Can A Deviated Septum Come Back After Surgery
In most experienced, well trained and excellent surgeon’s hands the chance for a deviated septum returning after surgery is less than 3-5%. Without any further trauma to the nose. In my own experience with over 1500 septoplasties I have seen only one case where there was a return of the septal deviation (6%).
Up to 25% of patients report nasal congestion or obstruction that has redeveloped after deviated septum surgery. This can be caused by many things including poor technique during surgery, under filling of the sinuses or simply postoperative swelling in the nose. The best solution to this problem is usually a small revision rhinoplasty performed at the same sitting as your initial procedure.
The cause of the majority of cases of recurrence is thought to be either inadequate correction of the structural problems associated with a deviated septum or improper placement of grafts used to correct them. There are several reasons why these problems occur and they include:
1) Improperly Placed Grafts – Many surgeons make the mistake of placing graft material on areas of the septum which do not need it. When grafts are placed too far back into the sinus cavity, they may be surrounded by mucosa and cartilage instead of bone. This makes them very prone to absorption and resorption. If grafts are placed too close to the lateral wall of the nose, scar tissue will form around them causing obstruction or narrowing of the passageways.
2) Under Filling of Sinuses – Most people who undergo septoplasty also receive an anti-inflammatory medication called Decongestants which prevent the nose from drying out. As a result, the sinuses become empty and dry resulting in thinning of their walls. This causes difficulty when trying to place implants within the sinuses. Also if you don’t wait long enough before doing your septoplasty, the lining of your sinuses may start to shed its cells and produce more mucous making your septum even narrower.
3) Poor Technique During Surgery – Some surgeons cut the septum too short or too low while others leave it so high that it obstructs the nostrils. They also fail to adequately address the turbinates. All of these factors increase the risk of a recurrent septal deviation.
4) Post Operative Swelling – Sometimes referred to as “Greenstick” deformity, this refers to a condition that happens quite commonly after a septoplasty. It occurs because the soft tissues surrounding the bones of the nose were not addressed properly and therefore get pushed inward toward the bones creating a “greenstick” effect. This results in the nose being much smaller than anticipated.
There are some surgical procedures available to treat these situations but the vast majority involve additional surgeries such as a secondary functional endoscopic sinus surgery, implant exchange or a simple revision rhinoplasty. These additional surgeries tend to be much more invasive and take much longer and cost much more money. An alternative approach would be to attempt to fix the problem through the use of injectable substances.
One substance currently being investigated for the treatment of both chronic sinusitis and craniofacial conditions is a biodegradable gel called Hyaloglide. Originally developed by Dr. Charles Toney, it was first introduced in Europe in 2004. Since then it has been approved for medical use in France, Germany and Spain. Although human trials have yet to begin, animal studies indicate that Hyaloglide has great potential for healing sinus wounds. Research indicates that this substance decreases inflammation, increases blood circulation and promotes wound healing.
Hyaloglide contains purified fibrillar collagen, an active ingredient found in the protein strands that hold skin and other connective tissues together. Collagen is normally present in the body and is responsible for holding our skin, nails, teeth, ligaments, muscles, etc., together. Recent research suggests that collagen molecules bind to certain types of white blood cells and stimulate them to release beneficial chemicals known as cytokines. Cytokines are important because they help regulate cell growth and function.
Collagen itself cannot serve as an effective wound dressing, however since it is naturally occurring it does not provoke an immune response like synthetic materials; thus it is considered safe. The unique properties of Hyaloglide allow it to absorb rapidly into the body’s natural scaffolding structure to fill defects and provide support for newly regenerated tissue. It provides a matrix for new bone formation and allows the body to repair damaged tissue naturally. It also helps reduce pain, decrease infection rates and promote faster healing times.
Dr. Toney believes that Hyaloglide could potentially replace lost bony structures such as those in the maxillary sinus, and he reports good clinical outcomes with his patients using the product. He claims success rate of approximately 90% in treating chronic sinus disease.
Although there are no published data regarding the effectiveness of Hyaloglide, it appears to be an ideal candidate for the treatment of chronic sinus disease. Its ability to effectively heal existing tissue damage without provoking an immune response has shown promise in reducing the symptoms associated with chronic sinus disease. Studies show that Hyaloglide reduces swelling, improves sinus drainage, relieves pressure build-up and prevents reformation of membranes. Patients treated with Hyaloglide reported significant improvements in headaches, facial discomfort and overall quality of life. For patients suffering from chronic sinus disease, a superior option exists in the form of Hyaloglide.
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