Septoplasty 101: Relief from Deviated Septum

The nose, besides being an efficient and aerodynamic structure with specialised function of smell and flavour detection, regulates breathing, warms up the inhaling air up to 31-34 ° C, humidifies it up to 90-95 %, and also contributes as an aesthetic factor on the face. The septum, one of the most critical components of the nose, is a thin wall of cartilage and bone that divides the nasal cavity into two halves; kind of working like a central pole of a tent. A deviated septum occurs when this wall is displaced to one side, it can cause nasal obstruction or external deformity. Once the nose is obstructed, infection sets in, causing headache, throat irritation, cough, and various other problems. In such cases, septoplasty presents a possible solution.

What is Septoplasty?

Septoplasty is a surgical procedure performed to correct a deviated septum. It aims to straighten the septum to improve airflow through the nose and alleviating associated symptoms, such as difficulty breathing, nasal congestion, snoring, and recurrent sinus infections. During the procedure, the surgeon makes an incision inside the nose and lifts the mucous membrane covering the septum. They then reshape or reposition the cartilage and bone to straighten the septum. In some cases, excess tissue may also be removed. Afterward, the mucous membrane is repositioned, and the incision is closed.

What are the Types of Septoplasty?

Common types of septoplasty include:

• Open septoplasty: This is the standard approach to septoplasty, where the surgeon makes an incision inside the nose and lifts the mucous membrane covering the septum. They then reshape or reposition the deviated cartilage and bone to straighten the septum. Excess tissue may be removed if necessary. Finally, the mucous membrane is repositioned, and the incision is closed.
• Endoscopic or closed septoplasty: In this approach, the surgeon uses an endoscope, a thin tube with a camera and light attached to it, to visualise the internal structures of the nose. The surgery is performed through the nostrils without the need for external incisions. Endoscopic septoplasty allows for better visualisation and precision during the procedure.
• Cartilage graft septoplasty: In cases where the septum is severely deviated or weakened, cartilage grafts may be used to reinforce or rebuild the septum. The surgeon may harvest cartilage from the nasal septum itself (septal cartilage) or from other areas of the body, such as the ear or rib. These grafts are then used to support and stabilise the septum, improving nasal airflow.

The choice of septoplasty technique depends on factors such as the severity of the deviation, the patient's anatomy, and the surgeon's preference and expertise. For example, in case a lateral projection (called a spur) is causing nasal blockage, it is removed by a technique called spurectomy, during which the dislocated nasal septum is restored back in its natural position or a deviation is corrected by giving multiple incision and straightening the defect. 

Note: All these procedures are done under anaesthesia as a day care surgery. The nasal cavities are packed with medicated material, which is taken out in about 48 hours, till then one can breathe through the mouth.

Who Needs Septoplasty?

Septoplasty is typically recommended for individuals whose symptoms and complications due to a deviated septum do not go away or start hampering their quality of life. Common indications for septoplasty include:

• Chronic nasal obstruction: A deviated septum can obstruct one or both nasal passages, leading to difficulty breathing through the nose. This obstruction can cause chronic nasal congestion, mouth breathing, and snoring.
• Recurrent sinus infections: A deviated septum can impede proper drainage of the sinuses, leading to recurrent sinus infections (sinusitis). Septoplasty may be recommended for individuals who suffer from frequent or severe sinus infections that are not adequately controlled with medication.
• Nasal deformity: In some cases, a deviated septum can cause noticeable asymmetry or deformity of the nose, affecting the individual's appearance. Septoplasty may be performed for both functional improvement and cosmetic enhancement along with Rhinoplasty
• Snoring and sleep apnea: A deviated septum can contribute to snoring and, in some cases, obstructive sleep apnea. Septoplasty may be recommended as part of the treatment plan for individuals with sleep-disordered breathing, especially if the deviated septum is a contributing factor along with turbinate reduction
• Difficulty with nasal hygiene: A severely deviated septum can make it challenging to effectively clean the nasal passages, leading to increased susceptibility to infections and irritation. Septoplasty may be considered to improve nasal hygiene and reduce the risk of complications.

