One of the most common reasons for needing nasal surgery is a deviated septum. The septum is a wall located in the center of the nose that separates the nasal cavities equally. Its front part is made of cartilage, while the back part consists of bone, commonly referred to as the nasal cartilage or nasal bone.
When the septum is bent or deviated toward one of the nasal cavities, it is called a septal deviation. This condition is often described by patients as having “bone in the nose” or “extra tissue in the nose.” Among the indications for nasal surgery, nasal bone deviation is the most frequent.
In septal deviation, nasal obstruction is usually felt on the side where the nasal passage is narrowed. In cases of unilateral deviation, individuals may only be able to use one nasal cavity effectively. When the open passage is functioning, nasal breathing occurs normally, but during rest or periods when the open passage is less active, the other nasal cavity may feel blocked due to the deviated septum, causing the sensation that both nasal passages are obstructed.
Sometimes, septal deviation can block both nasal passages. Although nasal obstruction can have other causes, septal deviation is the primary indication for nasal surgery.
Nasal congestion, mouth breathing, snoring: Typically, a constant blockage is felt on the side with the deviation, while the other side may experience variable obstruction due to occasional swelling of the nasal tissue. Patients often unconsciously breathe more easily when lying on the side of the deviated nasal passage. Even if the degree of deviation does not change, the sense of congestion and discomfort usually becomes more noticeable after the age of 30. Mouth breathing can lead to dryness and a sticky sensation in the throat, especially in the mornings. Sleep quality is negatively affected, and people often wake up feeling unrefreshed. Additionally, difficulty breathing through the nose can slightly reduce physical performance.
Frequent upper respiratory infections (sinusitis, pharyngitis, etc.): Individuals with significant deviation are more prone to recurrent upper respiratory tract infections, and recovery often takes longer.
Recurrent nosebleeds: In cases of sharp or pronounced deviations, the mucosa in the protruding area may become thin, dry, and prone to occasional nosebleeds.
Reduced sense of smell: Deviations can block odor molecules from reaching the olfactory region in the upper part of the nasal cavity, leading to difficulty smelling.
Facial pain: Contact points created by the deviation can cause contact headaches. These headaches are usually dull and located in the front of the face. They are not very severe but can be bothersome.
Postnasal drip
A septal deviation does not directly cause heart or lung disease, but it may worsen pre-existing conditions.
The nasal septum is examined by slightly opening the nostrils using a tool called a nasal speculum. To visualize the posterior part of the septum, the turbinates, and the openings of the sinus channels into the nasal cavity, an endoscopic examination is performed. During endoscopy, a thin instrument called a nasal endoscope, typically 2.7 or 4 mm in diameter with a small camera and light at the tip, is used to examine the inside of the nose.
Both examination methods are painless and quick. Diagnosis of a deviation usually does not require additional tests. However, if there are accompanying nasal problems such as enlarged turbinates, sinusitis, or polyps, a sinus CT scan may be performed to evaluate the nasal and surrounding sinus structures in detail.
The treatment for septal deviation is surgical, known as septoplasty. Septoplasty can be performed under general anesthesia, local anesthesia, or sedation without full unconsciousness. In previous years, local anesthesia was more commonly used, but recent advances in anesthesia, the availability of experienced anesthesiologists, and increased comfort for both the patient and surgeon have made general anesthesia the preferred option. Prior to surgery, the anesthesiologist evaluates the patient and performs necessary tests to ensure there are no conditions that would prevent or increase the risk of surgery.
The surgery begins with an incision inside the nose to access the septum. Severely deviated bone is broken and removed. Cartilage deformities are corrected either inside the nose or, if necessary, externally, and then repositioned back inside the nasal cavity. The incision is then closed using absorbable sutures.
In cases of external nasal deformity, severe deviation, or deviations at the tip of the septal cartilage, it may be difficult to correct the septum from inside the nose alone. In such cases, an open technique is used, where the nasal skin is lifted to perform the surgery.
The duration of septoplasty ranges from 30 minutes to 1.5 hours, depending on the type of deviation and the surgical approach chosen. After surgery, the patient is observed for 3–4 hours, then examined and discharged.
In crooked noses—where the nose deviates to the left or right, or forms a C- or S-shape—correcting the septum alone is often insufficient. Because the external shape of the nose affects the internal structure, achieving a successful outcome requires correcting both the external and internal aspects. This combined procedure is called septorhinoplasty, which addresses both aesthetic and functional nasal issues.
Before undergoing septoplasty surgery, the following precautions should be observed:
Discontinue certain medications: Stop taking aspirin, painkillers, and various blood-thinning medications at least 10 days before surgery. If you are on any essential medications, be sure to inform your doctor.
Avoid vitamin supplements: Taking vitamin supplements before surgery is generally not recommended. However, if your doctor deems it appropriate, you may take vitamin C before surgery to help promote faster wound healing.
Avoid smoking and alcohol: Heavy smoking and alcohol consumption can affect patients under anesthesia. Therefore, both should be completely avoided at least 10 days prior to surgery.
Pregnancy considerations: Pregnant women cannot undergo this surgery. If a pregnancy is confirmed during preoperative blood tests, the surgery should be postponed.
After septoplasty surgery, mild pain may occur, which can be easily managed with painkillers. Septoplasty does not cause any change in the shape of the nose, swelling, or bruising. At the end of the surgery, soft silicone splints (Doyle splints) are placed inside the nose. These splints have a hollow center, allowing the patient to breathe through the nose as long as they are not blocked by dried mucus or clots.
Tampon removal: If only septoplasty was performed, the splints are removed after 2–3 days. If the surgery included turbinate reduction (concha surgery) or was combined with rhinoplasty, the splints are removed after 5–7 days. The removal process takes 10–15 seconds and is painless. Some patients may undergo septoplasty without splints using dissolvable stitches to attach the nasal mucosa and septum. However, silicone splints are preferred as they reduce both bleeding and the risk of adhesions inside the nose.
Postoperative care: Minor bleeding may occur in the first 1–2 days, followed by discharge mixed with mucus in the following days. Crusting inside the nose can persist for 1–2 weeks and can be softened and removed with saline. Rest is recommended for 7–10 days, but if no complications arise, light work and travel can usually resume after day 5. Normal nasal irrigation and gentle nose blowing are allowed 10 days after surgery.
Complications after septoplasty are rare but may include:
Septoplasty is generally a highly successful procedure. Although many ENT surgeons consider it straightforward, incorrect assessment or technique may lead to failure.
After a successful surgery, deviation does not recur unless there is trauma or complications. However, cases with severe deviation, tip cartilage deviation, or fracture-line deviations may require additional techniques, sometimes necessitating an open surgical approach.
In patients with crooked noses, septorhinoplasty (combining aesthetic and functional nasal surgery) may be necessary for optimal results. The most common cause of failure is neglecting this. Additionally, other nasal obstruction issues such as turbinate hypertrophy, nasal valve collapse, or nasal polyps should be treated during the same session; otherwise, nasal obstruction may persist even if septoplasty itself is successful. If septoplasty fails or deviation recurs, a second or third surgery can be performed.
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