What Causes Excessive Bleeding During a Septoplasty?

It’s not unusual for patients to have bloody drainage
following septoplasty surgery.This is
normal following this type of procedure and usually resolves in two to three
days following surgery.Rarely
patients have excessive bleeding following septoplasty.This may be precipitated by coughing,
sneezing, straining or any other maneuver that increases pressure within the
nose.This can cause small blood vessels
to open and bleed profusely. When
this situation arises, it’s important to contact your surgeon immediately. In
most cases packing the nose will be necessary, but in rare cases a return to
the operating room may be necessary as well.When these maneuvers are undertaken bleeding is usually easily
controlled.

Intermittent bleeding after a septoplasty or septorhinoplasty is not uncommon and can last up to a week to ten days. If it gets heavy, you may wish to call your surgeon to discuss the matter with them to make sure that there are no other issues going on. Sometimes aspirin usage and motrin can contribute to the problem as well.

The nose, and specifically the nasal septum, has a very healthy blood supply.  Bleeding is generally minimized with the use of vasoconstrictive agents and injection with local anesthetic mixed with epinephrine.  Despite these measures, some degree of bleeding is always encountered, but generally controlled by the end of the case.  Sometimes, sutures and even packing material are used to assist in hemostasis.  Factors that will increase the amount of blood loss include an elevated blood pressure and/ or failure to stop medications that promote bleeding (NSAIDS, coumadin, vitamin E etc.)

Unfortunately, almost all surgery brings with it the possibility for bleeding during, or after the surgery.  This is difficult to predicted as it tends to be somewhat random in many cases.  Some individuals will have a greater predisposition for bleeding due to their medical condition(s).  Those who are on anticoagulants, such as aspirin, motrin, plavix, coumadin will  have a greater propensity for bleeding.  Medical conditions such as liver disease, or hypertension will also predispose of more bleeding during any surgery.  Bleeding during a septoplasty, is somewhat uncommon and probably occurs excessively when one of the more prominent nasal vessels are involved (anterior ethmoid artery), or when the highly vascular turbinate membranes are operated on.  Significant bleeding during nasal surgery can come from many areas, but the turbinates are a good candidate for the exact nasal culprit.   

A Septoplasty should NOT be followed by continuous bleeding. While there may be some bleeding associated with the performance of the operation all bleeding should have been stopped before the case was finished and you left the operating room. Most surgeons stitch the lining of the septum with quilting stitches to apply gentle pressure and promote adherence of the linings and some use nasal packing to further add to the closing of the septal space. If you coughed, sneezed, vomited or strained and began having active bleeding you should go to your surgeon or the ER he directs you to to be evaluated.

Bleeding can and does occur after any Rhinoplasty and/or Septoplasty but should be mild and intermittent.  If at any time after either procedure, other than the postop night or following day, you have profuse bleeding this may indicate a rupture of a blood vessel inside the nose and is a reason for you to contact your Rhinoplasty surgeon immediately.  If, on the other hand there is slight pink or spotting there is no urgency, IMO, but still a need to have your surgeon examine the inside of the nose in order to identify and potentially treat the source of the bleeding.