A septoplasty is a surgical procedure to correct a deviated nasal septum to improve breathing through the nose. The nasal septum is the wall that divides the two sides of the nose on the inside. The septum is made of cartilage in front and bone in the back. In most people, the septum is relatively straight and does not block either side of the nose. However, some people have bowing of the septum or obstructing spurs off of the septum which can block breathing through one or both sides of the nose. People who have had a broken nose in the past can have very crooked septums that significantly impair breathing.
A septoplasty is almost always an outpatient procedure. It is generally performed by ear, nose, throat surgeons, but can also be done as part of a rhinoplasty ("nose job") by a facial plastic or general plastic surgeon.
Every nasal septum is different. The surgery can take as little as 15 minutes for a very simple case or as long as 2 or more hours for a complicated case (especially if the patient has had previous nasal surgery). Most patients are asleep under general anesthesia though some surgeons prefer iv sedation with numbing medicine in the nose.
An incision is made along the front of the septum on the inside of the nose. There are no visible incisions on the face. Then, the lining over the bone and cartilage of the septum is lifted up. After this, the crooked parts of the bone and cartilage are removed. Some surgeons then crush the cartilage flat and replace it in the nose. Finally, the septum is stitched together straight in the midline. Some surgeons will leave plastic splints inside the nose for several days after the surgery which are removed in the office at the postoperative visit.
A septoplasty is frequently done along with a turbinate reduction procedure.
After surgery, there is usually some bloody oozing for the next day or two, but usually not any significant bleeding. It is important to use lots of nasal saline (salt water spray) in the nose every 2-3 hours to help healing and prevent crust formation. A pain medication such as hydrocodone (vicodin, lortab) or oxycodone (Percocet) is usually prescribed, though many patients only need Tylenol or Advil. If plastic splints were placed in the nose, an antibiotic should be prescribed as well. Patients should avoid nose blowing, strenuous exercise, heavy lifting over 10 pounds, or any other straining for 2 weeks after surgery.
People who have had a septoplasty should not expect 100% improvement in their symptoms forever. The surgery will correct the distorted anatomy inside the nose, but it does not cure allergies, chronic sinus infection, or other causes of nasal congestion. Everyone who has the surgery should note a definite improvement in their nasal breathing, though.
The risks of surgery include bleeding and scarring inside the nose (which can further block breathing). Another risk is a septal perforation (hole between the two sides of the nose), which can cause crusting, nosebleeds, and a whistling noise inside the nose. A perforation is a rare occurrence but is more likely in very deviated septums or patients who are having repeat surgeries on their septum. A final serious (but extremely rare) risk is a fracture of the very top of the septum as it meets the skull base. This can potentially cause a leak of cerebrospinal fluid from around the brain. Again, this risk is extremely rare.
Septoplasty is overall a very safe and effective procedure in the right patient.
The above article is for educational purposes only and should not be considered as specific medical advice.