Deviated Septum Information
Septoplasty: Surgery to Correct Deviated Septum

The septum is a midline partition that divides the nasal cavity in half. Almost no one has a perfectly straight septum, but when the septum bulges significantly to one side the patient often has difficulty with airflow through that passage. Septoplasty is the name of the operation to straighten out a septum and thereby improve breathing.

Diagnosis of Nasal Obstruction due to Deviated Septum

A deviated septum is not always the cause of nasal obstruction. Nasal obstruction can be structural (due to physical fixed obstruction) or functional (due to fluctuating changes in diameter of the passage). Turbinate hypertrophy is an example of structural obstruction: the turbinate is permanently enlarged and blocking the passage. Nasal valve collapse is functional: the passage only narrows when the patient takes a deep breath.

Deviated septum is most likely the reason for nasal breathing problems when other causes have been excluded, and there is evidence for a crooked septum on physical examination. Occasionally the septum is so crooked that the patient can diagnose it themselves by looking in the mirror and lifting their chin.

The Surgery

Septoplasty is usually performed through an internal incision. The surgeon must elevate the mucoperichondrium or skin layer that covers the septum, exposing the bone and cartilage underneath. Often the crooked part of the cartilage or bone is simply removed, but it can also be left in place and simply bent back to an appropriate shape. It is desirable  that the surgeon not perforate the mucoperichondrium covering the septum because a large tear may lead to a permanent hole in the septum. While these holes may not be symptomatic, the may also manifest as stuffy or noisy breathing and occasionally as nosebleeds.

Recovery

Recovery from septoplasty is usually immediate, with very little discomfort. Surgeons often leave internal splints sutured along the septum to hold it straight during the healing process. Splints also discourage adhesions, or scarring between septum and sidewalls of the nose that may occur after surgery. Adhesions can cause persistent nasal obstruction.