Septoplasty Surgery for a Deviated Septum: Plain English Guide for Patients

Septoplasty surgery is the most-commonly performed surgical procedure to improve the nasal airway. It may be required in individuals with deviated nasal septum as a result of trauma, deformation from birth, or severe nasal infections.¹Gandomi B, Bayat A, Kazemei T. Outcomes of septoplasty in young adults: the Nasal Obstruction Septoplasty Effectiveness study. American journal of otolaryngology. 2010 May 1;31(3):189-92.

Septoplasty Procedure Steps

The steps that are followed during a septoplasty procedure are:²Shah J, Roxbury CR, Sindwani R. Techniques in Septoplasty: Traditional Versus Endoscopic Approaches. Otolaryngol Clin North Am. 2018;51(5):909-917.

step 1

The anesthesia is injected into the nose to numb the area.

step 2

Using a blade, an incision (cut) is made on the mucosa (inner skin) of the nose through the nostril at the lower portion of the septum.

step 3

Following this, skin covering the septum is lifted and septum is exposed.

step 4

Cartilaginous and bony bents on the septum are identified and cut using an instrument.

step 5

The soft tissue is stitched back on the septum.

Effectiveness of Septoplasty

Studies show that septoplasty results in significant improvement in the symptoms associated with deviated septum, and within 3 months of the surgery, leads to a reduction in the use of medication to overcome the symptoms.³Stewart MG, Smith TL, Weaver EM, Witsell DL, Yueh B, Hannley MT, Johnson JT. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg. 2004 Mar;130(3):283-90.

This leads to overall improvement in the quality of life and higher satisfaction levels.

Research suggests that the success rate of the septoplasty varies from 65-83%. Younger individuals with a complain of nasal obstruction are more likely to benefit from the surgery.⁴Siegel, N. S., Gliklich, R. E., Taghizadeh, F., & Chang, Y. (2000). Outcomes of septoplasty. Otolaryngology-Head and Neck Surgery, 122(2), 228–232.

What to Expect After Septoplasty Surgery?

After the septoplasty procedure, patients can expect the following symptoms:⁵Bernardo MT, Alves S, Lima NB, Helena D, Condé A. Septoplasty with or without postoperative nasal packing? Prospective study. Braz J Otorhinolaryngol. 2013 Aug;79(4):471-4. English, Portuguese.

Post-surgery, the patient may feel uneasy due to the dressing and packing in nostrils. This packing is to stop post-surgery bleeding. The patient needs to breathe through the mouth until it is removed.
Mild oozing of blood can be expected from the nose after the surgery. A drip pad is placed underneath the nose to absorb bloody discharge from nose. In case of heavy bleeding one can immediately contact the surgeon.
Nasal pain can be experienced by patients in the first 48 hrs.
Mild to moderate swelling, bruising, and discoloration can be seen in nasal and adjacent areas, which subsides gradually.
If the surgeon has placed splints in the nose, the patient needs to visit the doctor in a week’s time to remove it.
Headaches, watering of eyes (epiphora), dryness of mouth, discomfort while swallowing, and sleep disturbances can be experienced by patients with nasal packing.
Mild pain and discomfort may be present during removal of nasal packing or nasal splint.

Septoplasty Surgery Recovery

To recover from septoplasty surgery, patients are advised to follow these instructions:⁶Simpson JC. Postoperative Care of The Patient After Nasal Surgery

Keep an ice or gel pack over the nose for 20 minutes intermittently for the next 36-48 hours post-surgery to reduce swelling and bruising.
Take medications on time for a specified duration.
Use a saline nasal spray (after the packing is removed) or saline irrigation for several weeks to keep the nose moist.
Use clean cotton swabs with antibiotic ointment or hydrogen peroxide to gently clean nostrils and the surrounding areas to prevent infections.
Visit the doctor for follow up visits as recommended after the surgery.

Precautions After Septoplasty Surgery

After the septoplasty procedure, patients should follow these precautions:⁷Simpson JC. Postoperative Care of The Patient After Nasal Surgery

Do not blow nose for at least a week. Post one week, try to blow nose gently, without any excessive pressure.
Avoid sneezing with mouth closed. Keep mouth open while sneezing.
Due to nasal packing, breathing through the mouth is recommended.
Keep head elevated, use 2-3 pillows while sleeping.
Avoid any vigorous exercise or lifting heavy objects, or bending forward.
Avoid hot steam baths and showers.
Avoid Smoking and drinking alcohol.
Avoid going to public places.

