Surgical correction of the deviated septum is one of the most common surgical procedures that I perform in the operating room. The formal medical term for this procedure is called “septoplasty,” ‘septo’ stemming from the Latin word saeptum which means “fence, enclosure, or partition” and ‘plasty’ deriving from the Greek word ‘plastia,’ which means “to form.” This is one of the most common nasal surgeries performed by Ear, Nose and Throat (ENT) surgeons and facial plastic surgeons. Often times it is performed in conjunction with other surgeries of the nose, such as rhinoplasty, turbinate reduction, and sinus surgery.

Let’s begin with the anatomy. The septum is the structure in the midline of the nose that is made out of cartilage. It functions as structural support for the tip of the nose and is made out of cartilage to allow it to absorb the occasional blow to the nose without breaking or fracturing. In addition, the septum separates the nose into two compartments and also functions to humidify and warm the air that we breathe.

How do I Know I Have a Deviated Septum?

Most of us do not have a perfectly straight septum. Either due to trauma or normal development, the septum does not always grow in a completely straight fashion. It can grow in one direction or sometimes lean from one side then back to the other. If the deviation is significant enough it can cause nasal obstruction on one side of the nose or even both nostrils. Some patients with severe deviations, often as a result of trauma, can be seen externally. Often times the “tip” or the furthest forward portion of the nose will be pointing to the left or the right.

The majority of patients who I perform septum surgery one typically arrive at my office complaining of difficulty breathing from one side of the nose, or sometimes both sides. Multiple nasal issues can cause nasal obstruction, but deviated septum is one of the most common. I first ask about the history of the nasal obstruction. Is it all day? Just in the morning? Left side or right side? While in bed? While these questions may seem strange, they are very effective at determining the cause of blockage before I have even touched the patient. After this, I often introduce a special camera and telescope made specifically for looking into the nose. Before doing this, I almost always give the patient a special spray that numbs the nose. This spray tastes very bad and the numbing sensation often lasts for up to an hour, so try to avoid eating in the period. Most importantly this medication can very rarely cause severe reactions. Make sure to tell your doctor if you have a history of heart problems, such as placement of a cardiac stent, or recent heart attack. Also tell your physician if you are allergic to anesthetic medication, such as Lidocaine.

After examining the nose with the camera any board-certified ENT surgeon will be able to tell you if have a deviated septum. Don’t be alarmed if your doctor informs you that it is deviated. Approximately 75 percent of the population has some degree of deviation in their septum. The real question is if the deviation is actually causing the nasal obstruction…or is it something else.

I Have a Deviated Septum and Nasal Obstruction…What Now?

Your physician can offer you a variety of treatment options when faced with this diagnosis. They fall in one of these three categories: do nothing, surgery, or medical treatment. Nasal obstruction, while often times extremely debilitating, does NOT need treatment. However, patients can experience significant benefit in their quality of life, ability to exercise, snoring, quality of sleep, energy level etc. The most common and prevalent issues patients with nasal obstruction from deviated experience include:

• Poor quality of sleep or difficulty sleeping. Obstructed airflow from the nose can cause snoring and even sleep apnea. This deprives your body and brain of oxygen that is critical for our ability to repair itself and feel rejuvenated in the morning.
• Fatigue. This often goes hand-in-hand with sleep quality. Many people with nasal obstruction are unable to exercise to their full potential because they are unable to breathe properly. Breathe Right strips were made specifically for this purpose to enhance nasal airflow and improve performance.
• Decreased sense of smell and taste. Decreased airflow to the nose means that tiny molecules floating never make it to the organ in our nose that allows us to experience smell which also impacts our ability to taste.

I Was Offered Septoplasty Surgery. What Do I Need to Know?

Fixing the septum is not always necessary and your doctor should always supply you with other treatment options, as well as with reasonable expectations after surgery. In addition, before you agree to have any procedure, you should always know the risks of the surgery. This includes the risk of having general anesthesia, complications from septoplasty surgery which include the need for more surgery, bleeding, pain, nasal obstruction, etc.

The goal of this surgery is to straighten and align the cartilage structure that exists in the midline of the nose in order to increase the airflow to the nose. Septoplasty is one of the major procedures I do to achieve this; however, there are other related procedures a surgeon can perform that can increase airflow and often times these procedures are performed together. One of these is called “turbinate reduction.” This is a procedure where the turbinates, small swellings at the sides of the nasal cavity that function to warm and humidify the air, are shrunken to allow for more space in the nasal cavity in which air can flow.

A second procedure is nasal valve surgery, also called functional rhinoplasty. This is a procedure often performed by a facial plastic surgeon where the cartilage of the nose is modified to allow for more airflow. This can sometimes slightly alter the shape of the nose and is often performed during cosmetic nose surgery as well.

Prior to performing any nasal procedures I relay the following information to patients:

• Recovery is about a one-four week process. Depending on what type of procedure you get the recovery will vary. Basic septoplasty has a very short recovery whereas rhinoplasty takes much longer. In general most patients take one week off of work. In addition I ask them to avoid heavy lifting and working out after the surgery. In patients where I perform extensive sinus surgery, rhinoplasty or tumor surgery I also add that they cannot fly on an airplane for one month due to the remote chance of significant bleeding.
• Use nasal irrigations. I personally use nasal irrigations on a daily basis even though I don’t have nasal obstruction or sinusitis. I describe it to many of my patients like brushing your teeth except for the inside of your nose. It is a good habit to form prior to surgery and after surgery it helps to clean the surgical cavity and remove any crusting or thick mucus away from the wounds.
• Take note of blood thinners. Although nasal surgery is not a very bloody surgery, I exercise every precaution that can maximize my ability to operate and minimize the chance for complications afterwards. I require nearly all patients to abstain from using medications such as aspirin and ibuprofen prior to surgery and even supplements such as garlic, fish oil, and ginkgo biloba, which can also thin the blood out.

What to Expect After Septoplasty Surgery

One of the most important things I do when discussing surgery with patients is manage their expectations and educate them about all possibilities after surgery. By doing this they are well prepared for anything that may arise after surgery. Here are some key takeaways:

• Bleeding is normal. A small amount of blood will ooze from the nose. We often send patients home with a small sling that holds tissue to collect the small amount of blood that will drip from the nose. This is completely normal especially in the first few days following surgery. If the blood flow becomes significant, it is never a bad idea to call your doctor.
• Breathing will not clear up immediately. Contradictory to the goal of the surgery, there is a good amount of swelling that occurs immediately after the surgery, which is normal. In addition, many surgeons place a type of sponge or packing, after the surgery that needs to be removed. You see a piece of plastic in your nose. Often times when I perform significant nasal reconstruction, functional rhinoplasty or cosmetic procedures I will place something called a nasal splint that is sutured in place. This will come out usually one week after surgery, afterwards which the patients usually experience dramatic change in breathing.
• Expect some throat pain and difficulty sleeping.  Many patients complain of a sore throat following surgery. This is due to the tube that is placed into the throat during general anesthesia. The pain goes away in several days but can be managed by spraying anesthetic spray that can be purchased over the counter such as Chloraseptic. Additionally, the onset of sleep may be difficult due to stuffiness and congestion.
• Nasal saline is your new best friend. I encourage all my post-operative patients to carry nasal saline with them at all times to humidify the nose and to use nasal saline irrigations twice a day. This softens the crusts and the irrigation action loosens and pulls them away. This can also give the greatest degree of relief in pain, and obstruction.