Deviated nasal septum (Septoplasty)

Overview:

Septoplasty is a surgical procedure performed to correct a deviated septum (nasal septum). The objective of this surgery is to restore the nasal septum to its original central position to facilitate unimpeded airflow through the nasal passages. During septoplasty, a surgeon uses a variety of techniques to reshape, reposition, or remove segments of cartilage and bone, obstructing nasal airflow. The focus of septoplasty is to correct nasal airflow and alleviate symptoms of a deviated septum.

Septoplasty is usually performed by an Ear, Nose, and Throat (ENT) physician/surgeon. It is generally regarded as a safe and routine procedure when performed by a qualified/experienced surgeon. In some cases, septoplasty may be performed in conjunction with rhinoplasty (a cosmetic procedure that alters the exterior appearance of the nose). For many patients who suffer from significant symptoms resulting from a deviated septum, septoplasty provides lasting relief from nasal breathing difficulties and associated nasal symptoms.

What Is Septoplasty?

A deviated nasal septum is surgically corrected during a procedure called septoplasty. The purpose of septoplasty is to make the septum normal again so that air can flow better through the nasal passages.

The surgeon will reshape, reposition, or remove portions of the cartilage and bone in order to improve the flow of air through the nasal passages and alleviate symptoms caused by the deviation of the nasal septum. Unlike cosmetic nasal surgery (rhinoplasty), septoplasty is functionally-oriented because it is done for the purpose of improving breathing and the general health of the nasal cavity.

Septoplasty is most often performed by an Ear, Nose, and Throat specialist. When the surgeon performing septoplasty is experienced, it is usually a very safe and routine procedure. In some cases, septoplasty and rhinoplasty are performed at the same time.

In many cases, septoplasty provides long-term resolution for individuals experiencing severe breathing difficulties as well as other nasal problems due to their deviated septum.

Why Is Septoplasty Done?

Septoplasty is generally recommended to address chronic or recurrent symptoms that negatively impact an individual's ability to breathe through his/her nose or cause discomfort.

While some individuals may not need treatment for mild deviations, significant deviations can cause nasal dysfunction.

There are a number of reasons why a doctor would recommend septoplasty to treat a deviated septum, including:

• Persistent difficulty breathing through the nose
• Nasal congestion that persists despite the use of decongestants
• Recurring sinus infections due to impaired sinus drainage
• Frequent nosebleeds
• Snoring or disrupted sleep patterns related to nasal obstruction
• Facial pain/pressure caused by nasal passage obstruction

When nasal septum obstruction affects airflow and nasal drainage, it can also create conditions that promote repeated sinus infections and chronic nasal inflammation. Septoplasty is intended to correct the anatomical deformity of the septum by positioning it centrally, thereby restoring normal airflow through both nasal passages.

What Is a Deviated Septum?

A deviated septum is a misalignment of the bony and/or cartilaginous nasal septum, which creates unequal-sized nasal passages. In a normally aligned nose, the nasal septum divides the nasal cavity into two equal-sized airways. When the septum is deviated, the nasal airway becomes narrowed on one side, potentially limiting airflow through the affected nasal passage.

The vast majority of individuals have a minor deviation of the nasal septum and do not experience symptoms. A more pronounced deviation can contribute to various nasal-related symptoms such as nasal congestion, headaches, facial pain or pressure, sinus problems, etc.

In addition to symptoms directly related to nasal obstructions, the deviation of the nasal septum can also contribute to aesthetic concerns of the nose if the deviation has resulted in an apparent asymmetry of the nose. In many cases, however, the deviation of the nasal septum is not visible externally, and the only symptom may be nasal congestion or difficulty breathing through the nose.

Symptoms of a Deviated Septum

Symptom severity may depend upon the degree of deviation. Many individuals may have little or no noticeable symptoms of a deviated septum.

However, symptoms can include:

• Difficulty breathing through the nose, particularly on one side
• Chronic nasal congestion or blockage
• Recurring sinus infections
• Facial pain or pressure
• Frequent nosebleeds
• Headaches
• Noisy breathing during sleep
• Snoring or sleep disruptions
• Impaired olfactory perception

In extreme cases, the deviation may be visible externally. The nostrils may differ in size when viewed from underneath the nose. If you continue to experience any of these symptoms or they impact your quality of life, consult with your primary care physician or a specialist for further evaluation and treatment options.

