--- title: "Septoplasty Part 3 - Complications & Approaches" description: "ENT notes on Complications & Approaches of Septoplasty." source: "The ENT Resident" author: "Dr. Mausumi Das" canonical_url: "https://www.theentresident.com/ent-notes-lectures/septoplasty-complications-approaches" categories: ["Rhinology", "Surgery"] video: "https://www.youtube.com/watch?v=5Kw0bbGkm_Q" image: "https://media.theentresident.com/og-images/septoplasty-complications-approaches.png" --- # Septoplasty Part 3 - Complications & Approaches ENT notes on Complications & Approaches of Septoplasty. Watch the full video lecture on YouTube: https://www.youtube.com/watch?v=5Kw0bbGkm_Q ## ⚠️ Complications of Septoplasty This post covers: - Classification of complications of septoplasty - Intraoperative complications - Immediate postoperative complications - Delayed postoperative complications - Approaches to septoplasty --- ### 📋 Classification of Complications of Septoplasty 1️⃣ **Intraoperative Complications** - Anaesthetic complications - Complications due to surgery 2️⃣ **Postoperative Complications** - Immediate postoperative complications - Delayed postoperative complications --- ### 🚨 Intraoperative Complications of Septoplasty #### 💉 1- Anaesthetic Complications - Hypotension from adrenaline used in the local anaesthetic - Drug allergy to anaesthetic gases - Cardiac arrest from anaesthesia **Management** - Managed by the anaesthetist intraoperatively **Prevention** - Good **pre operative assessment** before surgery > What are the things to check during Preoperative assessment for a case of Septoplasty? #### 🩸 2- Primary Hemorrhage Hemorrhage occurring **at the time of surgery**. **Management** - Nasal packing - Cauterization of the bleeding point **Bleeding from the Bone in the Floor** - Bone wax - Packing - Bone hemostat > What are the arteries at risk of injury during Septoplasty? #### ✂️ 3- Damage to Surrounding Structures **Tear of the Mucoperichondrial Flap** - Tear limited to **one side** → Not a concern - Tears on **both sides at identical points** → Leads to **Septal perforation** (delayed complication) ⚠️ Elevation of the mucoperichondrial and periosteal flaps is a **crucial step** in septoplasty. --- ### ⏳ Immediate Postoperative Complications of Septoplasty #### 🩸 1- Reactionary Hemorrhage Hemorrhage occurring **within 24 hours** of surgery. **Causes** - Adrenaline wearing off - Rise in blood pressure postoperatively > How do you manage Reactionary Hemorrhage in Septoplasty? #### 🤕 2- Headache **Cause** Tight nasal packing pressing on the turbinates and septum **Management** - Loosen the nasal packing - Early removal of the pack - Analgesics, if required #### 👁️ 3- Eyelid Edema **Cause** Tight nasal packing → Pressure transmitted via the thin **lamina papyracea** to the periorbital tissue **Management** - Self limiting - Resolves on removal of the pack #### 🦠 4- Infection Nasal packing may result in infection of: - Nose - Paranasal sinuses - Middle ear --- ### 🕰️ Delayed Postoperative Complications of Septoplasty ⭐ Most of these complications occur **more often in SMR than in septoplasty**, as SMR is a radical procedure and septoplasty is a conservative one. > What are the differences between SMR and Septoplasty? #### 🩸 1- Secondary Hemorrhage **Cause** - Infection **Management** - Antibiotics - Repacking of the nose, if required #### 🩸 2- Septal Hematoma **Features** - Smooth fluctuant swelling - Blocks both sides of the nose **Management** Drain immediately by: - Aspiration, OR - Incision and drainage > What is Septal Hematoma? When does it form in Septoplasty? #### 🦠 3- Septal Abscess Occurs when an undrained **septal hematoma gets infected**, with pus collecting between the flaps. **Features** - Fever - Fluctuant swelling on both sides - Severe nasal pain > How will you manage a case of Septal abscess in a post operative case of Septoplasty? #### 🕳️ 4- Septal Perforation **Causes** - Untreated septal abscess → Necrosis of cartilage → Perforation - Tear of the