septoplasty and smr

deviated septum

1. BY NITHIN.M
SEPTOPLASTY AND SUBMUCOUS
RESECTION

2. SEPTOPLASTY
INDICATIONS
Deviated nasal septum causing nasal obstruction
Recurrent epistaxis
As a part septorhinoplasty
Septaldeviation making contact with lateral nasal wall
As an approach to pituitary fossa
Septaldeviation causing sleep apnoeaor hypopnoea.
For approach to middle meatusor frontal recess in
endoscopic sinus surgery.

3. CONTRAINDICATIONS
Acute nasal or sinus infection
Untreated diabetes
Hypertension
Bleeding diathesis
ANAESTHESIA
Local or general
POSITION
Reclining position with head end of the table raised

4. TECHNIQUE
1.Infiltrate the septum with 1% lignocainewith adrenaline
2.For septaldeviation make a slightly curvilinear incision 2-3mm above the caudal end
of septalcartilage on the concave side known as killian’sincision.Incase of caudal
dislocation freer’sincision is made
3.Raise mucoperiostealflap in one side only
4.Separate septalcartilage from the vomerand ethmoidplate and raise the
mucoperiostealflap in opposite side
5.Remove maxillary crest to realign septalcartilage
6.Correct the bony septum by following methods
Scoring on concave side
Cross hatching or morselizing
Shaving
Wedge excision
7.Trans septalsutures are placed
8.Nasal pack

5. POSTOPERATIVE CARE
Septoplastyis a daycare surgery and the patient can go home
after recovering completely.
Avoid strenousexercise
Pack, if kept is removed and is instructed not to blow the
nose.
Saline spray or steam inhalation is encouraged
Oxymetazolinedrops are used
Nasal splints if used are removed on fourth to eighth day
Patient should avoid trauma to nose

6. POSTOPERATIVE COMPLICATIONS
Bleeding
Septalhematoma
Septalperforation
Supratipdepression
Saddle nose deformity
Columellarretraction
Persistence of septaldeviation
Toxic shock syndrome
Cerebrospinal fluid rhinorrhoea

7. Before and after septoplastysurgery

8. SUBMUCOUS RESECTION OF NASAL
SEPTUM(SMR OPERATION)
INDICATIONS
Deviated nasal septum
Obstruction
DNS causing obstruction to paranasalsinus, middle ear
resulting in recurrent sinusitis and otitismedia
Recurrent epistaxisdue to spur
As a part septorhinoplasty
As a preliminary step in hypophysectomyor vidian
neurectomy.

9. CONTRAINDICATIONS
Patients below 17 years of age
Acute episode of respiratory infection
Bleeding diathesis
Untreated diabetes or hypertension
ANAESTHESIA
Local anaesthesiais preferred general anaesthesiaused in
apprehensive adults
POSITION
Reclining position with head end of the table raised

10. Steps of operation
1.Infiltration of nasal septum is done with 2% xylocaineand 1:50,000
adrenaline
2.A curvilinear incision with forward convexity is made at the mucocutaneous
junction
3.Elevation of mucoperichondrialand periostealflap
4.Incision in cartilage is done posterior to the primary incision
5.Elevation of opposite mucoperichondriumand periosteum
6.Removal of cartilage and bone where cartilage is removed with the help of
ballengerswivel knife and bone is removed by luc’sforceps bony spur is
removed with gouge and hammer strip of cartilage is preserved to prevent
collapse
7.One or two catgut or silk stitches are applied in the initial incision
8.Packing is done with the help of a ribbon gauze smeared with an antibiotic
ointment to prevent collection of blood between flaps

11. POSTOPERATIVE CARE
Patient is placed in semi sitting position to prevent oozing of
blood
Soft diet to prevent active mastication reducing bleeding
Analgesics to control pain
Antibiotics for 5-6 days
Nasal packs are removed after 24 hours
Silk stitch is removed on 5
th
or 6
th
day
Trauma should be avoided for several days

12. COMPLICATIONS
Bleeding
Septalhematoma
Septalabscess
Septalperforation
Depression of bridge
Retraction of columella
Persistence of deviation
Toxic shock syndrome
Flapping of nasal septum

14. Difference between septoplastyand
submucousresection
SEPTOPLASTY SUBMUCOUS RESECTION
Limited selective dissection
removing minimal cartilage and
bone even deformed cartilage is
corrected and reimplanted
It can be done in children
Flaps are raised only on one side
Deformed cartilage is corrected
here
Less chances of complications
Reoperation is easier
It is extensive dissection of
septum removing all deformed
bony and cartilaginous parts
preserving only dorsal strut of
cartilage
Not done before 17 years of age
Flaps are raised n both sides
Bony and cartilage parts are
excised
More chances of complications
Re operation is difficult

15. Thank you