It's important to note that not everyone with a deviated septum requires septoplasty. The decision to undergo septoplasty is typically based on the severity of symptoms, the impact on quality of life, and the individual's overall health and preferences. 

What are the Advantages of Septoplasty?

Septoplasty offers several advantages for individuals with a deviated septum, including:

• Improved nasal airflow: Septoplasty aims to straighten the deviated septum, allowing for better airflow through the nasal passages. This can alleviate symptoms of nasal congestion, difficulty breathing through the nose, and mouth breathing.
• Relief from nasal symptoms: Many individuals with a deviated septum experience bothersome symptoms such as chronic nasal congestion, snoring, sinus infections, and sleep disturbances. Septoplasty can help alleviate these symptoms, improving overall quality of life.
• Enhanced sleep quality: Nasal obstruction due to a deviated septum can contribute to sleep disturbances, such as snoring, sleep apnea, and difficulty breathing during sleep. By improving nasal airflow, septoplasty can lead to better sleep quality and reduced daytime fatigue.
• Reduced risk of sinus infections: A deviated septum can interfere with proper drainage of the sinuses, increasing the risk of recurrent sinus infections (sinusitis). Septoplasty can improve sinus drainage and reduce the frequency and severity of sinus infections.
• Correction of nasal deformity: In addition to functional benefits, septoplasty can also improve the appearance of the nose in cases where the deviated septum causes noticeable asymmetry or deformity. This can enhance self-confidence and satisfaction with one's appearance.
• Minimally invasive procedure: Septoplasty is typically performed using minimally invasive techniques, such as endoscopic or septoplasty. These approaches minimise trauma to the nasal tissues, reduce postoperative pain, and promote faster recovery compared to traditional open surgery.
• Outpatient procedure: Septoplasty is often performed on an outpatient basis, meaning patients can typically go home the same day as the surgery. This allows for a quicker recovery and less disruption to daily activities.
• Long-term results: For many individuals, septoplasty provides long-lasting improvement in nasal breathing and symptom relief. While some degree of nasal congestion or other symptoms may persist, the majority of patients experience significant benefits from the surgery.

Overall, septoplasty can significantly improve nasal function, alleviate symptoms, and enhance quality of life for individuals with a deviated septum. However, it's important to discuss the potential risks, benefits, and expectations of the procedure with a qualified ENT specialist or rhinologist before making a decision.

Who may not be a Suitable Candidate for Septoplasty?

Septoplasty may not be recommended for individuals who:

• Smoke: Smoking can impair healing and increase the risk of complications after surgery.
• Have multiple medical conditions: Managing multiple health issues may increase the risks associated with surgery and anaesthesia.
• Don’t have breathing problems: If the deviated septum does not significantly affect breathing, septoplasty may not be necessary.
• Have minimal snoring: If snoring is not bothersome or does not significantly impact sleep quality, septoplasty may not be warranted.
• Do not experience nasal congestion or difficulty sleeping: If there are no symptoms of nasal obstruction or sleep disturbances related to the deviated septum, septoplasty may not be indicated.
• Have a bleeding disorder, anaemia, or other chronic illnesses: These conditions may increase the risks associated with surgery and affect healing.
• Are unable to tolerate anaesthesia: Septoplasty requires anaesthesia, and individuals who cannot tolerate anaesthesia may not be suitable candidates for surgery.

It's essential to discuss your individual circumstances with a doctor to determine whether septoplasty is appropriate and safe for you.

What are the Potential Risks of a Septoplasty?