mucoperichondrial flap at identical sites on both sides > How will you manage a case of Septal Perforation in a post operative case of Septoplasty? #### 🔗 5- Synechiae (Adhesions) **Cause** Injury to the septal flap and the turbinates on the lateral wall at identical sites → Raw mucosal surfaces on both sides join together **Prevention** - Avoid injury to the mucosal surfaces - Proper postoperative packing **Management** - Asymptomatic → No treatment required - Nasal obstruction → Release the adhesions and keep the raw edges apart using a **silastic sheet for 10–14 days** #### 👃 6- Columellar Retraction **Cause** Removal of too much **caudal cartilage**, with loss of caudal support > Which Septoplasty incision has a higher rate of Columellar Retraction? **Features** - Columella appears pulled upwards - Nostrils appear exposed **Management** - Reconstructive rhinoplasty #### 🐴 7- Saddle Nose Deformity **Cause** Loss of **dorsal strut** support due to excessive cartilage removal → Collapse of the dorsum **Management** - Dorsal augmentation with a cartilage or bone graft > Name the causes of Saddle nose deformity? #### 🔻 8- Supratip Depression **Cause** Disruption of the attachment of the **upper lateral cartilage to the dorsal septum** → Loss of support just above the tip of the nose **Management** - Grafting #### 🚫 9- Persistent or Recurrent Nasal Obstruction **Management** Examine the nose to determine the cause, then: - Revision septoplasty - Turbinate reduction - Anti-allergic treatment > What are the causes of Persistent or Recurrent Nasal Obstruction in a post operative case of Septoplasty? #### 💧 10- CSF Rhinorrhea ⭐ Very rare but serious complication. **Cause** Damage or avulsion of the **perpendicular plate of the ethmoid** **Management** - Bed rest - Head elevation - Surgical repair if no improvement #### ☠️ 11- Toxic Shock Syndrome ⭐ Very rare complication. **Cause** Nasal packing left for too long → Release of **staphylococcal exotoxin** **Features** - High fever - Diffuse rash - Hypotension **Management** (Medical Emergency) - Remove the pack - IV antibiotics - ICU management --- ### 🔍 Approaches to Septoplasty #### 1- Conventional Technique - Performed using a **headlight** - Most widely practised technique #### 2- Endoscopic Septoplasty - Performed using a **0° 4 mm telescope** - Gaining popularity in recent times > What are the Advantages of Endoscopic Septoplasty over conventional technique? #### 3- External (Open) Approach Septoplasty **Steps** - Bilateral marginal and transcolumellar incision - Elevation of the nasal skin after decortication - Nasal septum approached between the **medial crura** - Elevation of the mucoperichondrium - Reconstruction of the septum > What are the indications of External (Open) Approach Septoplasty? #### 4- Extracorporeal Septoplasty The entire septal cartilage is **removed, reshaped on the table and reinserted**. **⚠️ Risks** - Septal perforation - Saddle nose deformity > What is the indications of Extracorporeal Septoplasty? > What are the Advantages of Septoplasty over SMR? --- ### ⭐ Exam Pearls - Primary hemorrhage → **Intraoperative** - Reactionary hemorrhage → **Within 24 hours** - Secondary hemorrhage → Due to **infection** - Eyelid edema → Pressure transmitted via the **lamina papyracea** - Septal hematoma → Drain **immediately** - Untreated septal hematoma → Septal abscess → **Septal perforation** - Synechiae → Keep raw edges apart with a **silastic sheet for 10–14 days** - Columellar retraction → Most common after a **transfixion incision** - Saddle nose deformity → Loss of **dorsal strut** support - CSF rhinorrhea → Damage to the **perpendicular plate of ethmoid** - Toxic shock syndrome → **Staphylococcal exotoxin** from prolonged packing - Endoscopic septoplasty → **0° 4 mm telescope** --- ## About This Note This free ENT note on Septoplasty Part 3 - Complications & Approaches was written by Dr. Mausumi Das and is paired with a corresponding video lecture. 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