SEPTOPLASTY AND RHINOPLASTY

 

Septoplasty is a surgical procedure designed to correct a deviated septum. The septum is the wall of bone and cartilage that divides your nostrils. When it's deviated, it can make one nasal passage smaller than the other, which can lead to problems with proper breathing.

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During septoplasty, the surgeon works through the nostrils to reshape the septum, aiming to improve airflow and correct any obstructions. It's generally an outpatient procedure, meaning you can go home the same day.

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The procedure is typically recommended for individuals who have a significantly deviated septum causing health issues like chronic sinusitis, nosebleeds, facial pain, difficulty in breathing, or snoring. It's not usually performed for cosmetic reasons but primarily for functional improvement.

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Rhinoplasty, commonly referred to as a "nose job," is a surgical procedure that changes the shape of the nose. This surgery can be performed for various reasons, including altering the appearance of the nose, improving breathing, or both.

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The specific changes made during a rhinoplasty can include altering the size of the nose, reshaping the tip, narrowing the nostrils, and changing the angle between the nose and the upper lip. It's important to have realistic expectations and to discuss these with a qualified plastic surgeon before deciding to undergo the procedure.

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The surgery can be done using a closed procedure, where incisions are hidden inside the nose, or an open procedure, where an incision is made across the columella, the narrow strip of tissue that separates the nostrils. Through these incisions, the skin covering the nasal bones and cartilage is gently raised, allowing access to reshape the structure of the nose.

                                                                                                 

                                              Anesthetic Implications for Septoplasty or Rhinoplasty

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Anesthesia type: General, TIVA

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Airway: ETT, Oral RAE

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Preoperative:

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• Rhinoplasty is the surgical correction of the external appearance of the nose

• Septoplasty provides surgical correction of any deformity of the nasal septum

• The surgeon may prefer an oral RAE tube (keeps ETT out of surgical area) or reinforced type ETTs

• ETT tube may be taped to the mandible in the midline position

• Local anesthetic (cocaine, lidocaine or epinephrine) are placed in nares to decrease mucosal swelling and minimize bleeding

• The sphenopalatine and anterior ethmoidal nerves provide sensation to the nasal septum and lateral walls

• Special care must be taken to tape the patient’s eyes

• Mild controlled hypotension may be requested to facilitate hemostasis

• A throat pack is usually placed (prevents blood from entering the posterior pharynx

• Decongestant nasal spray may be administered

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Intraoperative:

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• Intranasal packing is inserted, and a plastic splint is placed

• A mustache dressing may be placed under the nares

• Position: Supine,  reverse Trendelenburg, arms tucked, table turned 90-180 degrees

• Intraop administration of decadron (8–12 mg iv) to minimize postop edema

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Postoperative:

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• Before extubation, gently suction the patient’s throat with soft suction

• Make sure throat pack is removed

• No pressure should be placed on the nose

• Avoid coughing, bucking, or straining

• Smooth emergence

• High risk of PONV

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Complications:

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• Bleeding

• Laryngospasm

• Aspiration of gastric contents or bloody

• Local anesthetic complications (HTN, dysrhythmias, seizures)

• Dysrhythmias

• Tachycardia

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Sources:

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Elisha, S. (2010). Case Studies in Nurse Anesthesia.

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Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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