Septoplasty Pain After Surgery

Most patients report feeling moderate pain after the septoplasty surgery. The patient may complain of pain in the nose and the surrounding facial areas. Intake of analgesics (pain killers) and avoiding straining of nose, application of cold packs, and keeping head in elevated position can reduce the discomfort.⁸Ketcham, A. S., & Han, J. K. (2010). Complications and Management of Septoplasty. Otolaryngologic Clinics of North America, 43(4), 897–904.

Septoplasty Surgery Side Effects

Potential side effects of septoplasty surgery include….⁹Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

Hemorrhage: Excessive bleeding after the surgery is reported in 6-13% of patients. Mild oozing of blood from nose is common after the surgery. In case of excessive bleeding, the patient should contact the surgeon.
Infections: Some patients may develop infections at the site of surgery.
Septal hematoma: Individuals may develop swelling due to accumulation of blood in the septal region. If left untreated, this may turn into an infection.
Overcorrected septum: In ~2% of patients, septum is overcorrected which hinders both shape and functioning of the nose.
Septal perforation: It is a late complication, seen in 1-6% of patients. Presence of small perforations may hinder the humidification of nose while large ones may cause structural deformities.
Adhesions: It is caused due to fusion between the mucosa (inner skin) of nasal septum with adjacent structures. This can lead to postoperative nasal congestion.
Cerebrospinal fluid leak: This is a rare case, where the patient experiences watery brain fluid discharge from nose and sinuses, and also experiences headaches.

When deciding whether or not to have this procedure done for your deviated septum, consider these pros and cons:

Pros of Septoplasty:¹⁰Baumann I. Quality of life before and after septoplasty and rhinoplasty. GMS current topics in otorhinolaryngology, head and neck surgery. 2010;9.

Eases the process of breathing by eliminating the obstruction present due to deviated septum.
Improves symptoms associated with deviated septum such as snoring, runny nose, nasal congestion, post nasal drip (mucus entering the throat), and reduced sense of smell.
Decreases the incidence of sinonasal infections.

Cons of Septoplasty:¹¹Ketcham, A. S., & Han, J. K. (2010). Complications and Management of Septoplasty. Otolaryngologic Clinics of North America, 43(4), 897–904.

Conventional septoplasty is associated with several side effects such as infections, perforation on septum, excessive bleeding, and hematoma (septal swelling due to pooling of blood).
In few patients, the nose gets overcorrected after the surgery which affects the appearance and functions of the nose.
Excess trimming of bone or removal of tissue can affect the postoperative discomfort.

Septoplasty Surgery Pictures

Here are some excellent photos that show the septoplasty procedure:

source

Septoplasty Surgery Videos

Here are some excellent videos that show the septoplasty procedure:

Frequently Asked Questions – Septoplasty Surgery

Here are answers to the most commonly asked questions related to septoplasty surgery:

Is septoplasty a major surgery?

It is the most-commonly performed nasal surgery with minor procedures compared to other surgeries. Considering its risk factors, we can label it as a major surgery.

How long does septoplasty surgery take?

Depending on the complexity of the condition, it takes 1- 1.5 hours to complete a septoplasty surgery.

What is the recovery time for septoplasty surgery?

Complete recovery from septoplasty may take about 6 weeks. Patients can resume their work within 7-10 days.¹²Baumann I. Quality of life before and after septoplasty and rhinoplasty. GMS current topics in otorhinolaryngology, head and neck surgery. 2010;9.

What is the cost of septoplasty in the USA?

The average cost of the conventional septoplasty procedure ranges between USD 6,000-30,000. The cost varies according to local standards, complexity of the nose to be operated, surgeon’s expertise, reputation, clinical experience, and operating room’s fees.¹³Cost of Septoplasty - 2020 Healthcare Costs

What are signs of infection after septoplasty surgery?

