The nasal septum
The nasal septum is the wall dividing the nasal cavity into halves. The septum is composed of cartilage and bone covered on each side by mucous membrane. The ideal nasal septum is midline, separating the left and right sides of the nose into passages of equal size. The nasal septum may develop bends as it grows or be damaged by injury to the nose – called nasal septum deviation – causing a blocked nose.
Nasal septoplasty surgery opens up the nasal passages blocked by a bent septum – to improve breathing.
Nasal septal deviation
A blocked nose is often caused by a bent nasal septum. Nasal examination including nasal endoscopy will assess the internal structures of the nose and identify the cause of a blocked nose. If sinusitis is suspected in addition to a nasal septal deviation, then a CT scan will be helpful.
Nasal septoplasty is often performed together with other procedures as needed including:
- Endoscopic sinus surgery
- Turbinate reduction surgery / Turbinoplasty
Nasal septoplasty may also be performed to improve access to the sinuses during endoscopic sinus surgery. Septoplasty surgery may be performed together with a rhinoplasty to reshape the nose and improve the appearance of the nose. Nasal septoplasty is a surgical procedure performed through the nostrils, so accordingly no bruising or external signs occur.
When septoplasty surgery is combined with a rhinoplasty, the external appearance of the nose is altered and temporary swelling/bruising of the face is evident. A septoplasty may be performed together with surgery to reduce the turbinates (turbinate reduction) when the turbinates are blocking the nasal passages.
Turbinate reduction surgery or turbinoplasty works together with nasal septoplasty surgery to increase the size of the nasal passages and improve breathing through the nose.
The time required for the nasal septoplasty averages about one to one and a half hours, depending on the severity of the blocked nose. In most cases an internal incision is made within one of the nostrils. The lining covering the nasal septum is lifted and the underlying cartilage and bone are straightened. The septum is realigned as close to the midline as possible leaving the normal support of the tip of the nose intact.
Once the septum is realigned the incision is closed with dissolving stitches and the nose may be packed or internal splints may be placed.
Anaesthesia for nasal septoplasty and turbinate surgery
Nasal septoplasty can be done with a local or combination of local and general anaesthetic. Septoplasty can be done either on a day surgery basis or with an overnight hospital stay. The anaesthetic is in your system for the first 24 hrs after surgery so you must be accompanied home by a responsible adult, and have an adult with you for the remainder of the 24 hrs after surgery. During the first 24 hours do not drink alcohol, do not drive, and do not operate machinery. You may drink normally and eat a light meal if you feel like eating.
Recovery after septoplasty surgery
Nasal septoplasty is reconstructive surgery of the bone and cartilage of the nose – the tissues of the nasal cavity are affected by this operation and will be tender and swollen until healing is complete after about 2 to 4 weeks.
This advice sheet gives information to help make you more comfortable following the operation and will encourage rapid, uneventful healing. Pain after nasal septoplasty is usually well controlled with Panadol or Panadeine as directed. Dissolvable nasal packing may be placed to prevent bleeding – this will be cleared by regular nasal saline irrigations.
For best results, nasal saline irrigations are recommended – on each side of the nose 4-5 times a day, starting 24 hours after surgery, for 14 days.
Avoid forcefully blowing the nose for the first few days after surgery – clearing the nose with saline irrigations is preferable.
Bending, straining, heavy lifting, strenuous exercise and sneezing should be avoided for the first 7 days after septoplasy surgery.
You may shower, bathe and wash hair etc., as you normally would – if you have a dressing on your nose avoid getting this wet.
Avoid very dry, dusty and smoky environments.
Local symptoms after septoplasty surgery
A variety of local symtoms are common for days to weeks after surgery including nasal stuffiness, a blood stained nasal discharge and numbness of the nose and upper central teeth. Nasal stuffiness and nasal discharge will improve with nasal saline flushes. Rarely nasal septal infection may develop – this may have occurred if the nose becomes very red, hot and swollen. If this occurs you must seek attention from your local doctor straight away who will arrange for antibiotics to be prescribed.
The main delayed complication of note is nasal septal perforation which may occur in 1 to 2 percent of patients
- Most perforations do not cause problems
- Occasionally symptoms may include bleeding, crusting and whistling which require surgical repair of the perforation
A septoplasty may rarely cause a saddle nose deformity or drooping of the nasal tip (less than 1 in 500 patients) – in this situation corrective surgery may be required.
Generally follow up after nasal septoplasty will include
- A visit at 2 to 3 weeks to have the nose checked
- A final surgical check up at 3 months
- In addition you will need to be seen by your local doctor one week after surgery
- You will need to ring to make appointments for these visits
If you have questions about treatment for a blocked nose or septoplasy see your local doctor who will arrange for you to visit an ENT Specialist surgeon.