Septoplasty
A blocked nose is one of the common problems I assess in practice, and a deviated septum is often part of the picture. I perform septoplasty regularly, both as a standalone operation and in combination with other nasal and sinus procedures. The key is deciding whether the septum is genuinely a major contributor to the blockage, and whether straightening it is likely to make a meaningful difference for that individual patient.
For some patients, a septoplasty is all that is needed. In others, the septum is only part of the problem and surgery may need to be combined with treatment to the turbinates or sinuses. Good results depend on understanding the whole pattern properly rather than assuming every blocked nose is simply due to the septum.
What is the septum?
The septum is the partition inside the nose made of cartilage and bone. It separates the right and left nasal passages. If it is bent or twisted, it can narrow one or both sides of the nose and contribute to ongoing nasal blockage.
What is a septoplasty?
A septoplasty is an operation to straighten the septum and improve airflow through the nose.
It is different from a septorhinoplasty. A septoplasty is aimed at improving the inside of the nose and helping nasal breathing. It is not usually intended to change the outside shape of the nose. However, if the tip or outside of the nose is also significantly deviated, that may need to be corrected as well, and in that situation a septorhinoplasty may need to be considered instead.
Open or closed septoplasty
Septoplasty is usually performed using a closed approach, which means the cuts are made inside the nose with no cuts on the outside.
In selected or more complex cases, an open approach may occasionally be needed, usually where the deformity is more severe or where access to the septum is particularly difficult. In practical terms, most septoplasties are closed procedures.
When might a septoplasty be recommended?
A septoplasty may be helpful when a deviated septum is clearly contributing to nasal obstruction and symptoms have not improved enough with appropriate medical treatment.
Symptoms that may point in that direction include:
persistent nasal blockage, often worse on one side
difficulty breathing through the nose, especially at night or during exercise
poor airflow despite treatment for rhinitis
a blocked nose contributing to poor sleep
a septum that is also limiting access for other nasal or sinus surgery
If the blocked nose is mainly due to rhinitis, turbinate swelling, or another inflammatory cause, treating the septum alone may not solve the problem. That is why proper assessment matters.
How do I assess whether septoplasty is appropriate?
I usually want to understand:
how much the nose feels blocked, and on which side
if the blockage is constant or variable
any rhinitis, allergy, or turbinate swelling
what sprays or other treatment have already been tried
if sinus disease is also part of the picture
if the outside of the nose is also deviated
how much the symptoms are affecting sleep, exercise, or day-to-day life
Examination often includes looking inside the nose with a headlight or a thin camera. In some patients, particularly where sinus disease is also part of the picture, further imaging such as a CT scan may be needed.
Can septoplasty be combined with other procedures?
Yes, very often.
A septoplasty is commonly combined with other procedures where needed. For example:
turbinoplasty, if enlarged turbinates are also contributing to blockage
endoscopic sinus surgery, if sinus disease is present and the septum is limiting access
more extensive nasal surgery, if the outside shape of the nose also needs to be addressed
This is one reason a septoplasty should be seen as part of an overall nasal airway plan rather than in isolation.
What does the operation involve?
Septoplasty is usually performed under a general anaesthetic. In most cases, the operation is done entirely through the nostrils, without cuts on the outside of the nose. The bent cartilage and bone are repositioned or trimmed so that the septum sits more centrally and the airway is improved. Dissolvable stitches are often used inside the nose.
At the end of the operation, I may use dissolvable packing inside the nose, particularly if it is needed to support healing or reduce bleeding. In some cases, small internal splints are also placed inside the nose to support the septum while it heals. If splints are used, they are usually removed later in clinic.
What are the benefits of septoplasty?
For the right patient, septoplasty can:
improve nasal airflow
reduce the feeling of constant blockage
improve breathing during sleep and exercise
make treatment for rhinitis work better
improve access for other nasal or sinus procedures when needed
It is important to be realistic. Septoplasty helps when the septum is genuinely a major part of the blockage. If the main problem is inflammation, allergy, turbinate swelling, or another cause, further treatment may still be needed even after surgery.
It is also important to understand that surgery does not always produce a perfectly straight septum. A very bent cartilage or severely deviated septum can be difficult to straighten fully, and some residual deviation is not uncommon.
What are the main risks of septoplasty?
Septoplasty is a common and usually safe operation, but like any procedure it carries risks.
The more common short-term issues include:
bleeding or blood-stained discharge
temporary blockage from swelling or packing
infection
crusting during healing
discomfort while the nose settles
Less common but important risks include:
a septal haematoma, which is a collection of blood under the lining of the septum
a septal perforation, meaning a hole in the septum
scar tissue inside the nose
temporary numbness of the upper teeth, lip, or tip of the nose
Although septoplasty is not usually intended to change the appearance of the nose, there is still a rare risk that the external shape of the nose can alter and feel unsatisfactory afterwards. This is more relevant if the septum is very severely bent or if the tip of the nose is also deviated.
It is also important to understand that improvement is not always complete. A very bent cartilage or severely deviated septum can be difficult to straighten fully, and some residual deviation is not uncommon. In some patients, the cartilage can also shift or warp again over time, and the blockage may return. If surgery does not help enough, or if the septum moves again later, revision surgery may sometimes need to be considered.
As with any operation under general anaesthetic, there are also the usual anaesthetic risks.
What is recovery like?
Most septoplasty operations are done as a day case, although some patients stay overnight depending on the extent of surgery and how they are afterwards. The nose usually feels more blocked before it starts to feel better, especially in the first week or two. It can take several weeks for swelling to settle fully, and sometimes a few months for the final improvement in breathing to become clear.
Saline spray
After surgery, I usually advise regular saline spray such as Sterimar, or a similar pharmacy equivalent, to keep the inside of the nose moist and help reduce crusting.
Naseptin
Most patients are also prescribed Naseptin after surgery, depending on the pattern of healing and the condition of the lining inside the nose. This can help reduce crusting and lower the risk of infection in the nose.
Antibiotics
Oral antibiotics are not needed for every patient, but they may occasionally be prescribed depending on the operation, the type of packing or splints used, or the way the nose is healing afterwards.
Activity and work
I usually advise taking it easy for the first few days. Most patients need around 1 to 2 weeks off work, depending on the type of job they do. Strenuous exercise should usually be avoided for at least 6 weeks, and the nose should be protected from knocks while it is still healing.
Nose blowing
Do not blow the nose for at least the first couple of days, then start very gently. Some blood-stained mucus is common early on.
When should I seek urgent advice?
Urgent advice is needed if there is:
heavy or persistent fresh bleeding
increasing pain or swelling
worsening blockage that feels out of proportion
fever or signs of infection
increasing redness or tenderness over the nose
concern that recovery is not going in the right direction
These can sometimes point to bleeding, infection, or a septal haematoma, which need prompt attention.
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Disclaimer
This page is intended as general information only. It does not replace a consultation, examination, or individual medical advice.