SUBMUCOUS RESECTION – SMR
What Is It?
The nasal septum is the partition inside the nose made of cartilage (gristle) which separates the two nostrils. Usually the septum is straight and upright, and is in the middle of the nose. Inside your nose the septum is bent over. You feel that your nose is blocked or may have headaches and pain in the face. You may have sinus (the space inside any face bone) infection and even ear problems.
Removing a small piece of cartilage from inside the septum will straighten it out. This should help you to breathe through your nose more easily, and lessen problems with your sinuses and ears.
Before the operation
Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital’s advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Sort out any tablets, medicines, inhalers that you are using. Keep them in their original boxes and packets.
Bring them to the hospital with you. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared and that you can have the operation as safely as possible.. Please tell the doctors and nurses of any allergies to tablets, medicines or dressings. You will have the operation explained to you and will be asked to fill in an operation consent form. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks. If you have a cold in the week before your admission to hospital, please telephone the ward and let the ward sister know. The operation will usually be put off, and you will be given time to get better before being sent for again.
You need to get over your cold before you have your operation because by having a general anaesthetic the cold could turn into a serious chest infection.
The operation in India
You will have a general anaesthetic and be completely asleep. A small cut will be made in the skin over the septum inside the nostril. The surgeon will then remove the bent piece of cartilage so that the passages on either side are the same. Further back, the septum changes into bone, and this may be crooked. The surgeon will remove small pieces of bone to make it straight again. The cut inside the nose will be closed with stitches which will dissolve on their own and do not need to be removed. Plastic splints and gauze packing soaked in Vaseline will then be put into the nose to keep everything straight and stop any bleeding. Because you are asleep you will not feel any pain at all during the operation. The nasal packing and splints will be removed on the second morning after your operation by the nurses on the ward. You should be fit to go home later that day.
Using tablets, nasal sprays or nasal drops may unblock the nose a little. The blockage will always get worse again when you stop the treatment. Using nasal drops for a long time may eventually make the blockage worse. These treatments are not as good as an operation.
What Are The Intended Benefits Of The Surgery ?
A septoplasty is performed to straighten the cartilage of the septum and allow air to pass through the nose more easily. A Submucus resection of the septum (SMR) is performed where there is only a small bump in the septum. This is simply cut away to leave a straighter septum. Sometimes a septoplasty/SMR is performed to allow easier access through the nose for sinus surgery.
What Are The Potential Risks ?
- Bleeding – this may result in a nose bleed, but this usually stops quickly. A bloodstained ooze may persist for a few days.
- Infection – as with any operation, infection may occur in the area that is involved but this is not very common
- Septal perforation – if blood builds up between the cartilage and the lining that was lifted away, the pressure from this blood may damage the cartilage and result in a hole. This is also a possibility when the surgery was technically difficult and the lining of the septum was damaged.
- Collapse – this unusual complication occurs when the damage to the cartilage is more extensive and the septum can no longer bear the weight of the nose. This leads to a deformity where the nose lies flattened against the face. This is a very uncommon event and occurs in about 1 in 200 patients.
- Packs – you may wake up from the anaesthetic with pack in your nose. These will make it impossible to breathe through your nose. They are removed the next day.
Numbness of the teeth – this is not a common complication but can result if the nerve that supplies your teeth, which is located near the septum, is bruised or damaged. This usually settles in a few months.
What Am I To Expect After The Operation ?
You may notice some pinkish fluid coming from your nose, this is normal for a few days after the operation. Your nose will feel blocked for up to six weeks after the procedure, the swelling will need to subside before you notice any improvement. There is not usually very much pain associated with this procedure.