What is a deviated nasal septum?
The nasal septum is the thin wall of cartilage and bone that divides the nose into two passages, one for each nostril. When the septum is bent, or has ridges and spurs (small projections of cartilage or bone), it is called a deviated septum.
A slight deviation is very common and often causes no problems. It may be present from birth, develop during growth or result from an injury to the nose. It becomes a problem when it narrows the airway enough to make breathing difficult.
What are the symptoms of a deviated septum?
The main complaint is difficulty breathing through the nose. How severe the symptoms are varies from person to person and does not depend only on how bent the septum is. The most common signs are:
- a blocked nose on one or both sides, often constant and worse at night;
- breathing through the mouth, with a dry mouth and throat on waking;
- snoring and poor-quality sleep;
- recurrent sinusitis, because a blocked nose hinders mucus drainage from the sinuses, the air-filled spaces around the nose.
When is septoplasty needed?
Septoplasty is considered when a deviated septum causes a nasal blockage that affects daily life or sleep and does not improve with medical treatment, such as nasal sprays and saline rinses. A bent septum that causes no symptoms does not normally need surgery.
The same symptoms can also have other causes, such as enlarged turbinates, nasal polyps or allergic rhinitis. That is why the first step is an ENT consultation, often with nasal endoscopy: a thin camera is passed into the nostril to look at the septum and the other structures inside the nose. The examination is quick and usually well tolerated.
The doctor may also request a CT scan of the nose and sinuses. Sometimes the septum also needs straightening to give access to the sinuses during endoscopic surgery for chronic sinusitis (FESS). The decision to operate is always made together with the patient.
Does septoplasty change the shape of the nose?
No: septoplasty is a functional operation, not a cosmetic one. Its aim is to improve airflow, and it is carried out entirely inside the nose without changing its outward shape.
Rhinoplasty, on the other hand, is a different operation that alters the external appearance of the nose. The two are often confused, but they have different goals.
How is endoscopic septoplasty performed?
The operation is carried out entirely through the nostrils using an endoscope, a thin telescope connected to a camera that shows the inside of the nose on a monitor. There are no external incisions and no visible scars on the face.
The surgeon lifts the lining that covers the septum, reshapes or removes the bent parts of cartilage and bone, and then lays the lining back in place. The operation is done under general or local anaesthesia, depending on the case. It typically takes about 30–90 minutes, and the hospital stay is usually short: day surgery or one night.
The turbinates are often reduced in the same session. These are ridges inside the nose that warm and humidify the air we breathe; when they are permanently enlarged (turbinate hypertrophy) they help block the nose. The reduction, known as turbinoplasty or turbinate decongestion, is done with laser, microdebrider (a small instrument that suctions and removes excess tissue) or radiofrequency.
What is recovery like after septoplasty?
At the end of the operation, packing or splints may be placed in the nose. Splints are thin, soft sheets that support the septum while it heals. They are not always needed; if used, they are usually removed after a few days at a check-up.
Over the following weeks a blocked nose, light bleeding and crusts are normal. Crusts are dried secretions that form while the lining heals. Saline nasal washes help to clean the nose and reduce crusting.
People with desk jobs usually return to work after 7–10 days, while sport generally needs a few weeks. Dr Nicola De Candia gives personalised advice after the consultation and at check-ups. For the period your doctor advises, it is best to:
- avoid blowing your nose, and sneeze with your mouth open;
- avoid sport, physical exertion and heavy lifting;
- avoid smoking and very hot environments, such as saunas and hot baths;
- follow the prescribed treatment carefully and attend your check-ups.
What are the risks of septoplasty?
Like any surgery, septoplasty carries some risks, which are generally uncommon. The risks, benefits and alternatives are explained carefully at the pre-operative consultation, before you sign the consent form. Possible complications include:
- nosebleeds, usually mild, in the days after surgery;
- infection or a septal haematoma, which is a collection of blood under the lining;
- adhesions (synechiae), small bridges of scar tissue between the septum and the turbinates;
- septal perforation, a small hole in the wall between the two nostrils;
- a nose that remains blocked, which sometimes needs further treatment;
- a temporary reduction in the sense of smell or in sensation in the upper teeth;
- very rarely, a weakening of the nasal support that changes the profile of the nose.
Who should I see for septoplasty in Bari?
Endoscopic septoplasty requires familiarity with the endoscope. Dr Nicola De Candia is a specialist in Otolaryngology (ENT) and Neurosurgery and has trained in endoscopic sinus and skull-base surgery on courses in Brescia, Graz, Brussels, Milan and Nice. He teaches “Endoscopic sinonasal techniques” at the ENT specialist school of the University of Bari.
If your nose has been blocked for some time, a specialist consultation can identify the cause. The practice is at Via Niccolò dall'Arca 19, Bari, near Bari Centrale station. Appointments can be booked online on MioDottore or by phone on 080 5219334.
The information on this page is for general education and does not replace a specialist consultation: indications, recovery times and risks are assessed case by case.