Infection is common in septoplasty and the signs can include systemic changes such as change in blood pressure and heart rate, vomiting, diarrhea, skin discoloration, and multiple systemic complaints.¹⁴Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

Frequently Asked Questions – Septoplasty Splints

Nasal splints are commonly placed in the nose after septoplasty surgery in order to stabilize the healing septum. As a result, many people have questions about splints. We answer the most common questions below:

What do nasal splints look like?

source

Nose splints are small plastic or silicone devices used to stabilize the nose after nasal surgery.¹⁵Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

Do you need splints after septoplasty?

After the septoplasty, internal splints are placed along the septum in each nostril for 1-2 weeks after the surgery. The splints help stabilize the treated septum and compress the septum to help reduce bleeding related complications.¹⁶Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

How long do splints stay in after septoplasty?

Intranasal splints may be placed for 1-15 days after the septoplasty surgery.¹⁷Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

How long does it take for dissolvable septoplasty splint to dissolve?

It takes 15-25 weeks for the splint to dissolve.¹⁸Lau, J., Elhassan, H. A., & Singh, N. (2018). History of intranasal splints. The Journal of Laryngology & Otology, 132(03), 198–201.

Can nasal splints fall out?

Yes, they can fall out. If the patient sneezes vigorously within 1-2 days of the surgery then there are chances of the splint falling out

Septoplasty splints clogged – what can I do to unclog them?

It is common for the splints to get clogged with dried blood shortly after surgery which can create significant congestion and pressure.

To relieve congestion, hydrogen peroxide can be used with a Q tip to clean both sides of the splint. The use of saline sprays may also help loosen up blockage. In case of excessive discomfort, the patient should consult a doctor.¹⁹Simpson JC. Postoperative Care of The Patient After Nasal Surgery

Septoplasty splint removal pain – how painful is it?

Removal of internal nasal splints can cause discomfort and pain. Research suggests that removal of internal nasal splints within 24 hours are less painful.²⁰Simpson JC. Postoperative Care of The Patient After Nasal Surgery

What to expect after nasal splints are removed?

There will be a slight discomfort or bleeding while removing the nasal splints.²¹Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.

Sources:

1
Gandomi B, Bayat A, Kazemei T. Outcomes of septoplasty in young adults: the Nasal Obstruction Septoplasty Effectiveness study. American journal of otolaryngology. 2010 May 1;31(3):189-92.
2
Shah J, Roxbury CR, Sindwani R. Techniques in Septoplasty: Traditional Versus Endoscopic Approaches. Otolaryngol Clin North Am. 2018;51(5):909-917.
3
Stewart MG, Smith TL, Weaver EM, Witsell DL, Yueh B, Hannley MT, Johnson JT. Outcomes after nasal septoplasty: results from the Nasal Obstruction Septoplasty Effectiveness (NOSE) study. Otolaryngol Head Neck Surg. 2004 Mar;130(3):283-90.
4
Siegel, N. S., Gliklich, R. E., Taghizadeh, F., & Chang, Y. (2000). Outcomes of septoplasty. Otolaryngology-Head and Neck Surgery, 122(2), 228–232.
5
Bernardo MT, Alves S, Lima NB, Helena D, Condé A. Septoplasty with or without postoperative nasal packing? Prospective study. Braz J Otorhinolaryngol. 2013 Aug;79(4):471-4. English, Portuguese.
6
Simpson JC. Postoperative Care of The Patient After Nasal Surgery
7
Ketcham, A. S., & Han, J. K. (2010). Complications and Management of Septoplasty. Otolaryngologic Clinics of North America, 43(4), 897–904.
8
Bloom, J. D., Kaplan, S. E., Bleier, B. S., & Goldstein, S. A. (2009). Septoplasty Complications: Avoidance and Management. Otolaryngologic Clinics of North America, 42(3), 463–481.
9
Baumann I. Quality of life before and after septoplasty and rhinoplasty. GMS current topics in otorhinolaryngology, head and neck surgery. 2010;9.
10
Cost of Septoplasty - 2020 Healthcare Costs - CostHelper
11
Lau, J., Elhassan, H. A., & Singh, N. (2018). History of intranasal splints. The Journal of Laryngology & Otology, 132(03), 198–201.

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