Septoplasty

Septoplasty is a surgical procedure that straightens the nasal septum (the wall of cartilage and bone that divides the inside of the nose into two passages) when it is crooked or displaced.

During the operation, a surgeon works entirely through the nostrils — no cuts are made on the outside of the nose. The surgeon carefully reshapes or removes parts of the bent cartilage and bone so that air can flow equally through both sides of the nose. The outer shape of the nose usually does not change.

Septoplasty is used when a deviated septum (a crooked nasal dividing wall) causes significant problems that cannot be managed with medicines alone. Doctors recommend it for patients whose quality of life or health is clearly affected.

• Chronic nasal obstruction — persistent blockage in one or both nostrils that makes breathing through the nose difficult
• Recurrent nosebleeds caused by turbulent airflow over a bent septum
• Chronic sinusitis (long-term infection or inflammation of the sinuses) linked to poor drainage because of a deviated septum
• Sleep-disordered breathing, such as snoring or obstructive sleep apnoea (repeated pauses in breathing during sleep), worsened by nasal blockage
• Headaches or facial pressure attributed to the deviated septum blocking sinus drainage
• Need to access the inside of the nose for other ENT or skull-base surgery

Septoplasty is generally not suitable in certain situations. Your surgeon will assess these carefully before recommending the operation.

• Children and young teenagers, because the septum is still growing — surgery is usually deferred until growth is complete
• Patients whose nasal blockage is caused by allergies or swollen tissue (turbinate hypertrophy) alone, with no structural deviation
• Patients with active nasal infection or severe uncontrolled bleeding disorders
• Patients who only have a very mild deviation that does not cause noticeable symptoms

Septoplasty is a well-established operation, but like all surgery it carries some risks. Most people do not experience serious complications, but your surgeon will discuss your individual risk before the procedure.

• Nasal congestion and swelling in the first weeks after surgery — this is expected and temporary
• Bleeding (epistaxis) during or after the operation, which occasionally requires packing inside the nose or a return to the operating room
• Infection inside the nose or sinuses, treated with antibiotics
• A septal haematoma (a collection of blood between the layers of the septum) — rare but requires prompt drainage
• Septal perforation (a hole that develops in the septum) — uncommon; may cause crusting, whistling sounds, or bleeding
• Temporary or, rarely, persistent numbness of the upper teeth or tip of the nose
• Changes in the sense of smell — usually temporary
• Incomplete relief of symptoms, meaning a second procedure may sometimes be needed
• Reactions to general anaesthesia (the medication that keeps the patient fully asleep during surgery) — rare but assessed before the operation
• Rarely, a slight change in the external shape or tip of the nose

Good preparation helps the surgery go smoothly and reduces the chance of complications. Your surgical team will give you personalised instructions, but the following steps are typical.

Before the operation, patients are usually asked to stop blood thinners and anti-inflammatory pain relievers (such as aspirin-type medicines) for a period advised by the surgeon, because these can increase bleeding. Smoking should be stopped as far in advance as possible, since smoking slows healing and increases infection risk. Alcohol is usually avoided for at least a few days beforehand.

Fasting is required before septoplasty because the procedure is performed under general anaesthesia. Usually this means nothing to eat or drink — including water — for a set number of hours before the operation. Your team will tell you the exact timing.

Common pre-operative assessments include:

• A physical examination of the inside of the nose, sometimes using a nasal endoscope (a thin, lighted camera inserted into the nostril)
• CT scan of the sinuses to map the anatomy and check for coexisting sinus disease
• Blood tests to check general health and clotting ability
• An anaesthesia review to assess fitness for general anaesthesia

On the day of surgery, the procedure typically follows these steps:

• The patient changes into a hospital gown and a cannula (a small plastic tube) is placed in a vein in the arm for fluids and medications.
• The anaesthetist gives general anaesthesia so the patient is fully asleep and feels nothing during the operation.
• The surgeon makes a small cut inside the nostril — not visible from outside — to lift the lining of the septum.
• Crooked cartilage and bone are carefully reshaped, repositioned, or partially removed.
• The lining is placed back over the corrected septum and secured with dissolvable stitches or small splints (thin, soft supports) inside the nose.
• Soft nasal packing or splints may be placed to support the septum while it heals — not all surgeons use these.
• The patient is moved to a recovery area and wakes up from the anaesthesia under close nursing care.

Recovery from septoplasty takes place in stages. Most patients spend a few hours in the recovery area before being discharged the same day or the next morning, though your surgeon will decide based on how the operation went and your overall health. Full healing of the septum's inner layers can take several months, even if you feel much better within a few weeks.

• Monitoring: You will be watched for bleeding and breathing comfort before you are allowed to go home. Pulse and blood pressure are checked regularly.
• Nasal packing or splints: If these were placed, they are usually removed by the doctor within a few days at a follow-up visit — not by the patient at home.
• Head position: Keeping the head elevated (raised above the level of the heart) when resting reduces swelling and bleeding in the first days.
• Nose blowing: Blowing the nose forcefully should be avoided for at least the period advised by the surgeon — usually one to two weeks — to protect the healing septum.
• Activity restrictions: Strenuous exercise, heavy lifting, and contact sports are typically avoided for several weeks. Your surgeon will give a specific timeline.
• Nasal rinsing: Saltwater nasal rinses (saline irrigation) are commonly recommended to keep the nasal passages moist, clear of crusts, and healing well.
• Wound care: There are no external wounds to dress, but internal stitches dissolve on their own. Any splints are removed by the medical team.
• Medications: Doctors usually prescribe pain relievers and may give antibiotics or steroid nasal sprays — the type and duration depend on your surgeon's assessment.
• Follow-up appointments: Regular check-ups allow the surgeon to monitor healing, remove any packing, and check that the septum is sitting correctly.
• Smoking and alcohol: Both slow healing and are generally advised against throughout the recovery period.
• When to seek help urgently: Heavy bleeding from the nose, fever, severe pain, or difficulty breathing should be reported to the medical team without delay.