Septoplasty, Turbinoplasty & Sinus Surgery in New York
Septoplasty & Breathing Difficulties
Patients with a significant deviated nasal septum (the wall that separates the right and left nasal chambers) often suffer from breathing problems. In addition, people who suffer from allergies tend to develop enlarged nasal tissue (called turbinates) which blocks their airways. Polyps and other nasal conditions can contribute to breathing difficulties and will be examined by Dr. Rizk when you come in for a consultation. Septoplasty surgery can relieve these symptoms. The procedure can be combined with sinus surgery if necessary. Patients can also choose to combine Septoplasty with rhinoplasty, if they are interested in improving their nose’s appearance, in a combination procedure called Septorhinoplasty.
Dr. Rizk specializes in nose surgery and sinus surgery, including treating various breathing problems with Septoplasty. He is double board certified in facial plastic surgery and otolaryngology, allowing him to understand the nose inside out and treat medical conditions while keeping in mind the aesthetic implications of changes done inside the nose. The endoscopic septoplasty is a procedure done from inside the nose to correct the nasal septum and it does not involve breaking the nose. Dr. Rizk does not usually use packing, as was commonly used in the past, which considerably decreases swelling and recovery. He sometimes uses nasal tissue glues in place of a pack.
During consultation in Dr. Rizk’s New York office, he will determine if your septum is significantly deviated, whether your turbinates are considerably enlarged and how a reduction would improve your breathing. In addition, Dr. Rizk will use 3D high-definition telescope to observe and evaluate other nasal conditions including Polyps which may affect your breathing. Dr. Rizk may recommend doing a CT scan in some cases to further analyze polyps or sinuses, as well as testing for allergies.
Initial treatment will include medications that are supposed to decrease the nasal tissue, such as antihistamines and nasal steroid sprays, or antibiotics if a sinus infection is detected. When this treatment fails, Dr. Rizk may recommend performing a septoplasty, sinus surgery and/or turbinate reduction.
Septoplasty with Turbinoplasty
In some cases, patients have a deviated septum where one side inside the nose is bigger than the other side and this can cause the turbinates to adjust themselves by getting bigger as well. As a result, the blockage of airways worsens. In these situations, Septoplasty surgery combined with tubinate reduction is required in order to improve your breathing as well as the level of sinus drainage.
Ethmoidectomy and maxillary antrostomy
The Ethmoid sinuses are located between the upper eye toward eyebrows and the bridge of the nose and drain into the nose. The maxillary sinuses are the cheek sinuses and drain into the nose as well. These are the main place that needs to be cleaned from all sinus infections and well-drained since all other sinuses drain through the Ethmoid sinuses, using them as a passageway. If this area is blocked, the infection can migrate/expand to other sinuses. Ethmoidectomy is a surgery in which Dr. Rizk removes the infected tissue and bone in the Ethmoid areas that block natural drainage. Maxillary antrostomy is a surgery in which Dr. Rizk opens or widens and cleanse diseased tissue or polyps from the maxillary sinus opening. These procedures are done with telescopes from inside the nose. Occasionally the sinus infection may involve the frontal or sphenoid sinuses as well and they may require cleaning and opening.
What is deviated nasal septum?
Deviated nasal septum or “crooked” internal nose can occur at childbirth or as the result of an injury or other trauma. If the wall that functions as a separator of both sides of the nose is tilted towards one side at a degree greater than 50%, it might causes difficulty breathing.
Sinusitis and Sinus Surgery
1 in 9 Americans suffer from Sinusitis, a chronic condition in which the sinuses are blocked and do not drain properly. Repeated infections develop and patients experience difficulty breathing, pressure, headaches and excessive drainage from the front of nose (rhinorrhea) or back of nose onto the throat (post-nasal drip). If you catch a cold or have an allergy attack and it lingers for more than a week, it can often be related to sinusitis. The nose collects mucous, and within a few days the sinus passages swell and block the airways. Mucous then starts to build up within the sinuses, causing the symptoms described above. Other causes of sinusitis are polyps, a deviated nasal septum, or narrowing of nasal drainage pathways. When there is a specific anatomical blockage which does not respond to medicine, CT scan is recommended. If it shows the etiology of the sinusitis, surgical drainage may be the only effective alternative. Functional Endoscopic sinus surgery (abbreviated as FESS) in combination with medications and allergy treatment can improve breathing and alleviate sinusitis symptoms.
What are the sinuses?
The sinuses are air pockets located within bones of the skull and face and are connected to your nasal passages by small tubes or channels (osteomeatal channels). These channels permit air to flow from the nose to the sinuses, and allow drainage of mucous from each sinus into the nose. We have four sinuses on each side: the maxillary (or cheek), ethmoid (or nose), frontal (above nose in between eyes), and sphenoid (in back of nose). The osteomeatal channel or connection from the sinus into the nose can vary in length and width. This difference can impact one's ability to drain properly and can predispose to blockage if narrow. A cold or allergy attack can easily block this channel if it is already narrow (these passages are millimeters wide). Blockage of these channels, partial or complete, by structural conditions, polyps, deviated septum or generalized swelling from a cold or allergies is the cause of rhinosinusitis.
How is sinus surgery done?
Functional endoscopic sinus surgery (FESS) is done by inserting small telescopes connected to a TV screen with a high definition camera system to visualize the narrowed or blocked sinus openings and micro instruments are used to enlarge the natural sinus openings into the nose. The word functional is added because the procedure enlarges the natural sinus openings and does not create new openings. Sometimes, a three-dimensional CT guided system is used to visualize all the sinuses and surrounding structures on a computer screen for additional precision.
Is sinus surgery covered by insurance?
If the sinus condition does not improve with medical therapy and if a CT scan documents the degree of blockage, sinus surgery may be covered by insurance. A rhinoplasty, however, is NEVER covered by insurance.
Does sinusitis recur? Can polyps come back?
Sometimes if allergy is severe, polyps or sinusitis may recur and this is why it is important to control the allergy with medication or allergy shots in order to prevent or delay the recurrence of these conditions. A condition called the aspirin triad, is where the patient is allergic to aspirin, has asthma and polyps. In this aspirin triad disease condition, the polyps tend to recurr more rapidly.
Is sinus surgery safe and can sinus surgery be combined with a rhinoplasty?
Sinus surgery is much more accurate than it was in the past, especially with better technology to visualize the sinuses. Complications may occur such as bleeding but is very rare. Other complications, which are rare, may include cerebrospinal fluid leakage (brain fluid) which may necessitate further surgery to correct, or eye injury. Dr. Rizk wrote one of the earliest articles on rhinoplasty and sinus surgery combined and it is a very safe procedure. It was published in Annals of Plastic Surgery in April, 1997
Do you use nasal packing after septoplasty or sinus surgery?
No, Dr. Rizk uses various tissue sealants but does not use packing after nasal or sinus surgery. Packing creates more swelling and is very uncomfortable for the patient. Also, removing the packing can be a stressful event for the patient.