Septoplasty

Overview

What is septoplasty?

Septoplasty is surgery inside the nose to straighten a deviated septum. The septum, about 7 centimeters long (2.5 to 3 inches) in adults, is made of cartilage and bone. It separates the inside of the nose into two chambers or nostrils.

What is a deviated septum?

A septum is deviated if it is crooked or bent instead of straight. A deviated septum can block one or both chambers of the nose and interfere with airflow. A septum can become deviated from an injury, but it can also grow that way naturally.

How is a deviated septum diagnosed?

A doctor will examine the inside of the nose, possibly by performing a nasal endoscopy, which involves inserting a tube with a camera on the end. A computed tomography (CT) scan can also detect a deviated septum, but it is usually unnecessary. After the diagnosis, the doctor will discuss treatment options, including septoplasty.

Are there other causes of nasal obstruction?

Yes. Allergies and polyps can cause nasal blockages. Also, turbinates – long ridges of bone and tissue inside the nose that protrude into the nostrils – can obstruct if they are too large. Steroid nasal sprays can reduce swelling in turbinates, and adhesive nasal strips can provide temporary relief.

Why is septoplasty necessary?

Septoplasty is the only way to correct a deviated septum, which can make breathing through the nose difficult and force breathing through the mouth. Mouth breathing can cause dry mouth. Inability to breathe through the nose is even more of a problem at night and can inhibit sleep.

Sometimes septoplasty is part of other medical procedures, including sinus surgery and the removal of nasal tumors. Also, although septoplasty itself does not change the nose’s shape, it can be combined with nose-shaping surgery called septorhinoplasty.

Ultimately, it is up to each patient to decide whether to undergo septoplasty to straighten a deviated septum. The condition will not hurt anyone who can tolerate the symptoms.

Procedure Details

How does a patient prepare for septoplasty?

The doctor must know of all medications — including nonprescription drugs, supplements and herbs — the patient is taking. Before surgery, the patient should stop taking drugs like aspirin, ibuprofen, naproxen and certain herbal supplements, which make it harder for blood to clot. The doctor should also know if the patient has allergies or bleeding problems.

How is septoplasty performed?

Septoplasty is usually performed on an outpatient basis, so most patients go home the day of the surgery. In most cases, the patient is placed under general anesthesia and is asleep during the operation. Local anesthesia, which numbs the part of the body targeted for surgery, might be an option.

The procedure takes place entirely inside the nose. The doctor cuts a wall on one side of the nose and lifts or removes the mucosa, a thin membrane that covers and protects the septum. This allows the doctor to reshape the septum’s bone and cartilage. Sometimes parts of the bone and cartilage are removed, then reshaped and repositioned. Afterward, the mucosa is placed back over the septum. The nose is not broken during surgery. The operation takes between 30 and 90 minutes.

Afterward, the doctor may insert splints or soft packing to hold nasal tissue in place, prevent nosebleeds and prevent the formation of scar tissue. Usually, the splints stay in one or two weeks and packing remains in the nose between 24 and 36 hours. Sometimes, the doctor might leave only dissolving stitches, which disappear on their own over time.

Risks / Benefits

Are there risks or complications with septoplasty?

Risks or complications are rare and unlikely. One risk is that bleeding may become excessive during surgery, especially if the patient did not stop taking blood-thinning medications beforehand. If this happens, the doctor may decide not to go ahead with the operation.

Infection is possible because the inside of the nose is not sterile. Toxic shock syndrome is an unusual and life-threatening infection, mostly related to packing being placed, which is rare. Symptoms include change in blood pressure and heart rate, fever and skin discoloration. If symptoms appear, notify the doctor or surgeon immediately.

Another rare occurrence is spinal fluid leakage. It can happen because the top of the septum is near the skull and brain, which is surrounded by protective cerebrospinal fluid. If spinal fluid leaks, infection can result. That might lead to meningitis, a serious condition involving inflammation of membranes surrounding the brain and spinal cord.

A septoplasty patient might also develop a hematoma, which is swelling caused by clotted blood in tissue, or an abscess, which is a pocket of pus inside the body.

Numbness in the upper teeth and lip or tip of the nose can follow septoplasty. That’s because nerves leading to the gums and front teeth in the upper jaw run through the nose. Those nerves might stretch or become damaged during surgery. Usually the numbness is temporary and ceases after a few weeks or months.

A septal perforation, a hole in the nasal septum, is another possibility. If the perforation does not cause symptoms, the doctor will leave it alone. But if the perforation leads to crusting, dryness or obstruction in the nasal passage, the doctor can perform another surgery to close the perforation or insert a synthetic button over it.

Changes in taste and smell, and voice quality and characteristics, can also affect septoplasty patients. The nose might appear uneven, or the bridge of the nose might dip, but such cosmetic changes can be repaired.

Finally, although more than 90% of septoplasty patients enjoy improved breathing, some do not. Unfortunately, the septum has a “memory” and sometimes returns to its original shape.

Recovery and Outlook

What can I expect after septoplasty?

Since the operation is done through the nostrils, patients do not have to worry about facial scars or black eyes. However, they can experience pain or tenderness on the front of the nose, stuffiness due to swelling and nasal drainage of blood and-or mucous. Swelling from surgery may last two to three days, and drainage might continue for two to five days. Usually, over-the-counter medications will suffice for pain, although the doctor may prescribe a pain reliever. The doctor might have the patient use saline sprays or irrigation treatments to clear nasal congestion. However, if packing is in the nose, the patient will have to breathe through the mouth until the material is removed. It may take up to three months for the nose to achieve maximum clearness.

How do I care for myself after septoplasty?

Rest the first day. Do not rub or even touch the nose. Do not blow the nose, even though it feels congested, because it might cause bleeding. If sneezing is unavoidable, sneeze through the mouth. You can apply an ice pack, covered with a clean cloth or towel, to the nose and eye area to reduce pain and swelling. At night, sleep with the head propped up on two pillows to diminish swelling and congestion. Do not take a shower or bath for the first 24 hours after surgery. Return to the doctor as scheduled because if stitches inside the nose do not dissolve on their own, the doctor may remove them. Avoid people for a while to prevent catching a cold, which can lead to an infection. Stay away from dusty or smoky places. Return to work or school after a week or two, but no heavy lifting right away. For a week or two after surgery, cut back on activities that might cause a fall. These include bending over and playing sports. In fact, you might be asked to avoid sports for up to a month. Try not to put pressure on the face by, for example, straining during bowel movements.

Additional information for self care after septoplasty can be found here:

Septoplasty - At Home Instructions

When to Call the Doctor

When should I call my doctor after septoplasty?

Call the doctor or surgeon if you experience:

  • Trouble breathing.
  • A heavy, uncontrollable nosebleed.
  • Pain that worsens and that is not made better by medications.
  • High fever and chills.
  • Headaches.
  • Disorientation.
  • Neck stiffness.

Last reviewed by a Cleveland Clinic medical professional on 11/20/2018.

References

  • The Royal College of Surgeons of England. About Septal Surgery. (https://www.entuk.org/sites/default/files/files/2012-2015%20About%20Septal%20Surgery%20(09005%29.pdf) Accessed 3/5/2020.
  • Han JK, Stringer SP, Rosenfeld RM, et al. Clinical Consensus Statement: Septoplasty with or without Inferior Turbinate Reduction. Otolaryngol Head Neck Surg. 2015;153(5):708-20. (https://www.ncbi.nlm.nih.gov/pubmed/26527752) (http://sjsupport.org/?page_id=451) Accessed 3/5/2020.

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