Septoplasty

Septoplasty is an operation to correct an asymmetry of the nasal septum and to improve nasal breathing or chronic nose bleeding.  When the nasal septum is deformed, there is no medicine that will cause it to be straightened.  People often find better long-term success with surgery.

The surgery may be done along with other procedures to treat chronic sinusitis, turbinate hypertrophy, or sleep apnea.

Septoplasty is usually performed with patients completely asleep (general anesthesia).  It takes about one hour and is usually done in an outpatient surgical center. 

There are no external incisions.  Working through the nostrils, the surgeon makes a small incision through the nasal mucosa or soft tissue covering of the septum.  The septal mucosa is detached from the cartilage and bones of the septum. The deviated portions of the septum are cut, removed or straightened.  The nasal lining is sutured back into its original position with absorbable suture. There are no bruises around the eyes because the outer nasal bones are not broken, unlike cosmetic nasal surgery (rhinoplasty).  It would be rare to have any change to the appearance of the nose.
 

What to expect after surgery

• After surgery, you may have a pack placed in your nostrils to stop bleeding.  This is traditionally removed the morning after surgery in the doctor’s office.
   
• There may also be plastic splints sutured inside your nose to keep the septum straight while it heals.  These “casts” are also removed in the doctor’s office about 5 days after surgery.  The splints will add some temporary congestion and crusting.
   
• Occasionally patients experience pain, tingling, or numbness of their front teeth for days after a septoplasty.
   
• Most patients are given a prescription for antibiotics to prevent an infection which should be taken faithfully after arriving  home on the day of surgery and pain medication which needs to be taken only if uncomfortable.
   

Risks

• Bleeding.  There is a concentration of blood vessels in the nose.  It is normal to have blood oozing from the nose for the first day.  Occasionally, patients need attention after a surgical procedure to control heavy or persistent bleeding.
   
• Unintentionally, tissue can be bruised, burned or cut by any one of the many instruments the surgeon uses. 
   
• Postop infections of the septum or sinuses are infrequent, but nasal packing carries a small risk of toxic shock syndrome and usually an oral antibiotic is prescribed to reduce this risk.
   
• Nasal crusting may occur if there is an area of mucosal scarring. 
   
• Nasal congestion may persist even after surgery.  There are several aspects of nasal anatomy and function which cause nasal obstruction.  Your surgeon will try to identify the most important problems, but this judgment is difficult to make correctly in all cases.  Sometimes, even after a septoplasty, the nose feels blocked because of nasal valve collapse (link).
   
• A complicated septoplasty has a small risk of healing with a hole in the wall between the nasal passages.  Sometimes this result does not cause any symptoms and can be left alone.  In other cases, the septal perforation (link) is repaired.
   

Warnings

• Your surgeon will use techniques which attempt to produce a lasting, satisfactory result, but there are aspects of wound healing that are unpredictable. 
   
• Nasal surgery cannot cure allergies.
   
• Septoplasty, without any other procedures, rarely is an effective treatment for sinusitis, snoring or sleep apnea. 
   
• In general, nasal surgery is ineffective in reducing the amount or thickness or nasal secretions.  In other words, it rarely helps postnasal drip or problems with phlegm. 
   
• It is important that your physician knows if you have had previous nasal or septal surgery and that you discuss your expectations with the surgeon.