Septoplasty: Everything You Need to Know

Close-up of gloved doctor doing surgical procedure on a nose to treat a deviated nasal septum

Murat Sarica / Getty Images

Septoplasty is a surgery used to correct a deviated septum, a condition in which the wall of cartilage and bone between the nasal passages (called the nasal septum) is displaced, making one passage larger than the other. Septoplasty is used when a deviated septum is causing airway obstruction and breathing problems like snoring or sleep apnea.

Septoplasty involves the repositioning and/or recontouring of the nasal septum, as opposed to another type of surgery, called submucous resection, that removes cartilage, bone, and tissue.

Symptoms of a Deviated Septum
 Verywell / Laura Porter

What Is Septoplasty?

Septoplasty is an outpatient surgery used on adults and adolescents that straightens a deviated septum through incisions made inside the nostrils and, on occasion, between the nostrils. It can be performed using conventional surgery but more commonly involves endoscopic surgery, a minimally invasive procedure using fiberoptic scopes and specialized surgical equipment.

By correcting a deviated septum, airflow can be restored and breathing improved.

It is estimated that around 80% of people have a deviated septum. Most can manage without significant symptoms, although the risk of complications tend to increase with age, obesity, and heavy smoking.

Contraindications

Septoplasty is considered a relatively safe and effective treatment, but there are people in whom the procedure may not be appropriate. These include individuals at risk of excessive bleeding who are more likely to experience delayed healing, infection, and nasal deformity.

As a general rule, septoplasty should be avoided or deferred in people with:

In addition, people who are unable to stop anticoagulants ("blood thinners") for health reasons, such as those with severe atrial fibrillation, may not be candidates for septoplasty. The decision to treat or not treat people with these conditions is made on a case-by-case basis.

Septoplasty is generally avoided in children as the septum is the dominant growth center of a child's nose and midface. If used to treat a severe breathing problem in children, septoplasty is generally reserved for those who are at least six years of age.

Potential Risks

As with all surgeries, septoplasty carries for a risk of injury and complications, the most common of which includes:

  • Excessive nasal bleeding
  • Septal hematoma (the pooling of blood within tissues)
  • Septal perforation (a hole in the septum)
  • A change in the shape of the nose
  • Decreased sense of smell
  • Temporary vision problems
  • Post-operative infection
  • Continued symptoms despite treatment

Purpose of Septoplasty

Septoplasty is typically used when the symptoms of a deviated septum are interfering with a person's quality of life and cannot be corrected by other less invasive means.

Among the possible indications for septoplasty are:

Depending on the aims of the surgery, certain criteria may need to be met before septoplasty can be performed. This is due as much to health insurance requirements as to medical necessity.

Generally speaking, septoplasty is considered necessary if:

  • There is documented evidence of a deviated septum
  • Symptoms are ongoing or recurrent (generally defined as three or more episodes per years)
  • Conservative measures (such as antibiotics, nasal sprays, decongestants, antihistamines, or CPAP therapy) have been unable to alleviate or prevent symptoms
  • Allergy has been excluded as a cause

To motivate for treatment, an imaging test called computed tomography (CT) or a procedure called nasal endoscopy (involving the insertion of a tiny camera into the nasal passage to assess the nature of the obstruction) would be performed. Allergy testing may also be required to exclude allergic rhinitis as a cause.

Septoplasty is not used to treat postnasal drip, chronic cough, or headaches that occur in the absence of nasal obstruction.

Contact your health insurance provider to better understand under what conditions septoplasty is covered and not covered.

How to Prepare

Prior to the surgery, you will meet with a surgeon to review the pre-operative lab reports and schedule the procedure. It is important to ask as many questions as you need to fully understand the benefits, risks, and limitations of septoplasty.

Although septoplasty can significantly improve or resolve your symptoms, not everyone will achieve the same result—particularly if the deviation is severe. While endoscopic septoplasty is considered to be "minimally invasive," it is still surgery and poses risks that should never be ignored.

Location

Septoplasty is an outpatient surgery performed in an operating room of a hospital or dedicated surgical center. The operating room is equipped with an anesthesia machine, an electrocardiogram (ECG) machine to monitor heart rhythm, a pulse oximeter to monitor blood oxygen, and a respiratory ventilator to deliver supplemental oxygen if needed. Endoscopic surgery is performed with a flexible fiber-optic endoscope with a live-feed video monitor.

What to Wear

As you will need to change into a hospital gown for the surgery, wear comfortable clothes you get easily get out of and put back on (such a tracksuit and mocassins). Because there is a chance of a nosebleed, do not wear an expensive top that may get soiled.

Leave any valuables at home, including jewelry and watches. Also be prepared to remove hairpieces, dentures, hearing aids, and tongue or nose piercings.

Food and Drink

You will be asked to stop eating at midnight the night before your surgery. Up until four hours before surgery, you can drink a small amount of water to take any morning medications your doctor has approved. Within four hours, nothing should be taken by mouth, including water or gum.

Most surgeries will be scheduled in the morning to avoid undue discomfort, especially in children.

Medications

You will be asked to stop taking certain medications anywhere from a day to two weeks before the surgery. These are typically drugs that increase the risk of bleeding, including:

You may be asked to stop taking some of these drugs for up to two weeks following surgery in order to improve healing.

If you are a smoker, many surgeons will ask that you avoid cigarettes for a week after surgery as they can impair circulation, slow healing, and increase the risk of a septal perforation.

