Nose
Septoplasty
The internal wall between each nostril is made up of cartilage and bone. If it is crooked and blocking the nasal passage way it is called a deviated nasal septum. If the blockage is severe enough it may block the sinus outflow tract of mucous from the sinuses. This will cause symptoms of stuffiness, congestion, mucous buildup, mucous drip into the throat (postnasal drip). A deviated nasal septum will commonly cause one side to always feel blocked. Sometimes the blockage alternates between both sides. A deviated nasal septum not only causes nasal obstruction and sinus infections, it can contribute to snoring and sleep apnea.
Surgery to correct a deviated nasal septum is called septoplasty. This is commonly performed under some type of anesthesia either general anesthesia or Intravenous sedation. While asleep the crooked cartilage and bone is removed and replaced in a straighter alignment. Placing a small incision inside the nostril, the nasal lining is raised up on both sides. The crooked cartilage and bone is removed. Some of it may be replaced for structural support. The sidewall of the nose, called turbinates, are usually reduced at the same time. Different methods are employed depending on the specific problem of the turbinates. Commonly, bone is removed or mucosal lining is reduced or a combination of these procedures is performed. We DO NOT PACK the nose unless severe hemorrhage occurs which is extremely rare.
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Deviated Nasal Septum Repair : Endoscopic Septoplasty HD Correction of deviated nasal septum via endoscopic approach with HD camera Click here to view video |
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Repair Deviated Nasal Septum with Stapler Septoplasty with stapler repair Correction deviated nasal septum with Scope Septoplasty endoscopic and stapler closure New technique in correcting deviated septum Click here to view video |
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Dr Schaeffer 's endoscopic repair of deviated nasal septum with stapler Deviated nasal septum repair with septal stapler, endoscopic septoplasty, B. Todd Schaeffer, MD, FACS, NoseMD, Click here to view video |
Rhinoplasty
The external appearance of the nose is corrected and repaired either for cosmetic reasons or from trauma, which has significantly changed the shape of the nose. Commonly a deviated nasal septum is repaired due to breathing problems at the same time. Cosmetic Rhinoplasty is usually performed in girls from the ages of 14 to 15 years old and up. In boys, it is commonly performed after the ages of 15 to 16 years old, once most of their growing is completed. Participation in contact sports also plays a role in timing of the operation. Recuperation is usually about five to seven days but physical activities are off limits for at least two weeks. Contact sports are to be withheld for at least six weeks so the bones heal properly.
Does my insurance cover rhinoplasty?
Cosmetic Rhinoplasty is an uncovered medical expense and is not medically necessary. This means surgery will not be covered by third party payers (insurance companies). Frequently, patients who undergo cosmetic Rhinoplasty have medically necessary surgery performed simultaneously to correct a deviated nasal septum for breathing problems. Partial coverage may apply, but out of pocket expenses will be applied for services considered cosmetic or medically not necessary.
A functional Rhinoplasty, usually being performed for recent trauma, may be covered by insurance (may be considered medically necessary). Most commonly this is from well-documented trauma (car accident, sports injury). Patients seen in our office have a thorough review of documents, photos are taken and the appropriate imaging (CT scans) are ordered and reviewed.
Click here to view Rhinoplasty before and after images
| Procedure Videos | |
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Endoscopic Rhinoplasty: Technique exclusively used by Dr. Schaeffer Endoscopic Rhinoplasty & Septoplasty HD. An endoscopic technique to obtain nasal profile with surgery. Correction of deviated nasal septum with an endoscope. Pre and post operative photos and intraoperative video of Rhinoseptoplasty. Through a closed rhinoplasty, endoscopic assistance to ensure a predictable profile. Dr B. Todd Schaeffer Click here to view video |
Minimally Invasive Skull Base / Endoscopic Pituitary Surgery
Since 2006 Dr. Schaeffer has partnered with neurosurgery colleagues to perform minimally invasive skull base surgery to remove brain tumors through the nose. The most common procedure performed is removal of pituitary tumors from behind and above the sphenoid sinus. Other types of surgical cases have involved repairing CSF leaks, removal of encephaloceles (brain tissue herniating through a crack in the skull base) and spinal cord decompression from bony spinal canal compression in arthritic patients who have lost strength in their arms and legs. All of these procedures combine trans-nasal endoscopic skull base surgery with image-guided, computer assisted surgery. This type of surgery has enabled quicker recovery, more complete tumor removal due to the optics of the scope being able to look around corners, no paresthesias (numbness), no incision, less bleeding and is less invasive.
