Surgery for a deviated septum (septoplasty)

Doctors may suggest surgery if medication isn’t helping enough and the deviated septum is becoming a real problem in everyday life, greatly affecting your quality of life. They will have to examine you first to assess whether the problems are being caused by a deviated septum and whether surgery could help.

Surgery is usually not recommended for

• children and teenagers who are still growing,
• people who have another illness that makes them very weak, like cardiovascular disease or a metabolic disorder, and
• people who have an acute infection in the nose or sinuses, like sinusitis.

Before the procedure, you’ll be given medication to reduce swelling in the soft tissue lining the nose. Septoplasty surgery is usually done under general anesthetic. The actual procedure takes about 30 to 90 minutes.

Usually, the surgeon inserts special instruments into the nose and makes a cut in the skin at the front of the septum. So there's no need for any cuts that can be seen from the outside. The surgeon then pulls the soft tissue away from the septum and takes out any cartilage or bone that’s causing problems. If the septum is very crooked, they can remove it, straighten it and then put it back in place in the middle of the nose.

If necessary, they will also widen the passages leading to the sinuses or reduce the size of enlarged turbinates (bony bumps in the nose covered by soft tissue). They can also adjust the shape of the outside of the nose. The medical term for surgery on both the outside and inside of the nose is septorhinoplasty.

At the end of the procedure, the surgeon sews up the cut in the soft tissue lining the nose. To stabilize the septum, they place plastic splints in the nose. These stay there for roughly three to seven days. It is common to have nasal packs inserted in your nose to stop any post-surgery bleeding. They are fixed in place with threads on the outside of your nose, and are usually removed on the day after the procedure.

It is not clear how effective surgery to straighten the septum is. There isn't very much research into whether surgery can relieve symptoms in the long term and how effective it is compared to waiting or using steroid nasal sprays or drops.

Some research suggests that the surgery can make it easier to breathe through the nose, improving quality of life, for a while. But most of the research only covered a period of a few months, with just a few studies lasting up to two years. So more research is needed to be able to say what the long-term effects of surgery are.

Common minor complications after septoplasty include bleeding and infection. They occur in about 7 out of 100 people, and can usually be fixed through outpatient treatment, like putting packing in the nose. If you develop an infection, the doctor might prescribe antibiotics.

Roughly 1 to 2 out of 100 people who have this surgery have severe pain, swelling, perforations (holes) or abscesses in the nasal septum afterwards. Other, rare, complications include an unintended change in nose shape, a distorted sense of smell, dry mucous membranes, and adhesions in the nasal cavity (where scar-like tissue sticks together).

People who have a septoplasty operation usually stay in hospital for a few days afterwards. Sometimes the procedure can be done in an outpatient setting (without a hospital stay). You will have to see an ear, nose and throat (ENT) doctor for check-ups afterwards. They can prescribe painkillers if you need them. A lot of people have trouble sleeping for a few days because their nose is swollen and full of fluid.

The nose and mucous membranes lining it feel sensitive in the first few weeks after surgery. So it’s important to avoid blowing your nose in the first week. You should also avoid low-intensity physical activity, saunas and swimming for at least two weeks, and contact sports like soccer, handball and martial arts for six weeks.

To help the membranes lining the nose heal, doctors recommend using saline (salt water) nasal sprays and rinses, as well as a wound-healing ointment, during the first three to four weeks after surgery.

It can take a while for your nose to feel normal again. But most people don’t notice much anymore after a few weeks.