A septum is a wall of bone and cartilage separating the nasal passages which are lined with mucous membranes on either side. When the wall is severely tilted to one side that is referred to in the medical world as a "deviated septum". Visually you can tell when a septum has deviated because it looks like one nostril is bigger than the other.
A deviated septum, depending on the severity, can cause a number of health issues such as difficulty breathing due to disrupted airflow, headaches, facial pain, sleep apnea, increased rate of infection, and a postnasal drip. While there are other medical treatments to alleviate the symptoms of a deviated septum such as a nasal dilator, in most severe cases surgery must be done because it is the only way to correct a deviated septum.
It is estimated that nearly 80% of people in the United States do not have a completely straight septum. Many deviations are so slight, you may not even notice them. It is only considered a medical condition if the septum is severely displaced and therefore in actuality, the prevalence of deviated septums is significantly lower. Only the more severe imbalances require medical treatment.
Surgical correction of a deviated septum is one of the most common surgeries performed by Ear Nose and Throat surgeons and plastic surgeons in the US. The medical term for the procedure is called a "septoplasty" derived from the Latin words "saeptum" meaning "fence, enclosure, or partition" and "plastia" which means "to form". It is often performed together with other surgeries such as rhinoplasty, turbinate reduction, or sinus surgery.
A traditional septoplasty is usually an outpatient procedure done in a hospital or surgery center. Either general or local anesthesia is used and the procedure takes anywhere from 30 to 90 minutes. Most patients are able to go home the same day, although they will need to be driven home, once the anesthesia has worn off.
Complications during the procedure are rare and symptoms tend to improve within a week and slowly continue to improve over the course of the year. Most patients experience pain or discomfort right after the procedure and due to blood loss, might be weak on their feet. Most doctors recommend getting plenty of rest and keeping the head elevated while sleeping.
Other precautions must be taken during the first three weeks after the procedure such as avoiding strenuous activity, making sure not to blow your nose in the first 12 days, and keeping the area well lubricated.
There are 5 steps to the procedure of the septoplasty;
- 1Anesthesia - most people opt for general anesthesia but you can discuss your options with your surgeon or doctor prior to the procedure. The medication is administered prior to the procedure so that the patient won't feel any pain.
- 2The Incision - The incision for a septoplasty is made inside the nose. If the septoplasty is being done in combination with a rhinoplasty, the surgeon will make an incision on the outside of the nose as well.
- 3Mucosal Lining Separation - In this step the surgeon will separate and lift away the membrane covering the septum, which is called the mucosal lining. This step is done very carefully because the lining is so thin and fragile that tearing can easily occur if extra care is not taken. The same is done for both sides of the septum.
- 4Deviated Septum Correction - The bone and cartilage of the septum are then removed and the mucosal membrane is left behind.
- 5Closing the Incision - The septum is then placed in the desired position and straightened. The mucosal lining is placed back on either side of the septum and then sutured back together.
- 6Final Steps - A splint or packing maybe use to hold everything in place while it starts to heal. Any internal stitches will dissolve over time and don't need to be removed.
Video Overview of Septoplasty Procedure by Dr Paulose FRCS (ENT)
One alternative to a traditional septoplasty procedure is an endoscopic septoplasty. An endoscopic septoplasty is less invasive than the traditional procedure. This is a tiny camera guided surgery that allows the surgeon to have a targeted approach at correcting any deformities.
It offers better visualization under direct light, improved access for additional nasal surgeries, reduced blood loss, less postoperative swelling and pain, easier posterior septal spur correction (difficult to reach and often missed during conventional surgery), a lower risk of tearing the mucosal lining, lower risk of blood clots, and eliminates the need for nasal packing (in most cases). These benefits can translate into a shorter hospital stay, less difficult recovery period, and a quicker return to normal activities.
It is especially helpful in revision surgeries where nasal obstructions persist; endoscopic septoplasty allows the surgeon to take a guided approach at making the necessary corrections, which often prove technically challenging otherwise. It’s also generally less expensive than a conventional septoplasty.
Although rare, there is always the possibility of complications arising. The most common complications that occur after a septoplasty are bleeding, infection, and an adverse reaction to the anesthesia administered.
Other risks include; continued symptoms, a change in the shape of the nose, a hole in the septum, a decreased sense of smell, a blood clot that has to be drained, and temporary numbness in the mouth or nose. The benefit of the surgery is the correction of the nasal obstruction which provides a clear path for the airflow and therefore easier breathing.
When searching for a surgeon to perform the procedure for you, there are a few tools you can use to help you find the best one for you. Try asking friends and family if they have any recommendations of ENT surgeons or facial plastic surgeons. Knowing someone has had a positive experience with a specific surgeon is a great way to find someone you can trust.
Another great resource is the internet. There are a number of websites such as www.yelp.com, www.ratemds.com, and other websites that will come up when you are searching. It is important to read reviews and make phone calls to the centers or hospitals to determine whether or not the surgeon/center is the right fit for you.
Quick Video Overview of Endoscopic Septoplasty