EVMS Ear, Nose & Throat Surgeons

Septoplasty: Straightening the Nasal Septum

Septoplasty is an operation in which the nasal septum is straightened. This page will describe in more detail when this operation is recommended, how it is done, and what to expect if you are going to have a septoplasty.

The nasal septum is the part of the nose that divides the right nasal cavity from the left nasal cavity. The septum usually lies directly in the center of the nose and rests on a bony ridge called the maxillary crest.. The septum is made up of several layers. In the front, the central portion of the septum is cartilage, a relatively soft material that is fairly flexible (colored blue on the diagram). More posteriorly, the central septum is made up of thin bone (light tan in the diagram). Lying on top of the bone and cartilage is the lining of the nose, called the mucosa.


A diagram of the internal structure of the nasal shows septum viewed in cross section


 ‌The picture to the left shows the internal structure of the nasal shows septum viewed in cross section. The front of the nose is to the left. The cross-hatched region is made up of cartilage (blue). Towards the back, the septum is made up of thin bone (light tan).

A septoplasty is done if the septum is so crooked that it interferes with breathing or causes other problems. Few people actually have a perfectly straight septum, but in most cases the amount of bending is not large enough to be noticed.



a diagram of the nose viewed from belowThis image shows the nose viewed from below. In this case the septum is deviated to the patient's right side. In some cases the front part of the septum is in the proper position, but the rear portion has the deviation. The most common symptom from a badly deviated (crooked) septum is difficult breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can interfere with the drainage of the sinuses, resulting in repeated sinus infections. The septum may also need to be straightened in individuals undergoing sinus surgery just so that the instruments needed for this operation can be fit into the nasal cavity.



Other Causes for Nasal Stuffiness 

It is important to remember that the nose goes through a natural cycle in which the nasal line on one side and then the other slowly expands and contracts. These cycles occur every several hours and may lead to the perception of nasal obstruction. If you have persistent difficult breathing through your nose, you should see an Otolaryngologist for a complete exam. You should NOT use any over-the-counter nasal sprays for more than a few days without contacting your doctor. Many of these products have ingredients that produce rebound nasal swelling when they are stopped. As a result, the user is required to keep using the spray in order to keep his or her nose clear. Long term use like this can cause injury to the lining of the nose. There are some sprays that can be used for a long time without side-effects; ask your doctor which spray is best for you.


Septoplasty: Performing the Operation 

The basic principle in a septoplasty is to straighten the crooked portions of the septum. The operation is almost always done through the nose, without an external incision (there may be an incision if a rhinoplasty is also done at the same time). Badly deviated portions of the septum may be removed entirely, or they may be removed, readjusted, and reinserted into the nose. The operation takes about 1-1.5 hours, depending on the complexity of the deviation. It can be done with a local or a general anesthetic, and is usually done on an outpatient basis. In many cases nasal packing of some sort is placed for one to several days. There almost never is any bruising on the skin for just a septoplasty, though there can be bruising if a rhinoplasty is also done at the same time.


Potential complications of a septoplasty

If the operation is done under a general anesthetic, there the usual risks with any general anesthesia. Bleeding is a possible risk, which may require nasal packing. Much more rare is the risk of a hole to developing in the septum after the operation. This may cause nasal crusting or interfere with breathing through the nose. An even rarer complication is postoperative infection of the septum, which could cause the front portion of the nose to bend inward. This would require a second operation to correct the deformity.


How do I know if I need a septoplasty? 

It is best to have a good nasal exam by an Otolaryngologist. Nasal obstruction can be caused by other things besides a crooked septum, so it is important to have a good examination of your nose..