Types of nasal surgery

Nasal surgery is generally a surgery that is performed inside or outside of the nose. The nasal obstruction results from functional and anatomic problems that cause dysfunctional airflow in the upper airway and play a vital role in snoring and Obstructive Sleep Apnea (OSA).
The cause of nasal airflow problems can be narrowing or collapsing of the nasal opening, enlarged nasal turbinates, nasal polyps, deviated nasal septum, and swollen nasal mucosa. 
Apart from breathing, the nose plays a vital role in hearing and tasting. Hence, taking care of the nose is essential to prevent it from being hurt or injured. 
Undergoing nasal surgery not only depends on the nose’s appearance but also to cure a medical condition that has prevailed for too long. This blog will provide fundamental insights into the different types of nasal surgery available that are less invasive and aid in speedy recovery.

Nasal surgery types

In general, a common cosmetic and reconstructive surgery is performed to accomplish the following:

• Repair nasal injuries
• Change the nose shape or size 
• Correct acquired or congenital deformities
• Improve breathing

Here are the different types of nasal surgeries and procedures:

1. Balloon Sinuplasty for Blocked Sinuses

Balloon sinuplasty is a minimally invasive treatment that allows the doctor to remove the diseased tissue that makes the nasal polyp and correct sinus inflammation-related issues. The procedure requires inserting an endoscope into the nostrils to reach the nasal cavities and lances the polyp using surgical instruments.
Balloon sinuplasty is performed on an outpatient basis, which is minimally invasive. It is increasingly popular nowadays that it helps treat chronic rhinosinusitis (CRS) when medical treatments have not provided adequate relief. 
This procedure is used to reconfigure the structure of the bones and restore normal sinus function. It is generally performed on adults and children who are not cured with other treatments for sinusitis and are ready for balloon sinuplasty, but only in limited scenarios.

2. Control of Nosebleed (Epistaxis) 

Epistaxis or nose bleeding is common in which blood starts flowing in one or both nostrils. A combination of tiny blood vessels and dry air that line the inner nose surface causes nosebleeds. There are simple steps you can take to treat and prevent them.
Doctors use techniques to control nosebleeds, such as chemical or electric cauterization, nasal packing with expanding sponges, embolization or surgery.

3. Endoscopic CSF Leak Repair

Cerebrospinal fluid (CSF) rhinorrhea is called brain fluid leakage through a defect in the skull base (the bone separating the sinuses and nasal cavity from the brain). It is a complication of nasal surgery due to a nasal tumour or increased intracranial pressure.
Endoscopic Repair of CSF leaks involves skull base defect identification and closure using minimally invasive endoscopic techniques.

4. Endoscopic Sinus Surgery

Endoscopic sinus surgery is a less invasive approach that utilizes an endoscope, a slender tube equipped with a camera and light, to eliminate obstructions and address various sinus issues. Unlike traditional surgery, this technique does not require any incisions on the skin as it is performed entirely through the nostrils.
It helps people who experience pain, breathing difficulties, nasal congestion, loss of smell sense, etc.

5. Nasal Endoscopy

A nasal endoscopy investigates the sinus and nasal passages and is carried out with an endoscope. The physician inserts a flexible, thin tube with a tiny camera and lights into your nose for evaluation. 
The sinuses are a group of air-filled spaces formed by the bones of your face and connect with your nasal cavity.
The doctor guides the endoscope through your nasal and sinus passages. This diagnostic procedure provides images of the area that can have congestion, tumours, blockages, infections, and more. In rare cases, small tools are used to take tiny tissue samples.

