Septoplasty — How It Works, Benefits & Recovery — Procedure Guide, Recovery & Risks | MyMedicPlus

Septoplasty is an ENT (ear, nose, and throat) surgical procedure to correct a deviated nasal septum — the cartilage and bone partition that divides the nasal cavity into left and right airways. A perfectly straight septum is anatomically uncommon; studies of the general population find that up to 80% of individuals have some degree of septal deviation, though the majority are asymptomatic. Clinically significant deviation causing nasal obstruction sufficient to impair breathing and quality of life occurs in approximately 20% of the population.

The nasal septum consists of cartilage (anteriorly — the quadrangular cartilage) and bone (posteriorly — the vomer and perpendicular plate of the ethmoid). Deviations can involve any part of the septum, can be a simple unidirectional deflection, an S-shaped deviation, a septal spur (bony projection), or a combination. The deviation may be congenital or, more commonly, acquired following nasal trauma (falls, sporting injuries, assault) in childhood or adulthood.

Septoplasty differs from rhinoplasty: septoplasty corrects the internal airway without altering the external nasal appearance, while rhinoplasty reshapes the external nose. When both are performed simultaneously to address internal and external deformity, the combined procedure is called septorhinoplasty. Septoplasty is frequently combined with inferior turbinate reduction to address the commonly coexisting inferior turbinate hypertrophy that contributes to obstruction.

Septoplasty is indicated for patients with symptomatic nasal obstruction due to a deviated septum that has not responded to at least 3–6 months of appropriate medical management. Medical treatment typically includes topical intranasal corticosteroids (fluticasone, mometasone) to reduce mucosal inflammation and turbinate swelling, nasal saline irrigation to clear mucus, and antihistamines if allergic rhinitis is a contributing factor. Persistence of significant obstruction despite these measures is the primary indication for surgery.

Specific symptoms that drive surgical decision-making include: unilateral or bilateral nasal obstruction impairing daily activities, sleep, or exercise tolerance; chronic mouth breathing (with associated dental and facial development concerns in children); obstructive sleep apnoea or snoring where septal deviation significantly contributes to upper airway resistance; recurrent sinusitis attributable to impaired sinus ventilation and mucociliary clearance from deviated airflow patterns; and epistaxis (nosebleeds) from a dry, exposed septal spur.

Septoplasty is generally deferred in children until after nasal growth is complete (mid-teenage years) as early surgery may interfere with midface development. However, significant septal deviation causing obstructive sleep apnoea or severe chronic sinusitis in children may warrant earlier intervention.

Septoplasty is performed under general anaesthesia for most adult patients, though local anaesthesia with sedation is used in selected adult patients. The nasal cavity is prepared with vasoconstrictive agents (xylometazoline or oxymetazoline nasal spray, and injection of lignocaine with adrenaline 1:80,000 into the mucoperichondrium) to minimise bleeding.

A hemitransfixion or Killian incision is made inside the nostril, within the mucous membrane lining of the septum (mucoperichondrium/mucoperiosteum). This lining is carefully elevated off the cartilage and bone using an elevator, maintaining the mucosal envelope intact — critical to preserve septal blood supply and strength.

Deviated cartilage is removed by scoring (weakening without excision), conservative trimming, or resection and replacement (cartilage is reshaped on a cutting board and reimplanted). Ethmoid plate and vomer deviations are corrected using Takahashi or Blakesley forceps. Importantly, a 1 cm dorsal and caudal strut of septal cartilage must be preserved to maintain nasal tip support and prevent saddle nose deformity.

If inferior turbinate hypertrophy coexists, turbinate reduction is performed simultaneously using out-fracture, submucosal diathermy, coblation, or trimming. Silicone splints or soluble packing may be placed inside the nose to prevent adhesions (synechiae) between septal surfaces and the lateral nasal wall during healing. The incision is closed with a single absorbable suture. Operative time is typically 45–75 minutes.

Septoplasty successfully improves nasal breathing in 80–90% of patients at 12-month follow-up, with patient-reported improvement in the NOSE (Nasal Obstruction Symptom Evaluation) score — a validated questionnaire — averaging 30–50% improvement from baseline. Patients consistently report improved sleep quality, reduced snoring, reduced mouth breathing, and improved exercise tolerance after successful surgery.

Where septal deviation is contributing to recurrent acute rhinosinusitis by impairing sinus ostia and drainage pathways, septoplasty as part of functional endoscopic sinus surgery (FESS) reduces sinusitis episode frequency by 50–70% at 12 months. The procedure is durable — results are generally maintained long-term, unlike medical treatments which require ongoing use.

For patients with obstructive sleep apnoea where nasal obstruction is a contributing factor, septoplasty may reduce CPAP (continuous positive airway pressure) pressure requirements, improve CPAP adherence, and in carefully selected patients with mild OSA, improve AHI (apnoea-hypopnoea index) as a component of multilevel surgical treatment. The cosmetic appearance of the nose is unchanged by septoplasty unless rhinoplasty is simultaneously performed.

Septoplasty is a low-risk procedure in experienced hands. Post-operative bleeding (epistaxis) requiring repacking or return to theatre occurs in approximately 1–2% of cases. Infection is uncommon (less than 1%) and usually managed with a short course of antibiotics.

Septal perforation — a hole in the septum — is a rare but significant complication (less than 1%) resulting from bilateral mucosal tears at the same site during elevation. Small perforations may be asymptomatic, while larger ones cause whistling on breathing, crusting, recurrent bleeding, and nasal collapse, and are difficult to repair. Excessive removal of cartilage can lead to a saddle-nose deformity (collapse of the nasal dorsum) — prevented by meticulous preservation of the dorsal and caudal cartilage struts.

Synechiae (adhesions) between the septum and turbinate form in 2–3% of cases, potentially impairing airflow and requiring surgical division. Temporary numbness of the anterior upper teeth (from infraorbital nerve proximity) is reported by some patients and resolves spontaneously within weeks to months. Dissatisfaction with breathing outcome (10–20%) may result from turbinate hypertrophy, nasal valve incompetence, or other contributors to obstruction not addressed at the initial procedure.

If nasal packing is used, it is removed 24–48 hours post-operatively, providing immediate relief of the bloated sensation caused by packing. Silicone splints, if placed, are removed at the 7–10 day post-operative visit. Most patients experience moderate nasal congestion, bloody discharge, and mild facial pressure for 1–2 weeks as the nasal mucosa heals and swelling resolves.

Saline nasal irrigation (Neilmed or similar) commenced from the second post-operative day helps clear blood clot, crusts, and debris, accelerating mucosal healing. Nasal corticosteroid spray is typically resumed at 2–3 weeks post-operatively. Patients should avoid blowing their nose forcefully for 2–3 weeks to prevent haematoma formation, and avoid strenuous exercise for 2 weeks to minimise bleeding risk.

Most patients return to office-based or light work within 5–7 days, and full breathing improvement becomes apparent as swelling resolves over 2–4 weeks. Final functional outcome is best assessed at 3–6 months once the mucosal remodelling process is complete. Follow-up appointments at 1–2 weeks (splint removal), 6 weeks, and 3 months are standard.