Can I get my nose septum fixed under local anesthesia?

Question

I have a deviation in my septum and a fracture in my nose bridge. All this due a car accident. I was told by a ENT that I can’t do local. I’m really worried about getting general anesthesia and I’ll like to do local. Mostly because I have a son and the recovery will be faster. I don’t want to risk myself.

Ivan Wayne, MD · Answer

While the majority of the 400 plus nasal surgeries I perform each year are done with patients under general anesthetic it is definitely possible to use local anesthetic. To do that you will need to be tolerant of full awareness of the surgery and some discomfort while the local anesthetic is injected into your nose and cheeks to numb the area before starting the surgery. Packing will be placed in the back of your nose to prevent anything dripping down your throat during the surgery so will need to breath through your mouth. Most people will require and appreciate some form of sedation drugs such as versed, or valium and IV medications such as fentanyl and propofol to reduce discomfort and increase relaxation as well helping you disconnect from the somewhat uncomfortable process. In conclusion if you are motivated and can tolerate the above issues you are a candidate for nasal surgery under local anesthesia.

Matthew Richardson, MD · Answer

A good option for nasal surgery without general endotracheal anesthesia is with IV sedation. I perform the majority of my rhinoplasty and septoplasty surgeries this way. This allows patients to continue to breathe on their own, but sleep through the majority of the procedure. We use local anesthesia to numb the nose. This method allows patients to bounce back quickly after surgery, yet keeps them very comfortable during the procedure. 
Be sure to see a nasal surgery expert who can perform both external (rhinoplasty) and internal (septoplasty) surgery comfortably.
All the best,

Pejman Aflaki, MD · Answer

Hello and thank you for the question. I would not recommend having septo-rhinoplasty under local anesthesia. Having it done by an experienced team of doctors (surgeon and anesthesiologist) is safer, will give you a better result and recovery should not be significantly longer. Best,Pejman Aflaki, M.D.Johns Hopkins-trained plastic surgeon

Michael Eisemann, MD · Answer

Hello and thank you for your question. I’m sorry to hear about your car accident. Septoplasty procedures are generally completed under general anesthesia or local anesthesia with intravenous sedation. Which options are available to you are ultimately determined by the extent of your procedure, your surgeon’s recommendation and your personal preference.

Before moving forward with your procedure, schedule a consultation with a board-certified plastic surgeon who specializes in septorhinoplasty to receive a second opinion. Best of luck with your procedure!
Michael Eisemann M.D.
Plastic Surgeon
Houston, Texas

William Portuese, MD · Answer

The last 25 years,  we have performed all septoplasty and rhinoplasty procedures under general anesthesia with a board-certified physician anesthesiologist for patient safety and comfort. Trying to perform a rhinoplasty and a septoplasty under local anesthesia is a very bad idea. It will be extremely painful, uncomfortable, and you could risk aspirating blood into your lungs.

John A. Standefer Jr., MD, FACS · Answer

Hello and thanks for the question! In the right situation, and with a surgeon experienced with local anesthesia, a septoplasty can absolutely be done using local anesthesia! I have performed full septorhinoplasty surgeries which includes osteotomies with local anesthesia and oral sedation. It is not universal, but certainly not out of the question. Every situation is different, but your concerns are not unusual and worth exploring. Safety is, of course, paramount, and finding a surgeon with experience with local anesthesia to discuss your situation and cover the risks vs. benefits will help you with your decision. My Best!John Standefer MD.

Nicholas S. Karter, MD · Answer

For the purposes of this question I will refer to the open reduction of a complex nasal bone and septal fracture as a rhinoplasty.  It is possible to perform a rhinoplasty under local anesthesia and there are some providers that will do this.  I personally do not as I believe the risks do not outweigh the benefits.  There are a number of concerns when attempting to perform a rhinoplasty under local anesthesia.  First, it is a very sensitive area with many different nerves innervating it.  They can all be blocked with local anesthetic however the process of doing that is quite uncomfortable.  Second, there can be a significant amount of bleeding encountered during rhinoplasty, particularly when having to re-break the nasal bones to straighten the nose.  This bleeding can cause choking and discomfort in an awake patient and, in rare circumstance, aspiration which can lead to pneumonia and other pulmonary problems.  Lastly, rhinoplasty requires a significant amount of finesse and fine movements. With a moving patient it can be quite a bit more difficult to perform.  Although you are right that general anesthesia does have significant risks associated with it, in modern day it is very safe and routinely performed.  There is no right answer of whether to perform the procedure under local anesthesia or general anesthesia and the decision must be made by weighing which risks and which benefits are most important to you.  I recommend finding a rhinoplasty surgeon in your area to discuss these risks and benefits in greater detail.  I hope this helps, good luck!!

William Marshall Guy, MD · Answer

Hello MWLop,The use of local anesthesia for a septoplasty would not be recommended.  The nose is a very sensitive area.  Trying to anesthetize that with purely local anesthesia would be quite painful.  Furthermore, there will be a few drops of blood that will come out during the procedure.  If this falls back towards your airway it can stimulate coughing and a gagging sensation.  This would likely cause you to move. Even small motions on your part could cause serious problems during the procedure including tearing the septal tissue and causing a perforation.  In my opinion it would be much safer with a better outcome to perform this under general anesthesia, especially if that is the preference if your surgeon.I hope this helps and good luck.

David Alessi, MD - Account Suspended · Answer

You can do it either way.  Please note that general anesthesia is very safe and the chance for something happening is very low.  However, a deviated septum and a repair of a nasal fracture can be repaired under local anesthesia by surgeons who are comfortable with this method.  Best wishes.

Michael Elam, MD (retired) · Answer

Each surgeon will have a anesthesia preference for nasal surgery.  This preference may be based on the facility which they are operating in. In order to use general anesthesia you must have a fully accredited operating facility that undergoes the same requirements and safety standards as a hospital operating facility. Some surgeons operate out of an office setting that is not accredited and thus can only use IV sedation or local. I personally have my own fully accredited operating facility and I always use a licensed MD anesthesiologist and provide general anesthesia for the majority of rhinoplasty cases. General anesthesia protects the patients airway during surgery and provides a safe and comfortable experience. My anesthesiologist uses short acting state of the art medications which allow the patient to awaken quickly after surgery without the drowsiness and nausea often caused by less expensive options often used in the hospital. Make sure you have surgery in a fully accredited operating facility and with an anesthesia provider (either a CRNA, a Certified Registered Nurse Anesthetist or an MD, Anesthesiologist)  to ensure your safety and comfort. Best regards, Michael V. Elam, M.D.

Can I get my nose septum fixed under local anesthesia?

Answers (10)

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