What is Septal Surgery or Septoplasty?

The septum is a thin plate of cartilage and bone situated in the midline inside the nose which divides the nose into right and left halves. The front of it can be felt at the bottom of the tip of the nose. It is about 7-8cms long in adults.

In some people the nasal septum is bent or deviated into one or both sides of the nose. This is commonly due to a previous nasal injury, although it is possible for it to occur even without an injury as the septum can naturally grow that way. If the angulated septum is sufficiently severe, it may cause difficulty in breathing through the nose. This can be corrected by means of an operation called a septoplasty which aims to straighten the septum.

Why should I have septal surgery?

If you have a blocked nose and your specialist has assessed that the blockage is due to the deviated septum, an operation is likely to help. Sometimes it is necessary to straighten a bent septum to create more room to carry out other types of surgery, the most common example being endoscopic sinus surgery or FESS.

In some cases a deviated septum may be present along with an angulation or twist in the outside shape of the nose. In these cases septal surgery may be combined with surgery to reshape the external framework of the nose (septorhinoplasty), which can be done at the same time.

What are the alternatives to having a septoplasty?

An operation to straighten a deviated nasal septum is really only advised if the bend is causing a blocked nose and the blockage is sufficiently severe to cause you problems in your day to day life. Therefore, if you have a deviated septum but you feel that you can live with the restricted nasal breathing, it may be preferable to leave it alone and see how things go. Having a deviated septum is not on its own a serious medical condition and it will not do you any harm if left untreated.

Occasionally, inflammation of the lining of the nose (rhinitis) can occur and this can be treated with medications including steroid nasal sprays. This will be discussed with your specialist as it may be the case that treating the rhinitis may bring about a sufficient improvement in your nasal breathing to render septal surgery unnecessary.

Whether you opt to go for septoplasty or not, you may change your mind about having the operation at any time. Also, symptoms can change with time, which is often due to worsening inflammation of the lining of the nose rather than any further change in shape of the septum. This may cause you to reconsider your decision in the future if your symptoms get worse.

Septoplasty – how is the operation done?

The operation is usually performed with you asleep under a general anaesthetic and takes about 30-45 minutes. The operation is normally carried out entirely inside your nose and there should be no external scars or bruises on your face.

A small cut is made on the inside of your nose through which the septum can be reached and straightened. This often involves removing some of the bent cartilage and bone and moving the rest of the septum back into the middle. At the end of the operation, sutures (stitches) are used to hold everything in place. Occasionally a small cut is required across the skin at the front of the nose between the nostrils. This is performed either in complex cases or where rhinoplasty surgery is also being carried out.

Packs and splints

It may be necessary to put a dressing into each side of your nose to prevent early bleeding. These are sometimes called ‘packs’, and they will block your nose so that you will have to breathe through your mouth. These are usually quite light and are usually removed a few hours after the surgery, although on occasions they may need to stay in overnight. It is quite usual to get some bleeding when the packs come out – this will settle quickly. By the way, contrary to common perception, removing packs from the nose is not excruciating, unlike in the past when heavier duty packs were used. Your packs should come out quite easily with only a little discomfort.

Sometimes a small piece of plastic may need to be put in your nose to prevent scar tissue from forming. These are called ‘splints’ and they will be removed after about a week.

What to expect after a septoplasty

You can expect to go home on the day of the operation although on occasions an overnight stay may be required. You will need to rest at home for at least a week. If you do heavy lifting and carrying at work, you should take two weeks off. Ask your nurse if you need a sick note for your time in hospital.

There will be a little bleeding from the nose for a few days after the operation. This may be blood or more commonly a mucous or clear discharge which is blood stained. This should not be particularly severe and should decrease in amount as time goes on. An increase in bleeding at a later date may indicate a postoperative infection and medical advice should be sought.

The front of your nose is likely to be tender for a few weeks.

Almost always the nose becomes more blocked before it gets clear again. It gradually gets worse for the first 7 to 10 days and it will feel as though you have a heavy head cold for the first two weeks. The salt water solutions and drops/sprays will help keep it reasonably clear.

You may be able to see some stitches inside the front of your nose – these will dissolve and fall out by themselves.

It can take several weeks and occasionally longer for your nose to settle down fully and for your breathing to be clear again.

How long will I be off work after a septoplasty?

You can expect to go home on the day of the operation although on occasions an overnight stay may be required. You will need to rest at home for at least a week. If you do heavy lifting and carrying at work, you should take two weeks off. Ask your nurse if you need a sick note for your time in hospital.

Do’s and don’ts after a septoplasty

Do not blow your nose for about a week, or it might start bleeding. If you are going to sneeze, sneeze with your mouth open to protect your nose. Your nose is likely to be tender for a few weeks so try not to get it knocked and be particularly careful around other people, especially young children. Try to stay away from dusty or smoky places. You should not play sports where there is a risk of your nose being knocked for about a month as it will feel quite tender.

What can go wrong after septoplasty?

Septal surgery is generally extremely safe, but there are some risks and complications that can occur as after any operation. Occasionally, the bleeding that you expect from your nose can be more severe than usual and it may be necessary to put additional packs into your nose or even to need another small operation under an anaesthetic to stop the bleeding. This can happen within the first few hours after surgery or up to 10 days later.

Infections of the nose are rare after this type of operation. You may suspect an infection if you notice a foul smelling discharge from the nose which may contain green pus, a high temperature, increasing headaches, new bleeding from the nose several days later or if your nose becomes more sore. If it happens you are advised to see a doctor as you will almost certainly require antibiotics.

More rarely, the operation can cause a hole in your septum going from one side of your nose to the other. You will more than likely be completely unaware that it is there as most of the time it causes no problems at all and needs no treatment. On occasions it can cause a whistling noise when you breathe, crusting with blockage or nosebleeds. Further surgery can be carried out if necessary to repair the hole.

Although septoplasty is not designed or intended to change the shape of your nose, in rare instances you may find that the tip of your noses becomes softer to touch and may even develop a slight dip in the bridge. Most people do not notice any change, but if you are not happy with it, the appearance can be improved with surgery.

You may also be aware of some numbness in the front teeth and/or upper lip. This usually settles with time.

Is there any alternative treatment to having a septoplasty?

The only way that the septum can be straightened is with an operation. If you are not keen on the idea of surgery, you may get some benefit from using nose sprays or drops, which can help treat inflammation in the nose. However, if your specialist has examined you and decided that the cause of your blocked nose is due to a deviated septum, the improvement gained from nasal sprays alone is likely to be limited until and unless the septum deviation is addressed.