6. Nasal Polyp Removal

Nasal polyps are noncancerous growths that can form on the nasal passages or sinus lining. While the polyps are not harmful, they can lead to various symptoms, including a reduced sense of smell, facial pressure, postnasal drip, and persistent congestion. Medical treatment for nasal polyps usually involves corticosteroids, either applied topically or taken orally. In cases where medical therapy does not provide significant relief from symptoms, surgery is advised.
If medication is ineffective in reducing or eliminating nasal polyps, endoscopic surgery offers a solution by removing them and addressing any sinus issues contributing to their formation. 
During endoscopic surgery, a surgeon utilizes a small tube equipped with a lighted lens or miniature camera, known as an endoscope, inserted through the nostrils and into the sinuses. With the aid of tiny instruments, the surgeon then removes the polyps. 
Additionally, the surgeon may opt to enlarge the sinus openings, which can be performed during endoscopic surgery. Another alternative is balloon ostial dilation, a procedure that does not involve the removal of nasal tissue. 
Following the surgery, a corticosteroid nasal spray may be recommended to prevent the recurrence of nasal polyps. Furthermore, a saltwater rinse can aid in the healing process post-surgery.

7. Septoplasty (Deviated Septum Treatment)

Septoplasty is a surgical procedure to straighten the cartilage and bone that divides the space between your two nostrils, known as septum. When it is crooked, it is called a deviated septum. This can make breathing harder through your nose and increase the sinus infection risk due to poor drainage.
During septoplasty, the nasal septum is placed differently in the middle of your nose. It requires the surgeon to remove parts of the nasal septum before reinserting to the proper position.
Once a septoplasty is healed, you will likely find breathing easy. Your surgeon can discuss what septoplasty can achieve for you.

8. Turbinoplasty (Surgery to Improve Breathing)

It is an operation performed to decrease the size of swellings, known as turbinates, on the side wall of the nasal passageways.
There are general risks associated with having an operation. These include nausea and vomiting, bleeding, infection, and allergies to medicines or dressings. When having an operation under general anaesthesia, other risks include blood clots in the legs or lungs, a stroke or a heart attack. However, the risk of these severe complications is shallow. Your anaesthetist will discuss these with you before the operation. 

9. Rhinoseptoplasty

When an associated deformity on the nasal valve or external portion or septal deviation becomes more complex, a rhino septoplasty is required to achieve adequate nasal breathing.
Suppose the deviation of the septum is located more externally. In that case, a piece of a donor rib cartilage needs to be utilized frequently to preserve the external shape of the nose and stabilize the nasal tip.

10. Rhinoplasty

Cosmetic nose reshaping or rhinoplasty is a procedure that increases or decreases the size of the nose, changes the angle between the upper lip and nose, narrows the span of the nostrils, and changes the nose tip or bridge. Also, it corrects some breathing problems and involves bone and cartilage resculpture.
When working on the nose, the surgeon can make an open procedure by working from the outside through a small incision across the tissue that separates the nostrils or work from within the nose by making an incision inside the nose. 

Postoperative instructions after a nasal surgery

Nasal splints

Using splints in nasal surgery involves two plastic pieces secured with a stitch inside the nose. While effectively achieving optimal long-term outcomes, they may hinder nasal breathing and cause temporary discomfort. However, these only temporary effects should subside once the splints and stitches are removed, typically occurring a week after the surgery.

Pain Control

The doctor will prescribe pain medications after nasal surgery. Take it as per your requirements.

Minimize physical activity

Patients can resume normal activities if they have only undergone isolated nasal surgery. Spending more time out of bed and walking rather than in bed helps reduce the risk of developing blood clots or pneumonia in the legs. However, the patients must avoid strenuous activity as it can cause Bleeding or increase swelling.

Bleeding

It is expected to have slight Bleeding for a few days after surgery. You can gently dab your nose with tissue, but avoid blowing your nose. Refrain from taking Non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin for at least two weeks, as they can increase the risk of Bleeding. 
To maintain a moist and clean environment in the nose, use nasal saline spray four to five times a day for two weeks. This will help wash away crusts and dried blood, promoting faster healing. 
If needed, you can use nasal topical decongestants like Afrin spray twice daily for three days, then as necessary to control minor Bleeding, for a maximum of one or two days. These decongestants reduce swelling in the nose and keep the nasal passages open during the healing process.

Takeaway

As we mentioned later, the effects of each type of nose surgery will differ depending on the person’s body. So, be sure of the actual necessity and thoroughly understand the procedure before surgery. And take care of yourself for a speedy recovery process.

FAQ’s