The shape of your nasal cavity could be the cause of chronic nasal complaints and even sinusitis. The nasal septum is the wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage and is covered by skin that has a substantial supply of blood vessels. The ideal nasal septum is exactly midline, separating the left and right sides of the nose into passageways of equal size.

What is a Deviated Septum?

A “deviated septum” occurs when the septum is severely shifted away from the midline. The most common symptom from a badly deviated or crooked septum is difficulty breathing through the nose. The deviated septum symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections and nasal blockage.

Septoplasty is the preferred surgical treatment to correct a moderate to severe deviated septum. This procedure is not generally performed on minors because the cartilaginous septum grows until around age 18. Septal deviations commonly occur due to nasal trauma or infections, and can be the result of previous unrelated nasal or facial surgery.

A deviated septum may cause one or more of the following:

  • Blockage of one or both nostrils
  • Nasal congestion, sometimes one-sided
  • Frequent nosebleeds
  • Frequent sinus infections
  • At times, facial pain, headaches, postnasal drip
  • Noisy breathing during sleep

Nasal Obstruction, the Septum, and Sinusitis

Patients with chronic sinusitis often have nasal congestion, and many have nasal septal deviations. However, for those with this debilitating condition, there may be additional reasons for the nasal airway obstruction. The problem may result from a septal deviation, reactive edema (swelling) from the infected areas, allergic problems, mucosal hypertrophy (increase in size), other anatomic abnormalities, or combinations thereof. A trained specialist in diagnosing and treating ear, nose, and throat disorders can determine the cause of your chronic sinusitis and nasal obstruction.

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Your First Visit

After discussing your symptoms, the primary care physician or specialist will inquire if you have ever incurred severe trauma to your nose and if you have had previous nasal surgery. Next, an examination of the general appearance of your nose will occur, including the position of your nasal septum. This will entail the use of a bright light and a nasal speculum (an instrument that gently spreads open your nostril) to inspect the inside surface of each nostril. A thorough examination of your septum and nasal cavity may also involve the use of endoscopic viewing of the back of your nose and the throat behind it.

Surgery may be the recommended treatment if the deviated septum is causing significant obstruction, debilitating and demonstrably related headaches, troublesome nosebleeds or recurrent sinus infections. Additional testing may be required in some circumstances.

Septoplasty

Septoplasty is a surgical procedure performed entirely through the nostrils, accordingly, no bruising or external signs occur. The surgery might be combined with a rhinoplasty, in which case the external appearance of the nose is altered and swelling/bruising of the face is evident. Septoplasty may also be combined with sinus surgery. It can be done with a local or a general anesthetic and is usually done on an outpatient basis. During the surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose.

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Frequently Asked Questions

What happens if you dont fix deviated septum?

Leaving a deviated septum alone depends on what type of problems it is causing. Deviated septums can cause nasal blockage, snoring in sleep disruption, trouble with exercise, trouble managing allergies or sinusitis. If your doctor thinks a deviated septum is attributable to these things and leaving it alone may cause problems to persist. There are some people with mildly deviated septumu2018s with minimal symptoms and they may be OK leaving it alone.

How painful is a deviated septum surgery?

Repair of a deviated septum is usually done while you are asleep under general anesthesia and so the discomfort of the procedure is well controlled. After surgery most patients are off their pain medicine between one and three days. Some people may have additional discomfort with other different types of nasal surgeries. Packing and splints might add some additional discomfort.

What is a deviated nasal septum?

Since a nasal septum separates the left and right side of the nose and normally would be in the middle of your nose, a deviated septum is when it is pushed to one side. A deviated septum may cause nasal blockage or contribute to a crooked nose.

Does a septoplasty change the appearance of my nose?

A routine septoplasty does not change the appearance of the nose as the basic surgery is intended to relieve the blockage in your nasal passages. However, septoplasty may be done in conjunction with other nasal surgeries such as rhinoplasty which does change the shape of your nose. If you want to change the appearance of your nose this may be elected and you should discuss with your surgeon.

Is a deviated septum a big deal?

Deviated septum's can range from mild to severe. Whether it is a “big deal” depends on what degree of symptoms it is causing. For example, a mild deviated septum with no significant symptoms is no big deal. However, a severe deviated septum causing nasal blockage, breathing problems and sinus issues may be worth correcting. Talking to an experience specialist will help you determine what is important to address.

