LP 9a Septoplasty

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Procedures

Basic Format

Septoplasty


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Objectives

Assess the anatomy, physiology, and

pathophysiology of the Septoplasty.

Analye the diagnostic and surgicalinterventions for a patient undergoing a

!!!!!!!!!!!!!!!.

Plan the intraoperative course for a patientundergoing!!!!!!!!!!!!!.

Assemble supplies, e"uipment, and

instrumentation needed for the procedure.


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Objectives

#hoose the appropriate patient position

$dentify the incision used for the procedure

Analye the procedural steps for!!!!!!!!!!!!!.

%escribe the care of the specimen

%iscuss the postoperative considerations for a

patient undergoing !!!!!!!!!!!!!!! .


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&erms and %efinitions

Anosmia

'pista(is

)yperosmia

*aris +plural nares

*asal +-atin for nose

*asal #honchae+turbinates

*asal septum

Olfactory

Paranasal sinus

Parosmia

hinitis

hino

Sinus


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%efinition/Purpose of Procedure

'(cision and resection of the septum to correct any

deviation as a result of injury or a congenital nasal

deformity0 to improve the functioning capabilities of the

nose1to improve breathing

&he cartilaginous or osseous portions of the septum that lie

bet2een the flaps of the mucous membrane and the

perichondrium are straightened0 cartilage 3 bony spurs

may bloc4 the meatus and compress the middle turbinate

on that side, resulting in an obstruction of the sinus

opening Other names5 nasal septal reconstruction +*S,

submucous resection of the septum +S6


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elevant A 3 P5 '(ternal nose1lateral

and anterior vie2s


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elevant A 3 P5 *asal Septum 3

elated Structures


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elevant A 3 P5 Blood Supply to *ose


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Pathophysiology


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%iagnostics

'(ams

7hinoscopy5 %irect vision

Preoperative &esting


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Surgical $ntervention5

Special #onsiderations

Patient Factors7 Pt should 4no2 before hand that he/she 2ill be mouthing8breathing

postoperatively because of postop nasal pac4ing 98: days post8op

7 Pt should understand that application of ice 2ill reduce s2ellingand brusing around eyes and nose postopertively

7 $f under local, 4eep noise to a minimum in the O7 Advise pt to remain still and to e(pect vibrations caused by bone

remodeling +mallet and osteotome

7 Be a2are of drapes on face1minimie claustrophobia andfacilitate respiration

7 &his is a clean case1use best techni"ue oom Set8up

7 Surgeon may prefer bed turned to ;< degrees of anesthesia forgreater access to head

7 Separate 6ayo set up for surgeon to use for preop anesthetic and

cocaine nasal pac4ing


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Surgical $ntervention5 Anesthesia

6ethod5 -ocal, egional, =eneral

7-ocal 2ith $> sedation and analgesia is typical

7=eneral for the very apprehensive

'"uipment

7*ote that anesthesia should ensure pt eye

protection using ointment 3 protective eye2ear


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Surgical $ntervention5 Positioning

Position during procedure7 Supine, head tilted bac4

7 )OB may be slightly elevated +reverse &rendelenburg

7 Pt comfort5 fle( hip and 4nees 2/O table settings or

pillo2 under 4nees/lo2er legs

7 &uc4 arms to sides0 use protective arm sleds and

padding

Supplies and e"uipment

7 Foam headrest or donut for head stabiliation

Special considerations5 high ris4 areas

7 ?lnar nerves 2here arms are tuc4ed


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Surgical $ntervention5 S4in Prep

6ethod of hair removal5 */A

Anatomic perimeters5 face1avoid solution from

getting in or near eyes and ears0 do not prepinterior of nose

Solution options5 may use betadine paint 7avoid

hibiclens at mucous membranes0 may not as4 for

prep


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Surgical $ntervention5 %raping/$ncision

&ypes of drapes7 ?sually turban8type head 2rap or : to2els arranged

triangularly

Order of draping

7 emove paper strips from disposable drapes 2ith adhesiveedges

7 Place bar drape across pt forehead 3 allo2 remainder ofdrape to fall to2ard floor covering the head of O table

7 Place ?8drape on upper lip. Bring edges of ? lateral to thenose and eyes. '(tend the rest to cover pt@s body

Special considerations

State/%escribe incision

7 $ntranasal incision into mucous membrane andperichondrium


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Surgical $ntervention5 Supplies

