Septoplasty

What is septoplasty and which structure is corrected?

Septoplasty is a functional surgical procedure that corrects a deviation of the nasal septum. The septum is a thin structure made of cartilage and bone that separates the two nostrils. Ideally it sits in the midline, but in most people there is some degree of deviation. When this deviation becomes pronounced it is referred to as a deviated septum, and it directly affects the quality of breathing.

The primary aim of septoplasty is not to change the external appearance of the nose. The surgery addresses only the internal structure of the nose; it leaves no visible external scar and produces no meaningful change in the shape of the nose. If aesthetic correction is also to be planned, septoplasty is combined with rhinoplasty and performed as a septorhinoplasty.

Septal deviation is a fairly common finding. However, surgery is considered only in cases that cause significant complaints. Mild deviations do not require intervention as long as they do not create a medical problem.

Why does it matter?

When there is a septal deviation, the two nostrils cannot allow an equal amount of air to pass through. Over time this leads to a range of complaints:

• Imbalanced airflow: Narrowing on one side increases the pressure load on the other
• Turbinate enlargement: On the side opposite the deviation, the turbinates enlarge to compensate for the airflow (compensatory turbinate hypertrophy). As a result, a sense of obstruction develops on both sides
• Dryness of the mucosa: Air passing rapidly through the narrowed passage dries out the mucosa
• Impaired sinus drainage: Ventilation and drainage of the sinuses become more difficult, increasing the tendency toward sinusitis attacks
• Reduced sleep quality: Breathing becomes harder at night, and snoring and mouth breathing increase

A septal deviation is not a cosmetic finding; it is a functional problem that affects quality of life over the long term.

Symptoms and signs

People with a septal deviation frequently experience the following complaints:

• Chronic nasal obstruction on one or both sides
• A habit of mouth breathing
• Snoring, reduced sleep quality, waking without feeling rested
• Frequent headaches, particularly a sensation of pressure in the facial region
• Recurrent sinusitis attacks
• A tendency toward nosebleeds
• Shortness of breath during exercise
• A reduced sense of smell
• A nasal tone to the voice

These symptoms usually develop slowly over years. Many people may not recognise the problem the condition creates, saying “it has always been like this.” In cases where intermittent obstruction is felt on the opposite side, an underlying septal deviation may also play a role.

Causes

There are two main groups of causes for septal deviation.

Structural (congenital) causes

In some individuals, septal deviation begins at birth. During facial growth, asymmetric development of the cartilaginous and bony portions of the septum can leave a deviation that becomes more pronounced later. Mechanical pressure during birth may also be a factor in some cases.

Acquired (developing later) causes

• Blows to the nose (sports injury, fall, accident)
• Childhood traumas — fractures that heal unnoticed
• Previous nasal surgery
• Changes in the cartilage structure with age

The onset of a deviation does not always trace back to a remembered trauma. A deviation can develop even without an obvious accident.

Diagnosis and assessment process

A septal deviation is usually diagnosed by examination. The assessment process often includes the following steps:

1. Medical history: The onset of nasal obstruction, any history of trauma, and allergic complaints
2. Anterior rhinoscopy: Direct inspection of the nostrils
3. Endoscopy: Detailed visualisation of the interior of the nose and detection of deviations in the posterior regions
4. Acoustic rhinometry / rhinomanometry: Objective measurement of airflow and nasal resistance
5. Computed tomography: Requested when there is a suspicion of accompanying sinusitis or a structural anomaly

During the diagnostic process, other conditions that may coexist, such as allergic rhinitis, chronic sinusitis and turbinate hypertrophy, are also evaluated. It is clarified whether the complaint arises solely from the septal deviation or from more than one factor.

Treatment approaches: from conservative options to surgery

There is no single path in the treatment of a septal deviation. A stepwise approach is followed according to the severity of the symptoms and the patient’s expectations.

Conservative (non-surgical) options

In cases with mild complaints, or where the patient does not yet wish to consider surgery, the following methods may be evaluated:

• Saline sprays and rinses: For moisturising the mucosa and for hygiene
• Topical corticosteroid sprays: To reduce turbinate swelling
• Antihistamines: Where accompanying allergic rhinitis is present
• Environmental adjustments: Protection from dust and allergens, humidifying the surroundings
• Lifestyle adjustments: Sleep position, smoking cessation

Conservative methods do not correct the deviation itself; they only help to control the accompanying inflammation. When there is a pronounced septal deviation, medical treatment relieves the symptoms only temporarily.

Surgical treatment: septoplasty

When conservative methods prove insufficient, or when the deviation causes significant structural obstruction, surgery is considered. Septoplasty is one of the standard procedures of modern ENT surgery.

The stages followed during surgery:

1. General, or where necessary local, anaesthesia is administered
2. An incision is made from inside the nose, beneath the mucosa — no external scar is visible
3. The deviated cartilage and bone segments are removed or repositioned
4. The supporting function of the septum is preserved; only the deformed portions are addressed
5. The mucosa is sutured, and thin silicone plates are placed if needed

The procedure takes an average of 45-90 minutes. In most cases a hospital stay is not required, and same-day discharge is possible.

Adding turbinate surgery

A septal deviation is often accompanied by turbinate hypertrophy. In this case, the volume of the turbinates is reduced in the same session. This additional intervention noticeably improves the openness of breathing.

