Hope2SleepGuide

Sleep Apnoea Forum Bringing Help + Support to the Patient

It will be interesting to hear if Ed Miliband has his septoplasty in July without the gross nasal packing which I had to have, and was the worst part of the whole operation.  Read here what Dr Park's has to say about it:-

 

June 12, 2011 by Dr Steven Park

One of the most uncomfortable things you can do to another person is to place nasal packs in their nose after nasal surgery.  What’s even worse is when you have to take it out. I know what it feels like, since I had nasal packs after I broke my nose when I was six. I still remember waking up after surgery, with my nose completely stuffed up, and my sleep was terrible.

Unfortunately, ENT surgeons still routinely use nasal packing after nasal surgery, especially during septoplasty. The reason why packing is used is due to a combination of of the nature of the surgery and tradition: The mucous membrane layer on both sides of the midline cartilaginous septum is peeled off, and the deviated portion of the cartilage or bone is removed. Next, the mucous membrane layers are placed back together in the midline. Packs (either long gauge strips or an expandable absorbent sponge are placed on either side of the septum, to compress the mucous membrane layers together. Since cartilage doesn’t have  blood vessels for nutrition, it has to receive its’ nutrient supply from diffusion and osmosis from the inner walls of the mucous membrane layers. If you have a blood clot that separates the two mucous membrane layers, nutrient flow to the remaining cartilage will be shut off, and the cartilage will die off, leading to a drooping of your nasal tip.

So if you don’t use nasal packs, what else can you do? Some surgeons place two plastic or silastic sheets in the nose next to the septum, and then tie the two splints together in the front through the nasal septum. You still have to put something in your nose to press the silastic sheets together. Some use rolled up Telfa pads (the nonstick surface that you see on Band Aids), and others place packing around the splints. Most surgeons take out the splints or packing after 2-3 days, but some leave it in up to 7 days.

Many years ago, I came across a paper showing that if you plug healthy college students’ noses and put them through a sleep study, you’ll see apneas. Another study showed that in patients without sleep apnea who undergo nasal packing for nasal or sinus surgery, the AHI increased from 11 to 37, and for patients with sleep apnea, 14 to 39. It’s interesting to note that patients without sleep apnea who need to undergo nasal surgery have mild underlying obstructive sleep apnea. This is in line with a study I performed many years ago showing that up to 80% of people who undergo nasal or sinus surgery and have recurrent or persistent symptoms have significant obstructive sleep apnea.

As I began to realize how important nasal breathing is to the quality of your sleep, I came to the conclusion that nasal packing was sure to cause apneas. If your septum is deviated, by definition, you’re going to be at a much higher risk of having jaw structures that predispose to obstructive sleep apnea. Total nasal congestion can only make things worse. This is also why even if you’re “normal”, having a stuffy nose from a cold or allergies makes you toss and turn more at night—it’s because you stop breathing more often. These obstructions don’t even have to be apneas or hypopneas—they can be short periods of obstruction that still wake you up multiple times per hour.

You’re probably wondering by now how I get away with not using any nasal packs or splints. It’s very simple: After removing the deviated cartilage or bone, I use a little 1/2 inch needle with a dissolvable chromic suture (stitch) and perform a quilting suture, back and forth from one side of the nose to the other, in a zig-zag manner, until all the areas of separated mucous membranes are closed together. In most cases, I do a very conservative shrinking procedures on the nasal turbinates, so there’s little to no risk of scar tissue connecting the raw surfaces of the septum and the turbinates. Some people also need their flimsy nostrils stiffened as well.

When you wake up from anesthesia, you’re breathing really well. But after a few days, it’s expected to get stuffy again, since all the blood, mucous and secretions will block your nose. You’ll go home a few hours after surgery. Two to three days later, I’ll see patients in the office for a 2 minute “cleaning”, after which you can breathe much better again.  Most people can go back to work after 2-3 days, and about 2/3 of patients don’t even take any prescription pain medications.

Contrary to conventional perceptions of the misery of undergoing a septoplasty procedure, there are now ways of minimizing pain and discomfort. Surgery is never a walk in the park, but the well worth the ability to breathe clearly through your nose again.

Views: 399

Reply to This

Sleep Apnoea Forum

New to the Sleep Apnoea Forum? 

1. Stop by our Sleep Apnoea Welcome Center to introduce yourself to the SleepGuide community.
2. Start a New Topic of Conversation.
3. Post your photos - of yourself, your old CPAP machine, your new CPAP machine, your pet, something about you!

Interested in advertising, have a problem or need to contact us? Click the Report an Issue page.

