Successful Septoplasty & B/L Inferior Turbinoplasty for Chronic Nasal Obstruction in a 22 Y.O. Male

Chief Complaints

A 22-year-old male patient with a body mass index (BMI) of 22 presented to the ENT Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of right-sided nasal obstruction for the past 3 months. The patient also reported recurrent episodes of cold, watery nasal discharge and frequent bouts of sneezing.

The patient has a history of a nasal surgical procedure performed at the age of 9 years; however, no medical records or documentation are available to confirm the details of the surgery. There is no history of other significant chronic illnesses, and the patient is a non-smoker with no known drug allergies.

On examination, the patient was conscious, coherent and oriented. Vital signs were stable. Nasal examination revealed S-shaped deviated nasal septum with septal spur to right and posterior spur to left, along with the presence of septal spurs. Bilateral inferior turbinate hypertrophy accompanied by allergic (mulberry) mucosal changes was noted. The nasopharynx appeared normal with no evidence of mass or collection. Both tympanic membranes were normal, and facial nerve function was intact. Oral cavity examination showed a bulky tongue with no posterior pharyngeal wall congestion. The rest of the systemic examination was within normal limits.

Following the clinical examination, the ENT team conducted a comprehensive assessment, which included a detailed review of the patient’s medical history and a focused evaluation of the nasal cavity, paranasal sinuses, ears, and oral cavity.

The patient underwent a detailed diagnostic workup, including diagnostic nasal endoscopy, which revealed right-sided deviated nasal septum with septal spurs and bilateral inferior turbinate hypertrophy with allergic mucosal changes. Radiological evaluation with CT scan of the paranasal sinuses demonstrated an S-shaped deviated nasal septum with a spur toward the right side, while the paranasal sinuses and osteomeatal complexes were otherwise normal. 

Laboratory investigations, including immunoglobulin E (IgE) levels, coagulation profile (bleeding time, clotting time, prothrombin time, and activated partial thromboplastin time), and renal function tests, were within normal limits, supporting an underlying allergic etiology and confirming fitness for surgery.

Based on the confirmed diagnosis, the patient was advised to undergo Allergic Rhinitis Deviated Nasal Septum with Bilateral Inferior Turbinate Hypertrophy Treatment in Hyderabad, India, under the care of the expert ENT department, to relieve nasal obstruction, improve airway patency, and provide long-term symptomatic relief.

After a detailed consultation with Dr. Mohana Jambula, ENT Surgeon, and cross consultation with Dr. Snigdha Panuganti, Consultant General Physician, a comprehensive evaluation was conducted to determine the optimal diagnostic and therapeutic approach for the patient presenting with right-sided nasal obstruction for 3 months, along with recurrent episodes of cold, watery nasal discharge, and frequent sneezing. Based on the clinical findings and radiological assessment, surgical intervention was deemed necessary due to persistent symptoms despite medical management.

It was determined that the patient had a deviated nasal septum with septal spurs and bilateral inferior turbinate hypertrophy associated with allergic rhinitis, leading to significant nasal obstruction and impaired airflow. Septoplasty with bilateral inferior turbinoplasty was identified as the most effective intervention to correct the septal deviation, reduce turbinate size, and improve nasal airway patency. The cross consultation also helped in evaluating and managing associated medical considerations, including perioperative blood pressure monitoring and overall fitness for surgery.

The patient and his family members were informed about his condition, the planned procedure, its associated risks, and potential benefits, including relief from nasal obstruction, reduction in allergic symptoms, and improvement in overall breathing and quality of life.

Following the decision, the patient was scheduled to undergo Bilateral Inferior Turbinoplasty with Septoplasty in Hyderabad at PACE Hospitals under the expert care of the ENT Department.

The procedure involved the following steps:

• Patient Positioning and Anesthesia: The patient was placed in a reverse Trendelenburg position to reduce venous congestion and improve surgical field visibility. General anesthesia was administered to ensure patient comfort and immobility throughout the procedure. Local infiltration with anesthetic and vasoconstrictor agents was used to minimize intraoperative bleeding.

• Left-Sided Septal Correction: A Freer’s incision was made on the left side of the nasal septum. Mucoperichondrial and mucoperiosteal flaps were carefully elevated to expose the underlying cartilage and bony septum. The cartilaginous junction was dislocated and the bony deviation corrected. A septal spur on the left side was removed to ensure a straight nasal airway.

• Right-Sided Septal Correction: An anterior cartilaginous incision was made on the right side. The corresponding flap was raised to access the deviated cartilage and bone. Cartilaginous deviation was corrected and the septal spur on the right side was removed. Airway patency was confirmed after correction.

• Bilateral Inferior Turbinoplasty: Bilateral inferior turbinate reduction was performed to reduce hypertrophy and improve nasal airflow. Care was taken to preserve the mucosa to maintain nasal function and reduce postoperative complications.

• Closure and Hemostasis: The septal flaps were sutured with absorbable catgut to maintain flap position and ensure healing. Bilateral nasal packing was applied to support the septum, control bleeding, and prevent postoperative hematoma. Hemostasis was achieved, confirming a stable surgical field before completing the procedure.

The patient was closely monitored following septoplasty with bilateral inferior turbinoplasty. On the first postoperative day, elevated blood pressure was noted, and a general physician consultation was obtained; regular blood pressure monitoring was advised. Intravenous fluids were administered to maintain hydration and electrolyte balance. Supportive medications were provided for infection prevention, pain relief, inflammation control, and management of allergic symptoms.

Bilateral nasal packs were removed 48 hours after surgery, with no active nasal or postnasal bleeding observed. The patient remained conscious, coherent, and hemodynamically stable, with gradual improvement in airway patency and symptomatic relief. The patient was discharged in a stable condition with specific postoperative instructions.

The patient was prescribed medications to prevent infection, reduce gastric acidity, and control allergic symptoms. Pain relief was provided to manage postoperative discomfort, while anti-inflammatory therapy was recommended to minimize swelling. Nutritional supplements were advised to support immunity and overall recovery. Hemostatic agents were available to control bleeding if needed, and topical nasal sprays were recommended to maintain airway patency. Saline nasal irrigation was prescribed twice daily to aid mucosal healing and clear nasal secretions. All medications were to be taken as directed to ensure smooth recovery and prevent complications.

The patient was advised to wear a mask, perform saline nasal irrigation 4–5 times daily, and ensure adequate rest for one week. A normal diet including sufficient protein was recommended to support healing and recovery.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms like fever, nasal bleeding and vomiting.

The patient was advised to follow up with the ENT specialist in Hyderabad at PACE Hospitals, after 2 days for nasal endoscopy with suction clearance to assess healing and airway patency, along with a physician review.

This case highlights a patient with allergic rhinitis, a deviated nasal septum, and bilateral inferior turbinate hypertrophy, presenting with chronic nasal obstruction and recurrent allergic symptoms. He underwent a successful septoplasty with bilateral inferior turbinoplasty, with an uneventful postoperative course. The patient was discharged in stable condition with instructions for nasal care, follow-up, and supportive therapy to ensure optimal healing and symptom relief.