=eneral7 )ead and *ec4 +'*& pac40 suction tubing, 'S? pencil, rayte(,

p4 hand to2els, needle magnet, syringe for cleaning suction

Specific7 Suture 3 Blades5 Fine +8


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Surgical $ntervention5 $nstruments

=eneral

Specific +see follo2ing slides


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Surgical $ntervention5 '"uipment

=eneral

Specific

7Operating headlight


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Surgical $ntervention5 Procedure Steps An incision is made

internally on oneside of the nasalseptum. After the

mucous membraneis elevated away

from the bone,obstructive parts ofbone and cartilageare removed, and

plasticsurgery isperformed as

necessary. Thenthe mucousmembrane isreturned to itsoriginal position.


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Surgical $ntervention5 Procedure Steps

Before the surgical scrub, the surgeon 2ill place cocaine8

soa4ed cottonoids into the nares and inject of local anesthetic

+usually lidocaine 2/epinephrine

H S&S 2ill set up medicine cup, cottonoids, speculum and bayonet

forceps on 6ayo for surgeon to pac4 the nose. &he circulator 2illpour the I #ocaine and count cottonoids 2ith the S&S and ensure

DJ g.local/needle and -uer8loc4 syringe is available

Surgeon opens nostril 2/speculum, incises themucoperichondrium 2/nasal 4nife, then deepens the incision

2/ fine, sharp dissecting scissors.

H Provide surgeon 2/nasal speculum of appropriate sie. )ave cottleclamp available to aid incision process. ?se 9C blade on a J

handle for incision.


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For retraction, small s4in hoo4s are placed Surgeon elevates the mucoperichondrium from the septal

cartilage using a fine +Freer elevator, 3 removes anyspurs from the septum or nasal bone 2/nasal/septumcutting forceps +punch, ronguer, or cutting forceps

H Provide suction as needed. 6ost li4ely, the sharp end of the Freerelevator 2ill be used.

H )ave chisel +or gouge 3 mallet available. S&S may be as4ed toKtapG the chisel held by the surgeon 2/ the mallet. This may not beconsidered within your scope of practice at your facilityfind out

before hand.* )ave bayonet or &a4ahashi forceps available to e(tract tissue

remnants. Surgeon may reinsert bone and cartilage to refashionthe nasal cavity and to strengthen 2ea4ened areas +4eep moist2/*S on the bac4 table in a small basin


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Lith the mucochondrium fully elevated, the surgeon

removes the septal cartilage 2/ a nasal forcep. '(aminesseptal tissue 3 reshapes as needed 2/scissors, rasp, or

special bone crusher that flattens cartilage.

Surgeon replaces the septal cartilage 2ithin the nose.

)emostasis is achieved.

H )ave suction, hemostatic agents, 3/or 'S? pencil

available.

Surgeon closes the incision 2/suture 3/or hold cartilage in

place 2ith pac4ing material +petroleum gaue 3 nasalsplints

H)ave splint material ready1surgeon may cut to fit the

patient using )eavy scissors. $t may be sutured in

place.


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%ressing may include e(ternal splints andKmustache dressingG

Secretions are removed from pharyn( to reduce

ris4 of aspiration H provide Lieder retractor and

Man4auer tip.

For &urbinectomy


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#ounts

$nitial5 Sponges and sharps +rayte( and

cottonoids

First closing

Final closing

7Sponges

7Sharps


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%ressing, #asting, $mmobiliers, 'tc.

&ypes 3 sies

7 6ustache dressing7have D(D@s available and G sil4 or

micropore tape7 '(ternal Splint of surgeon@s preference +eg. %enver

splint 4it

&ype of tape or method of securing1leastirritating to s4in

)ave ice pac4 available+can ma4e using D gloves tiedtogether 2/crushed ice


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Specimen 3 #are

$dentified as nasal cartilage

)andled5 routine in formalin


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Postoperative #are

%estination

7PA#?

7Outpatient %ischarge

'(pected prognosis +=ood

7Full restoration of nasal function

7eturn to normal activities about J days


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Postoperative #are

Potential complications

7)emorrhage

7$nfection

7Other5 %amage toN.perforate septum, cause

2ea4ened septum 2hich could lead to future

deformity Surgical 2ound classification5 $$


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esources

Ale(ander@s pp. JC;8JD

6A>## ?nit J OB J, Q, ;, 9


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#ase Studies in &e(t

#ase Studies in S&S Study =uide

Documents

LP 9a Septoplasty