time points that surgery, if needed, can be considered:
The first is within roughly 10 days after the injury.
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The bones have not yet healed in the “wrong” place and can be reset during this time.
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A “closed reduction” can be performed which involves manipulation of the bones under light local anesthesia followed by a nasal splint or cast for one week.
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A light intranasal packing is placed for 1-2 days.
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An initial closed reduction can only be performed if there is minimal swelling so that the surgeon can adequately assess if the fracture has been returned to its normal position.
If there is a significant amount of swelling initially, then surgery often must be delayed because it is difficult to judge exactly how the nose really looks. Also, if there is a significant deformity inside the nose (such as a severely twisted septum) often it is best to wait for a more formal surgery.
The second time point would be to wait at least 3 months to completely allow for all swelling to resolve and allow any fractures to heal:
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An “open reduction” can then be performed. This is a more involved surgery which requires more manipulation of the nasal bones.
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Postoperatively, swelling and bruising can be expected for about 1 week.
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A cast or splint is worn for 1 week.
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Any internal deformities can be addressed at the same time and often a septoplasty will be performed at the same time.
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General anesthesia is often required.