Does deviated septum get worse with age?

The most likely reason the deviated septum would get worse is because of additional trauma that occurred somewhere later in your loop life. However, nasal blockage could worsen do the other factors related to age, allergies or sinus conditions.

How do you assess a deviated septum?

A deviated septum is best assessed by a trained surgical specialist and that usually begins with a physical exam. Sometimes medical therapy may be attempted if other conditions are discovered. Other tests may include nasal endoscopy and CAT scan if needed.

What is a septoplasty?

A septoplasty is a surgery to repair a deviated septum. This is usually performed by a qualified surgeon under anesthesia where incisions are made in the nose to correct the crooked deviated septum to improve breathing or straighten the nose.

What is it like to recover from a septoplasty?

Routine septoplasty is done as an outpatient surgery under anesthesia and it takes about an hour. People typically experience some congestion after the surgery and most pain is easily managed and resolved within a few days. He will get checked within a week and may need a number of weeks or months to fully recover. People return to work or school in 2 to 7 days.

When can I resume exercise after a septoplasty?

You should be on your feet and doing most easy routine things and easy walks within a day or two after this outpatient surgery. However, intense cardiovascular activity or strenuous exercise should be postponed until two weeks after surgery.

What is the nasal septum?

The nasal septum is essentially a wall inside the nose that divides the left and right nasal passages. It is a wall composed of cartilage and bone and covered by mucous membranes. While it divides the left and right it also supports the overlying structures of the nose. Ideally, the septum would be in the midline of your nose but when it is pushed to one side we describe it as deviated. A deviated nasal septum can cause nasal blockage and a number of nose and sinus symptoms.

How is a septoplasty surgery done?

A routine septoplasty surgery is typically done as an outpatient surgery in an operating room under general anesthesia where you are asleep for the operation. Incisions are made inside the nose to get access to the parts of the deviated septum that are blocking your nose. Often some cartilage or bone may be removed from your nose to relieve the blockage in some other parts are repositioned and then sutured for repair. Sometimes a different approach is used if rhinoplasty is needed to repair the outside structures of the nose.

What are the complications of septoplasty surgery?

When performed by an experienced surgeon, most septoplasty surgeries go very well with no problems and people get great relief. However, like any surgery there are risks. Those may include bleeding, infection, and not achieving the desired result to improve breathing, unacceptable change in the appearance of the nose, need for revision surgery, and even rare concerns such as eye problems or spinal fluid leak. Overall, those risks are very low and your surgeon can explain what your individual risk may be with your health history.

How long is nose blocked after septoplasty?

After the surgery, you should expect some congestion in your nose. Most often this is due to some mucus and blood accumulation. Sometimes you may have some splints in your nose to protect the repair until your follow up appointment and that might increase some congestion. Our surgeons rarely ever put packing or gauze in the nose and this is a great relief to the patient.

Can your septum collapse after septoplasty?

Collapse of the nose or septum after septoplasty surgery is possible, but it is rare and can easily be avoided in a well executed septoplasty Surgery.

How do you open a blocked nose after septoplasty?

After septoplasty surgery, you will need to do saline rinses in your nose to clear the mucus blockage that occurs. Also, at your follow up appointment the surgeon will suction your nose to clear it further.

Why can't I breathe through my nose after septoplasty?

After septoplasty surgery, there will be natural swelling that is normal due to the wound healing process and as a result, you will feel congested or not yet experienced the full breathing improvement. Typically patients will start seeing some improvement in the second week after their follow up appointment and it continues to improve as it heals further over the weeks and months beyond.

Sources:

  1. www.entnet.org
  2. www.mayoclinic.org
  3. www.medlineplus.gov
  4. www.american-rhinological.org

 

 

Christopher R. Cote, M.D.

With more than 25 years experience,Dr. Christopher Cote is double-board-certified by the American Board of Otolaryngology and the American Board of Facial and Reconstructive Surgery. He received his medical degree from Tufts University and performed a surgical internship and residency at Walter Reed Medical Center and National Naval Medical Center. He received fellowship training at Johns Hopkins University in Facial Plastic And Reconstructive Surgery, his subspecialty area of expertise and focus, including rhinoplasty and nasal airway surgery . He also enjoys hiking, skiing, and traveling with his family.

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