Deviated Septum and Its Correction (Septoplasty)

Often, a patient presents to their ENT surgeon for symptoms of nasal obstruction. Though nasal obstruction may be due to adenoid hypertrophy, turbinate hypertrophy, and allergy which often obstruct both sides of the nose, usually the nasal obstruction preferentially occurs on only one side. If such unilateral obstruction is present, a deviated septum is the most common culprit. However, both sides can also become obstructed if the septum deviates to one side anteriorly and than to the opposite side posteriorly. Sometimes, the deviation may be so severe that it blocks the sinuses leading to recurrent sinus infections. Other deviations jut out in one spot (septal spur) and press into the face resulting in persistent pain/pressure over the cheek and around the eye; a phenomenon called Sluder's Neuralgia.

What is a Nasal Septum?

A nasal septum is an intra-nasal wall that divides the right side of the nasal cavity from the left side (blue arrow). The nasal septum is composed of cartilage in the front and bone in the back of the nose. Ideally, this nasal septum should be straight to allow symmetric airflow into both sides of the nose. If the septum is deviated as shown in the illustration (green arrow), one side becomes more narrow resulting in nasal obstruction. The red arrows point to the nasal mucosa lining the septum. It is possible that the septum could be deviated to BOTH sides if it first buckles over to one side and than buckles to the other side (shape of an "s") resulting in nasal obstruction on both sides. In this particular illustration, the patient would have more difficulty breathing through the nose on the right.

Figure from EVMS

GREAT! So I have a Deviated Septum. What's the Next Step?

The only way a deviated septum can be fixed is surgical. There are no medications that can correct what is essentially an anatomic problem. What medications can do is make it a bit easier to breath through the nose by decreasing any swelling inside the nose. Such medications include steroid nasal sprays and other allergy-type medications. Should surgery be decided on, the procedure to correct is called septoplsty. The steps of a septoplasty are shown below:

Step 1: A small incision is made inside the nose and the mucosal lining carefully lifted away from the septum on one side. It is during this stage of the procedure that one of the complications of the procedure, septal perforation, may occur. This complication occurs when the lining gets torn resulting in a hole as the mucosa is lifted away from the septum.
Step 2: The septum is incised immediately in front of the deviation and the nasal mucosal lining is lifted away from the septum on the opposite side.
Step 3: The deviated septum is now physically removed. One removes the deviated septum completely instead of forcing it into a midline position. Why? Because just like a young tree sapling, the nasal septum has "memory" and bending or forcing it into a certain position will last only temporarily before it springs back into its original position.
Step 4: The nasal mucosal lining is reapproximated in the midline. There are several methods how this last step is performed. One method is to suture the lining back together like a quilt (NO nasal packing or septal splints are used). Occasionally, the nose is packed with septal splints or nasal packing material. Both methods are used in our practice depending on the physician and the condition of the septum itself.

Recovery from septoplasty is general about 1 week long. Most patients are surprised by how little pain there is after surgery. There is NO bruising or swelling of the face or external nose. Essentially, there will be no change in your appearance after surgery compared with before surgery. Read post-operative instructions here.

Often, a given patient's nose may have more than one problem contributing to nasal obstruction such as turbinate hypertrophy and/or adenoid hypertrophy. It is not a problem to perform other surgical procedures simultaneously to completely address all the factors that lead to a person's nasal obstruction.

If a deviated septum is affecting your life, please call our office for an appointment.

Any information provided on this Web site should not be considered medical advice or a substitute for a consultation with a physician. If you have a medical problem, contact your local physician for diagnosis and treatment.