What to Bring

Be sure to bring your driver's license or some form of government photo ID for registration. You will also need your insurance card and an approved form of payment if upfront payment is required for coinsurance or copayment costs.

You will also need to bring someone to drive you home after surgery. Even if local anesthesia is used, you may still experience significant pain, dizziness, and blurring.

What to Expect on the Day of Surgery

Septoplasty can be performed by a general surgeon, plastic surgeon, or otolaryngological (ear, nose, and throat) surgeon. Accompanying the surgeon will be an anesthesiologist, an operating nurse, and a circulating nurse or surgical technician.

Once you are registered and have signed the necessary consent forms, a nurse will take you to the back to change into a hospital gown.

To prepare for the surgery, the nurse will take your vital signs, place ECG electrodes on your chest, and clamp a pulse oximeter to your finger to monitor blood oxygen levels. Finally, an intravenous (IV) line will be inserted into a vein in your arm to deliver fluids and medications.

Prior to the surgery, the anesthesiologist will meet to double-check on drug allergies history or adverse reactions you have had to anesthesia in the past. In most cases, you won't see the surgeon until you are wheeled into the operating room.

During the Surgery

Septoplasty is a relatively straightforward procedure but one that can vary by the type of anesthesia used. Surgeries that are complex or performed alongside other procedures (such as turbinectomy or rhinoplasty) may require general anesthesia. Others may only require local anesthesia combined with a mild IV sedative to induce "twilight sleep."

Once you are asleep, an incision is made inside the nostril. Mucosal tissues covering the septum are then lifted to reveal the underlying bone and cartilage. The deviated portions of the bone and cartilage can either be reshaped or removed, sparing as much tissue as possible.

When endoscopy is used, there is less need to do cut the nasal columella (the tissue between the two nostrils), particularly in people with small nostrils. Instead, a narrow endoscope is fed into the nostril to direct the correct placement of surgical tools via a video monitor.

Unlike submucous resection, the aim of septoplasty is to conserve tissue and leave behind as enough non-deviated bone and cartilage to maintain the shape of the nose.

When the surgery is complete, the incision is stitched shut, typically with dissolving sutures that don't require removal. The surgeon may place soft plastic sheets or splints inside the nose to help the septum heal correctly and reduce the chances of scarring. Packing is rarely used to prevent nosebleeds following septoplasty.

When performed on its own, septoplasty usually takes between 30 and 90 minutes to complete. Some procedures may take longer.

After the Surgery

Once the surgery is complete, you are taken to a recovery room and monitored by a nurse until you awaken. Food and drink may be provided as well as anti-nausea drugs if you feel nauseous from the anesthesia.

It is not uncommon to feel pain, nasal stuffiness, dizziness, and a runny nose immediately after surgery. These are normal and usually resolve on their own within the first week.

Once you are stable enough to dress and there no signs of complications (such as nosebleeds), someone can drive you home and ideally stay with you overnight to monitor for any adverse events.

Recovery

It generally takes a couple of days before the acute symptoms of surgery begin to resolve and a full week before you able to manage normally (albeit at a pared-down scale). Some people may be able to return to work in a week or so but those who have undergone a more extensive procedure may be advised to stay at home for a full two weeks.

Most people are fully recovered from septoplasty within four weeks, although some make take as long as six weeks.

Healing

For the first 24 hours, rest as much as possible. Do not bathe or shower, and avoid touching or rubbing your nose.

For the first two weeks, avoid blowing your nose as this may cause bleeding. If you do need to sneeze, do so through your mouth. You should also avoid lifting more than 10 to 20 pounds as the strain can instigate a nosebleed. To reduce swelling and improve sleep at night, sleep with your head in a slightly propped position.

Unlike some forms of nasal surgery, septoplasty almost never causes black eyes or significant bruising. However, there will often be pain and tenderness in the front of the nose, which usually can be relieved with a painkiller like Tylenol (acetaminophen). Cold therapy can also help reduce swelling and nasal stuffiness.

To reduce nasal congestion, most doctors will recommend an over-the-counter saline nasal spray that helps draw excess fluids from mucosal tissues. A nasal irrigation kit (like NeilMed Sinus Rinse Kit) or a neti pot can also help.

You also need to avoid playing sports for at least two to four weeks and only after your surgeon gives you the OK.

When to Call a Doctor

Call your doctor if any of the following develops after undergoing septoplasty:

  • High fever (over 101.5 F) and chills
  • Difficulty breathing
  • Heavy, uncontrollable nosebleeds
  • Severe headache with a stiff neck
  • Sudden changes in vision
  • Continued nasal discharge a week after surgery

Follow-Up Care

A day after surgery, you will be asked to return to the outpatient clinic to remove the dressing around your nose. This also allows the doctor or nurse practitioner to check for any problems and offer additional care instructions if needed.

If splints were inserted into the nasal cavity, another appointment will be scheduled in about a week to remove them.

Barring any complications, a final follow-up appointment will be scheduled within two to four months to check if the desired results were achieved. In some cases, a CT scan would be ordered beforehand to compare with the initial findings.

A Word From Verywell

If you suspect that you may have a deviated septum, it is important to visit your healthcare provider. After an initial examination of your nasal passages with a device called a nasal speculum, you may be referred to an ENT specialist for further evaluation.

Not every case of deviated septum requires surgery, but those that do will almost offer an improvement in symptoms if not a complete resolution.

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