Deviated nasal septum and Septoplasty
Deviated nasal septum and Septoplasty
The septum is the middle part of the nose running between your left and right nasal passageways and can been seen from each nostril. It is made up of cartilage called the septal cartilage and three bones (the vomer, the perpendicular plate of the ethmoid and the maxillary crest) and is sandwiched between the mucosa (lining of the nose).
Symptoms of a deviated nasal septum include:
- nasal blockage which may be on one or both sides of the nose
- excessive discharge or mucus from an obstructed nostril(s)
- occasionally, some patients suffer with nose bleeds (epistaxis)
- rarely patients experience a collapse of the outside of the nose on breathing in, due to narrowing at what is called the internal nasal valve
CAUSES OF A DEVIATED NASAL SEPTUM
The causes of a deviated (bent) nasal septum include a congenital deviation, continued growth of the septal cartilage and trauma. The outside of the nose may also be deviated in the lower 3rd of the nose towards the tip of the nose if the septum is severely deviated.
The diagnosis of a deviated nasal septum is made on examination findings in clinic and past medical history. This will include an external examination, looking into the nostrils and using a nasal endoscope. Nasal endoscopy uses an endoscope to view further up at the back of the nose. A tiny camera passes through the back of the nostril into the throat. This can be performed within consultation and is usually well tolerated by patients. If patients feel it is too uncomfortable, an anaesthetic spray can be used to numb the area. (see further information here.)
A Septoplasty procedure is performed when the septum is deviated to one or both sides causing persistent nasal obstruction or blockage to one or both sides of the nose. The blockage needs to be persistent as the normal nasal cycle moves between nostrils meaning one always feels more blocked than the other.
A Septoplasty is a day case procedure, meaning you can go home from the Hospital on the same day as your operation. It is performed under a general anaesthetic (the patient is asleep for the procedure). A small cut is performed on the nasal septum within the nostril (nearly always on the left side) so there are no scars. The lining of the nose is elevated on both sides of the nose and cartilage and bone of the septum in the centre is partially removed or manipulated to so that the septum becomes straight, clearing your nasal passages. The operation lasts from 45 minutes to one hour.
The procedure is straightforward with a low complication rate and patients should discuss the risks versus the benefits during their consultation. Everything will be fully explained and an informed decision on surgery will be taken. However, risks include:
- infection and bleeding
- Minor scarring inside the nose
- A small chance of a hole between the two sides of the nose called a perforation. This is unusual and affects around 1% of patients who are often asymptomatic. However, in some instances it can cause crusting and bleeding which can be treated
- Some patients experience numbness and tingling of their front teeth if the front part of the septum just behind the nostrils needs to be adjusted, however this usually settles with time
- There is a very small chance of a change in shape of the nose, however this only occurs if too much nasal cartilage is removed or if you had a severe infection
The procedure is not particularly painful afterwards and there are no stitches to be removed. Simple pain killers such as paracetamol and ibuprofen are all that is needed. Occasionally, nasal packing is inserted during the operation to minimise bleeding. This is usually removed before a patient is discharged from the hospital. Rarely, a nasal splint (blue in colour) is inserted inside the nose which is usually removed within a couple of weeks in clinic.
We advise patients to use a nasal decongestant for one week after the procedure to help keep the nose clear as it will feel very stuffy after the operation due to swelling. A nasal douche (saltwater wash) is also recommended, to use for two weeks post-operatively.
Patients are seen in clinic for a post-operative follow up appointment after around 6-8 weeks to check that everything has healed well.
If you have any questions regarding a Septoplasty or would like to know more, please contact the Practice Management Team.