 

Latest Activity

Jonathan Lait is now a member of Hope2SleepGuide
yesterday
Becky Murkin replied to Becky Murkin's discussion F20 AirFit small marking bridge of nose
"no such luck getting F40 as was not in stock yet at the hospital. Tried the F30 but unfortunately my nose is so small that even the smallest mask is not small enough and leeks. Now trying out the Philips Dreamwear full mask/ Hybrid mask.  So…"
yesterday
Becky Murkin posted a discussion

mask "whiskers" marks

Hello lovely wise people,How do you prevent/ remove marks (indents) on your face left by mask for hours later. I call them my "whiskers". Still experimenting trying to loosen mask straps but keeping the seal.Using my Xylimelts at night for dry mouth…See More
yesterday
Becky Murkin replied to Becky Murkin's discussion F20 AirFit small marking bridge of nose
"I have an appointment with my NHS Respiratory physio team on Friday and will plead my case for an F30 or F40. They said to me last week they did not have f40 in as yet however they are soon to see resmed rep any day now."
May 7
Judy posted a discussion

Headgear tips please

Hi, this is a rather trivial question, and apologies if it isn't appropriate for this forum, but I’m hoping someone might have some tips.I use the Resmed N20 mask. I also dye my white hair roots with a decent brand (as it would take several years to…See More
May 6
Judy updated their profile
May 6
Jonathan replied to Iain Noble's discussion Resmed Airfit F20 Woes
"Hi.  No first hand experience, but you can see reviews here, which are mixed: https://www.cpap.com/productpage/resmed-airfit-f40-full-face-cpap-mask I notice cpap.com still appear to be selling the Quattro FX.  I have imported stuff from…"
Apr 28
Iain Noble posted a discussion

Resmed Airfit F20 Woes

Dear FolksI have been using the Resmed Quattro FX mask ever since I was diagnosed over 7 years ago.…See More
Apr 28
Iain Noble replied to Becky Murkin's discussion F20 AirFit small marking bridge of nose
"Hi All I can say is I feel your pain! I got the F20 as a replacement this year and it is very uncomfortable. I have just ordered the new Resmed F40 which is very small and light and so far it has been a lot easier to use for a mouth breather that…"
Apr 28
Sarah Martin is now a member of Hope2SleepGuide
Apr 27
jjimjam updated their profile
Apr 17
Kath Hope replied to Becky Murkin's discussion noisy humidifier normal?
"It sounds like you're getting rainout issues (condensation) so here's an article to help with this. www.hope2sleep.co.uk/water-in-the-mask-hose-known-as-rainout"
Apr 16
Becky Murkin posted a discussion

noisy humidifier normal?

Hello,I have an air sense 10 auto.When I have the humidifier and the heated tube plugged in it makes a sort of drumming noise. Like that at the gallows in films.Is this normal? It wakes me up  and I have to give up and switch off  for the night.See More
Apr 16
John posted a discussion

Dentists in Hull that know about Mewing ?

I was wondering if there are any dentists in Hull who know about John & Mike Mew, and changing jaw shape over time?I could add that I saw an ENT consultant recently and she said jaw shape, malocclusion, is genetic, which has become a debatable…See More
Apr 9
Profile IconKaren Mcleod, Fiona Watson, Teresa Hobbs and 5 more joined Hope2SleepGuide
Apr 3
Jonathan replied to John's discussion Airsense 10 -humidifier runs dry
"I did replace the tank in my SleepCube, and had to regularly take the silicone sealing gasket out and give it a goof clean, but not infrequently found it standing in a pool of water in the morning.  The machine sat on a tray because of…"
Mar 26
John posted a discussion

Nasal valve collapse

Does anyone have any experience of nasal valve collapse?Wondering if I have this but I don't know what the norm is.Been trying widgets that hold the nose open and it's like night and day.See More
Mar 24
John replied to John's discussion Airsense 10 -humidifier runs dry
"Wow it's the other way round for me.I found with the Sleepcube I'd often have a good bit of water still there in the morning. Today I woke up with a dry tank on the Resmed again and it's not on full heat or flow. I got it on 6…"
Mar 24
Becky Murkin posted a discussion

F20 AirFit small marking bridge of nose

Please help or give advice all wise people on here.I have had the Resmed F20 AirFit small mask for over a month. Seals yet…See More
Mar 19
Frances Knight replied to Frances Knight's discussion Air Sense 10 - changing pressure settings
"A very helpful reply Jonathan. I found the pressure setting for the full face mask to be too high when I changed to a nasal mask, but perhaps I should have persisted? I'll try again and I'll also discuss with the clinic whether an APAP…"
Mar 13

© 2024   Created by The SleepGuide Crew.   Powered by

Badges  |  Report an Issue  |  Terms of Service