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Endoscopic Approach for Pituitary Surgery Minimally invasive skull base surgery with endoscope Pituitary surgery Skull base surgery Sphenoid surgery endoscopic endoscopic septoplasty Click here to view video |
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Endoscopic Pituitary Surgery Removal of Pituitary Tumor with Endoscopes, Endoscopic Trans-nasal trans-sphenoidal removal of Pituitary Macroadenoma, Septoplasty, endoscopic septoplasty, Endoscopic approach to the skull base. Click here to view video |
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Endoscopic Resection of Clival Tumor Click here to view video |
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Pituitary Apoplexy: Endoscopic Removal & Reconstruction Endoscopic Pituitary Removal & Reconstruction, Pituitary Tumor, Pituitary Apoplexy, Dr Mark Eisenberg neurosurgeon, Dr. Todd Schaeffer Otolaryngologist, Skull Base Surgery Endoscopic, Trans-nasal, Trans-sphenoidal, cavernous sinus, naso- septal cartilage graft, septoplasty, Dura-Seal, prevention of CSF Leak, skull base surgeons Eisenberg, Schaeffer Click here to view video |
Article Link - Endoscopic Skull Base Article, March 2009
Audio Link - Dr. Schaeffer interviewed on Health Radio discussing endoscopic skull base surgery
Nasal Fracture
The most commonly fractured (broken) bone in the human body are the nasal bones. As a result of a nasal fracture the nose will appear crooked and will be either off to the side or indented. This requires the nasal bones to be "reset" into position. This is called a closed reduction of nasal bones and is commonly performed in the office or emergency department at the hospital. The trauma may also cause the internal wall between the nostrils called the nasal septum to be pushed off to one side or the other causing nasal obstruction or congestion. A collection of blood might be trapped inside this wall contributing to nasal obstruction. This is called a septal hematoma. Patients should consult with a nasal surgery to evaluate for a septal hematoma. If this goes undetected the nose may collapse if not diagnosed and treated. Nasal fractures, if displaced (out of position) require "re-setting" either within several hours after the trauma or five to eight days later when most of the swelling goes down. Other fractures of the cheekbone, eye socket (orbit) and jawbone can also be fractured and need to be evaluated.
Initial treatment for nasal trauma is ice compresses, control of nose bleed with pressure and nasal sprays and head of bed elevation at night on two pillows. X-rays are commonly performed in the emergency rooms but are usually not required unless some of the surrounding bones are affected.
After all the swelling dissipates after several weeks a formal nasal operation to correct nasal deformities and deviated nasal septum may be required despite a closed reduction performed within the first week of the trauma. This formal operation is called an open reduction of nasal fracture or functional Rhinoplasty.
Recuperation is about five to seven days and physical activities are withheld for two weeks. Black and blue around the yes is common but resolves in a week to ten days.
Obstructive Sleep Apnea Surgery
Obstructive sleep apnea (OSA) is stoppage of breathing for more than ten seconds when we sleep at night. The upper airway collapses at night when breathing either due to muscle weakness in the airway or to anatomical blockages contributing to the obstruction. Low oxygen concentrations when we sleep due to the obstructions prevent the body to refresh itself at night and could lead to irregular heartbeats. Snoring may be a sign of OSA. Partial obstructions or hyponeas also contributed to symptoms of sleep apnea. OSA is a serious, sometimes-undetected, medical problem. It may manifest as excessive daytime sleepiness, which interferes with daily cognitive activities and poor work performance. It also may contribute to hypertension, congestive heart failure, strokes and heart disease if left untreated. Therefore, diagnosis is required to make appropriate treatment plans. A sleep study performed in an over night lab is required to make that diagnosis. Once the diagnosis is made and the patient is significantly tired by history, treatment is recommended. The gold standard is CPAP. CPAP is wearing a mask to sleep at night. It is connected to pressurized oxygen, which is gently forced in through your nose to open the collapsed airway. Unfortunately, 50% of patients cannot tolerate wearing the mask at night. The next option would be an oral appliance to be worn in the mouth which helps pull the tongue forward to relieve the blockage. Again some patients don't tolerate the oral appliance either. The last option if CPAP and oral appliances fail is surgery. There are many different types of OSA surgery. The correct surgery has to be determined by the surgeon. Commonly, deviated nasal septum and elongated uvula and soft palate and extremely enlarged tonsils contribute to the blockage. Surgery may include Uvulopalatopharyngoplasty (UPPP) which removes tonsils and floppy, long soft palate. Septal surgery is commonly performed at the same time. Correcting a deviated nasal septum may make wearing the CPAP mask easier to tolerate.
