The nasal septum is the middle divider of the nose and separates the left and right nasal passages. The nasal septum is composed partly of cartilage and partly of bone.
Scan of Deviated Nasal Septum
The nasal septum has three functions: to support the nose, regulate air flow, and support the mucous membranes (mucosa) of the nose.
Unless injured at birth, the nasal septum is usually straight and remains straight in childhood. As the nose grows, however, there is a tendency for the septum to bend to one side or the other, or for an irregular shelf of cartilage or bone to develop (septal spur). Often, there is no history of injury to account for the deviated septum. Few adults have a septum that is completely straight. Trauma during childhood or adult life may result in the septum becoming deviated.
Septoplasty is performed to correct a crooked (deviated) septum. It is performed to help treat nasal obstruction and to correct the shape of the nose that is caused by a deformed septum.
Septoplasties are performed in an out patient surgery center, most often under general anesthesia. The procedure may also be performed with a combination of local anesthesia and intravenous sedation. A cut (incision) is made inside the nose in the mucus membrane that covers the septum. The tissue is lifted, exposing the cartilage and bony part of the septum. Usually, one side of the mucous tissue is left intact to provide support during healing. Cartilage is cut away as needed.
The septum straightens as cartilage is removed. Some patients have bony obstructions (bony spurs and ridges) that are removed during the septoplasty procedure. These bony obstructions may contribute to drying, ulceration, or bleeding of the mucous tissue that covers the inside of the nasal passages.
During surgery, the patient’s own cartilage that has been removed can be reused to provide support for the nose if needed. External septum supports are not usually needed. Splints may be needed occasionally to support cartilage when extensive cutting has been done. External splints can be used to support the cartilage for the first few days of healing. Tefla gauze is inserted in the nostril to support the flaps and cartilage and to absorb any bleeding or mucus.
Before performing a septoplasty, your surgeon will evaluate the difference in airflow between the two nostrils.
As with any other operation, patients are evaluated for any physical conditions that might complicate surgery and for any medications that might affect blood clotting time.
Patients with septoplasties are usually sent home from the hospital later the same day Aftercare includes a list of detailed instructions for the patient that focus on preventing trauma to the nose (see list).
- Significant bleeding is uncommon. This is generally treated with nasal packing or cauterization. Patient’s should discontinue aspirin and other non-steroidal anti-inflammatory drugs (Motrin, Advil, ibuprofen) for 10 days prior to surgery as these medications can produce bleeding.
- Infection is uncommon. Toxic shock syndrome has occurred rarely when nasal packing has been used. This condition causes a high fever and rash. Patients must contact their physician immediately if these symptoms occur.
- Numbness of the tip of the nose or the upper front teeth is not uncommon and usually resolves within several months following the procedure. Rarely, the numbness may persist.
- The nasal airway may not improve.
- Swelling of the external nose or change in the external appearance is possible.
- Septal perforation or hole in the septum may occur rarely.
- Septal hematoma may occur when blood accumulates under the skin flaps of the septum. This is treated with drainage. This is a rare complication.
- Loss of smell has been reported but is quite rare.