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Treatment for a deviated septum
If your septal deviation is severe enough to cause nasal
blockage and other reasons for your condition are eliminated,
then your ENT physician may recommend an operation called a septoplasty.
Some non-prescription devices claim to reduce nasal obstruction,
but none has been shown to be effective in a prospective,
randomized, clinical trial. Surgery is the only way to correct a
deviated septum.
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A septoplasty can straighten a deviated septum and restore normal breathing and mucus flow. Typically, a septoplasty takes between one and two hours, and is
performed on an outpatient basis in a day surgery center under local or general anesthesia.
During the procedure, your ENT surgeon will reshape the cartilage and bone in your nose to straighten your septum. It usually doesn't change the outward appearance of your nose (that is what a rhinoplasty does, and the two are sometimes performed together). Turbinate reduction may be done simultaneously with a septoplasty if enlarged turbinates are contributing to your obstruction. |
Septoplasty is very common—in fact, it's the third most common head and neck procedure in the US. However, it's always important to choose your surgeon carefully and inquire about his or her experience level with the procedure you are going to have because any surgery involves a certain level of risk.
Although rare, one potential complication is a septal perforation, a hole in the septum between the right and left sides of the nose that creates a whistling sound when you breathe. Sometimes it can cause bleeding and pain, as well. If the perforation doesn't improve over time or worsens, then surgery may be required to repair it.
Techniques for performing a septoplasty include:
Minimally invasive powered septoplasty
Many surgeons now prefer the minimally invasive powered septoplasty approach. This technique requires no outside incision and uses an instrument called a microdebrider (pronounced "MI-cro-duh-BREE-der"). The microdebrider has a tiny rotating tip that offers the surgeon more precision and control than traditional tools.
Compared to traditional surgery for a deviated septum, the minimally invasive powered
septoplasty:
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Provides improved visualization for the surgeon
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Allows for more precise, targeted tissue removal
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May reduce the risk of damage to nearby healthy tissue
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Is a faster procedure and requires less time under anesthesia
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May reduce the risk of septal perforation
In a powered septoplasty, the goal is to save as much healthy tissue as possible. The precision and control afforded by the microdebrider allows your surgeon to correct the deviation, keep as much of the structural support intact as possible, and minimize damage that could cause a septal perforation. If your septal deviation is in a structurally weak area of the nose, then it's especially important not to remove too much cartilage and/or bone since the septum acts as a structural support for the nose. Too much removal of septal bone or cartilage can cause your septum to collapse and result in a horse saddle-shaped deformity. Submucous resection
(SMR)
This traditional method of correcting a septal deviation has been in practice since 1902. A submucous resection, or SMR, involves substantial dissection (cutting) of the surface mucous lining of the septum to allow access by multiple instruments. The goal is to remove any deviated bone and cartilage from the same side of the nose without compromising the mucous lining on the opposite side of the nose and risking a septal perforation. In most cases, the surgeon will
sew both sides of the septum together and insert a nasal splint (a stiff sponge) to reinforce the septum while it heals. Splints that have a hole in the middle allow you to breathe better after surgery. After your
septoplasty
In the early period following the surgery, there is usually some pain and swelling inside the nose. Because the nasal cartilage has some "memory," there can be a tendency over time for the septum to reshape itself back toward its deviated position.
Other complications from the surgery are very rare, but can include septal perforation as described previously, bleeding, change in shape of the nose, some numbness of the front teeth, or impairment and a loss of the sense of smell. Be sure to talk to your doctor about any questions or concerns you may have
before your procedure and follow your doctor's advice for what to do after your surgery.
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