Process and recovery

Recovery after septoplasty is quite rapid thanks to modern techniques. A typical recovery process proceeds as follows:

• First 24-48 hours: A sense of obstruction may be felt due to packing or a silicone plate inside the nose. Mild pain and pressure in the head region are typical
• 3-5 days: The packing is removed. The ease of breathing becomes noticeably apparent
• 5-7 days: Most patients can return to normal social activities
• 2-3 weeks: Healing of the nasal mucosa continues
• 6-8 weeks: Full recovery is completed

Because septoplasty does not change the external shape of the nose, significant swelling or bruising is generally not seen after surgery.

Quality of life, follow-up and points to consider

The main recommendations for the recovery period after septoplasty are as follows:

• Heavy lifting and strenuous exertion are avoided for the first 1-2 weeks
• Nose blowing is not done for the first 1-2 weeks
• Moisturising the inside of the nose with saline spray supports healing
• Quitting smoking is recommended, as it slows healing of the mucosa
• Sleeping face down is avoided
• A return to sport is generally possible after 2-3 weeks
• Regular check-ups (week 1, month 1, month 3, month 6) allow confirmation that healing is progressing correctly

After septoplasty, patients frequently report a noticeable improvement in sleep quality, a reduction in daytime fatigue, a change in voice quality and an increase in overall quality of life.

Framing expectations realistically after septoplasty

Septoplasty is an effective method when the underlying cause of the obstruction is a septal deviation. If the complaints are accompanied by allergic rhinitis, sinusitis or a different factor, septoplasty alone may not resolve all of the symptoms. For this reason, carrying out the assessment process correctly directly affects satisfaction with the outcome.

Types of septal deviation

Septal deviation does not appear in a single form. In clinical practice, several different patterns of deviation are described, and these patterns directly influence surgical planning.

C-shaped deviations

This is a deviation that runs from one edge of the septum to the other as a single, one-directional curve. It is one of the most common types. It usually creates significant one-sided obstruction and can be corrected with a properly planned septoplasty.

S-shaped deviations

These are complex deviations in which one section of the septum curves in one direction and another section curves the opposite way. They can create obstruction in both nostrils. Surgical planning is carried out in greater detail.

Spur deformity

A sharp projection forming at a particular point on the septum can come into contact with the turbinates and cause chronic headache and sinus complaints. In surgery, removing only this projection may be sufficient.

Vertical and caudal deviations

Deviations in the anterior (caudal) portion of the septum are particularly challenging; they may also affect the shape of the nasal tip, and aesthetic concern may accompany them. In these cases, septorhinoplasty may be considered.

Complex post-traumatic deviations

Deviations developing after nasal trauma usually involve more than one plane and may be seen together with a bone fracture. In these cases, planning is carried out more comprehensively.

Distinguishing septoplasty from aesthetic expectations

Septoplasty is often confused with aesthetic intervention; however, the two surgeries serve different purposes. The aim of septoplasty is solely to resolve the structural problem inside the nose. The shape of the nose, a dorsal hump, the position of the nasal tip and the form of the nostrils are not changed by septoplasty.

This distinction is important for most patients. If there is both a breathing problem and dissatisfaction with the shape, septoplasty alone will not resolve the second issue. In this case, a combined surgery known as septorhinoplasty may be planned. The decision is made together with the patient during the assessment.

Septoplasty and paediatric patients

Septal deviation may be seen during childhood, but the decision for surgery is deferred to a period closer to adulthood. Because nasal development is still ongoing, surgery performed early may adversely affect growth. Only in cases of serious functional problems may a limited paediatric septoplasty be considered.

Advances in modern septoplasty techniques

Although septoplasty has been performed for decades, it has undergone a significant technical evolution. Whereas the traditional method removed a large part of the septal cartilage, the modern approach prioritises preserving the tissue.

Preservation of the mucosa

The mucosal layers on both surfaces of the septum are preserved as far as possible, while deformed pieces of cartilage are reshaped and put back in place. This approach speeds healing and preserves the long-term supporting function.

Endoscopic septoplasty

In endoscopically assisted septoplasty, deviations in the posterior regions in particular can be reached more effectively. This technique may be preferred when a limited and targeted correction is required.

Packing-free septoplasty

In the traditional method, 1-2 days of packing was standard. In modern approaches, fixing both sides of the septum with a suturing technique can eliminate the need for packing. This makes the postoperative period considerably more comfortable.

The effects of septoplasty on sleep and the body

The nose is not merely an organ for breathing in and out; it is a structure connected to overall balance. In people who have struggled to breathe for a long time because of a septal deviation, the following effects may develop:

• A marked decline in sleep quality; snoring; symptoms of sleep apnoea
• Chronic fatigue; difficulty concentrating
• A reduction in exercise tolerance
• Dry mouth and indirect adverse effects on dental health
• A reduced sense of smell

After septoplasty, gradual improvement is observed in these areas. It is a surgery that creates change not only in the nose but also in sleep, energy level and exercise tolerance. This contribution to quality of life is the dimension that sets septoplasty apart from a purely local ENT procedure.

When should a specialist be consulted?

Nasal obstruction does not always mean a septal deviation; however, it is appropriate to consult an ENT specialist for an assessment in the following situations:

• Nasal obstruction that has continued for more than 3 months
• One side being markedly more blocked than the other
• Snoring, symptoms of sleep apnoea, or waking without feeling rested
• Recurrent sinusitis attacks
• Chronic complaints that do not respond to nasal sprays
• A change in breathing after a significant injury to the nose
• A tendency toward nosebleeds

When performed for the right indication, septoplasty is a procedure that creates a long-term difference in quality of life. The decision, however, is always made together with the patient following a comprehensive assessment.