Septoplasty is generally considered a safe and effective procedure, but like any surgery, it carries certain risks and potential complications. Some of these risks include:

• Bleeding: Bleeding during or after septoplasty is relatively common. In most cases, it can be managed with packing or other techniques, but in rare instances, it may require further medical intervention.
• Infection: There is a risk of developing an infection after septoplasty, which can manifest as increased pain, swelling, redness, or drainage from the nose. Antibiotics may be prescribed to treat the infection if it occurs.
• Septal perforation: In rare cases, septoplasty may result in a perforation or hole in the septum. This complication can cause nasal crusting, bleeding, whistling sounds during breathing, and nasal obstruction. Additional surgery may be necessary to repair the perforation.
• Changes in nasal sensation: Some individuals may experience temporary or permanent changes in sensation in the nose following septoplasty. This can include numbness, tingling, or altered sensitivity.
• Septal hematoma: Accumulation of blood within the septum, known as a septal hematoma, is a rare but serious complication of septoplasty. It can lead to increased pressure, pain, and difficulty breathing and may require immediate drainage to prevent further complications.
• Anaesthesia risks: Septoplasty is typically performed under general anaesthesia or local anaesthesia with sedation, both of which carry their own risks. These risks include adverse reactions to anaesthesia, respiratory complications, and cardiovascular events.
• Cosmetic concerns: In some cases, septoplasty may result in changes to the appearance of the nose, particularly if septal cartilage is removed or reshaped. This can include asymmetry, saddle nose deformity, or other aesthetic issues.
• Persistent nasal obstruction: While septoplasty is intended to improve nasal airflow, some individuals may continue to experience nasal obstruction even after surgery. This may be due to incomplete correction of the deviated septum, scar tissue formation, or other factors.

It's important for individuals considering septoplasty to discuss these potential risks and complications with their surgeon and to weigh them against the potential benefits of the procedure. Most complications are rare, and the majority of patients experience significant improvement in nasal breathing and quality of life following septoplasty.

What Happens Before Septoplasty?

Before undergoing septoplasty, several steps typically occur to ensure that the procedure is appropriate and safe for the individual. These steps may include:

1. Physical examination: The ENT specialist will perform a thorough physical examination of the nose, including internal and external evaluation of the nasal structures. This examination helps determine the severity of the septal deviation, assesses nasal airflow, and identifies any other nasal issues that may be present.
2. Nasal endoscopy: In some cases, the ENT specialist may perform a nasal endoscopy, which involves inserting a thin, flexible tube with a camera into the nasal passages to visualise the internal structures more closely. Nasal endoscopy allows for a detailed assessment of the septum, turbinates, and other nasal structures.
3. Diagnostic tests: Additional diagnostic tests, such as nasal imaging studies (e.g., CT scan or MRI), may be ordered to further evaluate the extent of the septal deviation and assess for any associated nasal or sinus abnormalities.
4. Discussion of expectations and goals: The ENT specialist will discuss the individual's expectations, goals, and motivations for undergoing septoplasty. This helps ensure that the procedure aligns with the individual's treatment preferences and desired outcomes.
5. Preoperative instructions: Prior to surgery, the individual will receive instructions from their healthcare provider regarding preoperative preparation. This may include guidelines for fasting before anaesthesia, discontinuation of certain medications (such as blood thinners), and instructions for postoperative care.
6. Anaesthesia consultation: If general anaesthesia will be used during septoplasty, the individual may need to undergo a preoperative anaesthesia evaluation to assess their overall health and fitness for anaesthesia.
7. Informed consent: Before proceeding with septoplasty, the individual will be asked to provide informed consent, indicating that they understand the purpose of the surgery, its potential risks and benefits, and alternative treatment options.

By completing these steps before septoplasty, healthcare providers can ensure that the procedure is tailored to the individual's needs and that they are well-prepared for surgery and the recovery process.

What Happens During Septoplasty?