What Causes a Deviated Septum?

A deviated septum can occur at any time during an individual's lifetime. It may be congenitally present (i.e., at birth) or develop later in life due to an injury, trauma, or alteration of the nasal septum during the growth years of an individual.

Common causes of a deviated septum include:

• Congenital causes: Some children are born with a deviated septum. This could occur either during fetal development or due to pressure exerted during delivery.
• Trauma to the nose: Traumatic injuries to the nose can alter the alignment of the nasal septum. These injuries may occur during sports, a fall, a motor vehicle accident, or physical blows to the nose.
• Changes in the nose during adolescence: As an individual's nose grows during childhood and adolescence, the septum may be forced off-center, resulting in a deviation.

Certain predisposing factors increase the likelihood that an individual will develop a deviated septum. For example, a history of nasal trauma, participation in contact sports, or multiple injuries to the nose and face.

How Is a Deviated Septum Diagnosed?

Typically, a deviated septum is diagnosed through a thorough medical evaluation conducted by a healthcare professional. Evaluation begins with a discussion of the patient's symptoms and medical history. The doctor may inquire about breathing difficulties, frequency of sinus infections, sleep disturbances, or prior nasal injuries. The next step is a physical examination of the nose. Physicians commonly utilize a nasal speculum (a small hand-held tool that gently opens the nostrils) to visually assess the interior of the nose. Depending on the extent of the evaluation needed, additional testing may be required. Testing may include:

• Nasal endoscopy to evaluate deeper nasal structures
• Imaging studies (e.g., CT scans)
• Detailed assessment of nasal airflow and sinus drainage

These diagnostic tests assist in determining the degree of deviation of the nasal septum and whether it contributes to nasal airflow limitations or sinus drainage impairments.

How to Prepare for Septoplasty

Preparatory procedures for septoplasty generally begin with an appointment with an ENT specialist. During this visit, the surgeon will evaluate the patient's symptoms, physically examine the patient's nose, and determine whether surgical correction is the best course of action.

Prior to undergoing septoplasty, the patient may be instructed to:

• Review his/her medical history with the physician.
• Discuss all current prescription medications and/or supplements.
• Avoid taking certain medications that increase the risk of excessive bleeding during and following the procedure.
• Follow any specific pre-surgical instructions given by the medical team.

The surgeon will discuss the specifics of the surgery, potential advantages and disadvantages, and the anticipated recovery process with the patient before the procedure. This information enables the patient to better comprehend the nature of the surgery and feel comfortable with the proposed treatment plan.

What Happens During Septoplasty?

Septoplasty is usually performed under local anesthesia or general anesthesia. The focus of septoplasty is to restore the nasal septum to a central position while maintaining the integrity of the surrounding nasal structures.

To gain access to the septum and perform the corrective surgery without creating visible scarring on the external surface of the nose, the surgeon will make a small incision internally within the nose.

The surgeon will then gently lift the mucosal lining of the septum and surgically reshape or remove those segments of cartilage and/or bone contributing to the obstruction. Upon successful repositioning of the septum in the midline of the nose, the mucosal lining will be replaced.

Occasionally, a small internal splint or soft packing material will be inserted to maintain support of the septum until the initial stages of healing are completed.

Generally, septoplasty will take anywhere from 30 to 90 minutes, depending on the severity of the deviation of the nasal septum.

Recovery After Septoplasty

Postoperative recovery from septoplasty is variable among individuals; however, most patients report symptomatic improvements within a few weeks of the surgery.

• After the first week of surgery, most patients will experience minimal nasal swelling and/or congestion. Most patients will refrain from engaging in strenuous activities during the immediate postoperative period.
• Routine follow-up appointments with the surgeon are necessary to monitor the progress of healing.
• Breathing should progressively improve as the swelling resolves. Most patients will be able to resume their normal daily routines within one-two weeks of surgery.
• Compliance with the surgeon's postoperative instructions is essential to ensure optimal healing and obtain the desired results.

Complete healing of the nasal septum may require several weeks to months.