SEPTORINOPLASTY

By definition, it is the name of the operation that intervenes in the middle part of the nose and the outer roof anatomy. Of course, this operation is evaluated in two different categories in terms of its aims and results.

It is actually a combination of two different operations. Septoplasty is the name of the operation in which the curvatures of the cartilage and bone wall that partially support the roof in the middle part of the nose are corrected. Rhinoplasty, on the other hand, is the correction operation of the nasal roof by adhering to some proportions visually (aesthetically).

The patient’s wishes and complaints should be carefully analyzed and the operation should be planned accordingly. The fact that the inner part of the nose is in the middle line ensures that the air circulation in the nose flows without turbulence and the surgeon intervenes in this direction. The intervention on the roof is done with a facial analysis suitable for the face and finding the point where the patient’s wishes intersect. The anatomical structure of the patient may not be suitable for every surgery, so a joint decision should be made for the best possible result by talking to the patient and performing a facial analysis with advantages and disadvantages.

Although the patient’s intranasal curvatures are easily understood with the help of a normal nasal speculum during examination, it is sometimes useful to visualize the inside of the nose endoscopically for the ease of explaining the pathology and the procedure to the patient. In patients with suspected chronic sinusitis, paranasal sinus tomography is planned to exclude the possible diagnosis of sinusitis.

Nasal roof and external appearance analysis is more comprehensive. Facial proportions, skin analysis, gender cause different planning. The patient’s cartilage framework and supports should be analyzed particularly well. ***** Postoperative edema (swelling) is more common in patients with thick and oily skin. In patients with thin skin, the smallest irregularities may be noticeable, so the transition points should be camouflaged. While the skin is thicker at the tip of the nose, it has the thinnest skin thickness at the full cartilage-bone transition area. In the root of the nose, the skin is thin, but the subcutaneous tissue is more.

Gender is important for the support of cartilage and bone structures. Often the bone and cartilage skeletons of female patients are more fragile and prone to damage. A plan should be made taking into account the age factor. A much better anatomical and surgical plan is obtained in a young patient who has completed the cartilage development. Although the age limit changes, performing an aesthetic intervention under the age of 17 poses a risk in terms of cartilage development. However, septoplasty can be performed if functionally needed.

Before Septorhinoplasty Surgery:

* A detailed anamnesis (story) is taken from the patient. From time to time, the psychological state of the patient also plays an important role in the observation.

* The physical examination of the patient is carried out in detail, taking into account the conditions described above.

* The patient’s wishes should be understood very well and appropriate interventions for surgery should be planned.

* The patient’s facial analysis should be discussed.

* After the patient decides on the operation, examinations are planned for the preliminary preparation for this operation to be performed under general anesthesia. (Blood tests, ECG and AC evaluation.) chronic diseases should be questioned. Especially allergic diseases such as seasonal allergies may require delaying the operation for a while.

Septorhinoplasty Surgery Process:

* The patient is asked to fast for 8 hours before the operation.

* The surgery can be planned as open and closed technique. In open technique operation, anatomy and thus pathology (abnormalities) dominate more. In surgeries performed with the open technique, a horizontal incision is made in the middle section that separates the nostrils. A very thin suture material is used after the surgery, and the least scar is targeted.

* The operation time can be between 2 and 4 hours.

* In revision (re-operation) cases, it may be necessary to take cartilage tissue from the auricle and ribs depending on the support condition of the cartilage structure. This may prolong the operation time by 45-60 minutes.

* Since anatomy cannot be predicted in revision cases, it may be inevitable to make changes in the plan during the operation.

* During the surgery, suitable cartilage pieces are joined to form a new cartilage skeleton with the help of sutures. If there is growth in the meat structures called concha in the nose during the operation, they are reduced by RFC (radiofrequency surgery).

* At the end of the operation, a silicone corrugated pad is used to control bleeding and adhere the tissues to the appropriate anatomy areas as soon as possible.

* After the operation, a thermoplastic plaster is placed on the back of the patient’s nose to protect it from external effects and to prevent edema (swelling) from increasing too much.

After Septorhinoplasty Surgery:

* At the end of the operation, when the patient goes to the room, ice is applied to both cheek-nose junctions for 15 minutes every hour, not too heavy. After the patient is fully recovered from the anesthesia (3rd hour of arrival in the room), a cold and soft diet is started by mouth first.

* The patient’s blood pressure, pulse and bleeding controls are taken during follow-ups.

* The patient is instructed not to touch his face and not to touch the thermoplastic plaster.

* The patient is 7-8 days after surgery. can be sent home on time. However, when deemed necessary, the patient can be hospitalized for 24 hours for follow-up.

* Home care is important. In the first place, the patient should protect himself from traumas and should not lie face down. The patient continues to apply ice for 20 minutes every 2 hours for another 24 hours at home. Ice applications reduce the bruises that will occur on the face, as well as reduce bleeding and pain. Bruises under and around the eyes 2 . day reaches its maximum. On the 2nd day, with the removal of intranasal tampons, it quickly improves and almost never stays between 10 and 12 days.

* The patient will be prescribed medications to use at home after the surgery. These include antibiotics to prevent post-operative infections, pain relievers for aches, and antihistamines to prevent sneezing episodes. Even if sneezing occurs, the mouth should be open and pressure should not be directed to the nose.

Control :

* When the patient arrives on the 2nd postoperative day, intranasal silicone pads are removed and nasal crusts and clots are cleaned without too much effort. In addition to the drugs he uses, solutions are prescribed to the patient for cleaning and moisturizing the inside of the nose.

* Although the patient is relieved by removing the tampon, the nose swells and becomes clogged in response to surgery. The solutions will help open this blockage. At the end of the 2nd day, you can take a shower so that no water comes to the face area.

* After the tampon is removed, the nose should not be cleaned by blowing. Tap water should not be drawn into the nose.

* The thermoplastic plaster on the nose will be removed at the end of the first week and a plaster will be applied instead. During this period, the patient will begin to massage the nose area at appropriate angles. There is no need for medicine anymore, except for washing and moisturizing solutions.

* At the end of the second week after the operation, since the skin edema still continues after the patches on the nose are removed, at least 30 factor sunscreens should be used to protect the skin from direct sunlight.

* The use of sunglasses or optical glasses is interrupted for 4-6 weeks. Sports activities can be started in the 3rd week without causing trauma to the nose area.

* Post-operative check-ups are planned at 1-3-6 and 12. months. As it can be understood from here, the postoperative period-follow-up takes a long time.

I wish you healthy days.

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