Septoplasty is typically performed under general anaesthesia or local anaesthesia with sedation. The surgeon follows a series of steps to correct the deviated septum. Here's an overview of what happens during the procedure:

1. Preparation: The patient is positioned comfortably on the operating table, and anaesthesia is administered to ensure they are unconscious and pain-free during the procedure.
2. Accessing the septum: The surgeon begins by making an incision inside the nose, either along the nasal septum or within one of the nostrils. This incision provides access to the underlying septal cartilage and bone.
3. Elevating the mucous membrane: The mucous membrane (nasal lining) covering the septum is carefully lifted and separated from the underlying cartilage and bone. This allows the surgeon to visualise the deviated portion of the septum.
4. Reshaping or removing deviated tissue: Using specialised surgical instruments, the surgeon then reshapes or removes the deviated portions of the septal cartilage and bone. This may involve straightening the septum, removing excess tissue, or repositioning displaced structures.
5. Repositioning the mucous membrane: Once the septum has been corrected, the mucous membrane is repositioned over the newly aligned septum and secured in place using dissolvable sutures or tissue adhesives.
6. Addressing additional nasal issues: In some cases, additional procedures may be performed during septoplasty to address other nasal issues, such as reducing the size of enlarged turbinates or repairing a deviated nasal septum.
7. Checking for bleeding and closing the incision: The surgeon carefully inspects the surgical site for any signs of bleeding and ensures that the nasal passages are clear and patient. The incision is then closed with sutures, and nasal packing may be placed inside the nose to help support the septum and minimise bleeding.

What Happens After a Septoplasty?

After septoplasty, the individual receives instructions for postoperative care and follow-up appointments. Here's what typically happens after septoplasty:

1. Recovery in the hospital or clinic: After the procedure, the individual will spend some time in the recovery area under observation. Vital signs such as blood pressure, heart rate, and oxygen saturation will be monitored to ensure stability.
2. Pain management: The individual may experience some discomfort or pain in the nose and surrounding areas after septoplasty. Pain medication, either over-the-counter or prescription, may be prescribed to manage pain during the recovery period.
3. Nasal packing: In some cases, nasal packing or splints may be placed inside the nose to support the septum and minimise bleeding. If packing is used, it is usually removed within a couple of days following the procedure.
4. Nasal care: Proper nasal care is essential during the recovery period. The individual may be instructed to perform nasal saline rinses or use nasal sprays to keep the nasal passages clean and moist. It's important to avoid blowing the nose forcefully or engaging in activities that could disrupt healing.
5. Activity restrictions: Physical activity may be limited in the immediate postoperative period to reduce the risk of bleeding and complications. The individual may be advised to avoid strenuous exercise, heavy lifting, or activities that could increase nasal pressure or strain.
6. Resuming normal activities: Most individuals can resume normal activities, including work and school, within a week or two following septoplasty. However, it's essential to follow the surgeon's instructions regarding activity restrictions and gradual return to normalcy.
7. Monitoring for complications: While complications are rare, it's important to monitor for signs of infection, excessive bleeding, or other complications during the recovery period. If any concerning symptoms develop, such as severe pain, fever, or persistent bleeding, the individual should contact their surgeon promptly.
8. Follow-up appointments: The individual will be scheduled for follow-up appointments with their surgeon to monitor healing and assess the results of the septoplasty. These appointments may occur within a few days to a week after surgery.

Overall, the recovery period after septoplasty varies depending on the individual's health, the extent of the surgery, and other factors. Following the surgeon's postoperative instructions and attending follow-up appointments are essential for a smooth recovery and optimal outcomes.

Wrap up

Septoplasty is a surgical procedure designed to correct a deviated septum and improve nasal airflow. While the procedure carries certain risks, it offers significant benefits for individuals experiencing symptoms such as nasal congestion, difficulty breathing, and snoring due to a deviated septum. With careful preoperative evaluation, skilled surgical techniques, and diligent postoperative care, septoplasty can provide long-lasting relief and improved nasal function for eligible candidates. If you or a loved one has been experiencing the symptoms of a deviated septum, consult with a specialist at Max Hospitals, and be assured of personalised and compassionate care, ensuring the best possible outcomes.