Deviated Nasal Septum – What You Need to Know

What is a deviated nasal septum (DNS)?

A nasal septum is a thin bony-cartilaginous wall that separates the nasal cavity into two sides, a right side and a left side (Figures 1a-b). A deviated nasal septum occurs when this wall is crooked or shifted to one side of the nasal cavity (Figure 2). A significant deviation of the nasal septum may result in one nasal passage being smaller than the other.

Figure 1a – Location of the nasal septum in the nose

Figure 1b – The side view of a nasal septum showing the bony and cartilaginous parts.

What causes a deviated nasal septum?

A deviated nasal septum may be due to:

1. A condition that is present at birth
2. An injury to the nose – e.g. trauma to the nose from fights, sporting injuries or road traffic accidents

What are the symptoms of a deviated nasal septum?

Majority of the time, a mildly deviated nasal septum does not cause any symptoms and can be left alone. However, depending on the severity of a deviated nasal septum, it can cause the following symptoms:

1. Blocked nose (on one or both sides of the nose)
2. Frequent nosebleeds (epistaxis)
3. Recurring sinus infections (recurrent sinusitis)

How is a deviated nasal septum treated?

There is no medication that can treat a deviated nasal septum. It is a structural problem and can only be addressed by surgery. The surgery to address a deviated nasal septum is called Septoplasty.

When do I need Septoplasty?

Septoplasty is recommended if you have:

1. Significant symptoms due to a deviated nasal septum
2. A deviated nasal septum that prevents access to the nose or sinus during surgery (e.g. during sinus surgery or during surgery to stop a bleeding vessel behind a deviated nasal septum)

What does Septoplasty involve?

Septoplasty is a surgical procedure to help straighten a deviated (crooked or bent) nasal septum. The procedure is performed under general anaesthesia (with the patient completely asleep). The operation is performed through the nose with no external cuts or wounds on the face. Some surgeons may perform the surgery with the aid of an endoscope.

During a typical septoplasty, a surgical cut (incision) is made on one side of the nasal septum inside the nose (Fig 3b). The lining of the nasal septum (mucoperichondrium) is carefully lifted (Fig 3c & 3d). Underlying bone and cartilage that is crooked is removed or shifted. It is advisable to understand that some portions of the nasal cartilage and bone may not be removed because they are important in maintaining the structure of the external nose.

Once the desired straightening of the nasal septum is achieved, the incision is sutured with an absorbable material that will dissolve on its own with time (Fig 3e). To keep the shifted septum in place and to prevent the accumulation of blood underneath the mucosa, plastic splints may be inserted (Fig 3f). These splints are usually removed a week later in the clinic. Quite often, a septoplasty is performed together with an inferior turbinate reduction procedure.

What are the possible risks and complications of Septoplasty?

Septoplasty is, in general, a safe surgical procedure. However, as with all surgical procedures, there are some risks involved. The most common risk is bleeding (<5%). Rare complications of Septoplasty include infection, perforation of the septum, altered shape of the nose, and a decreased sense of smell.

Mild remnant deviation of the nose may occur after Septoplasty as structural portions of the septal cartilage or bone may have been preserved during the operation. To minimise risks of bleeding and infection, it is important for patients to keep their nose clean by frequent nasal irrigation.

What is the recovery like after Septoplasty?

The surgery can be done as a Day Surgery Procedure (the patient goes home on the same day) or as an Inpatient Procedure where the patient is warded overnight. If the surgery is performed together with an inferior turbinate reduction procedure, nasal packings may be inserted. The nasal packings are usually removed 1 – 2 days after surgery. Patients will be given oral antibiotics, pain relievers and a nasal wash (douche).

The patient is advised to return to the clinic 5-10 days after surgery. During this time, the ENT doctor will remove the nasal splints and clean the nasal cavity with a nasal suction. The subsequent clinic reviews depend on how well the septum is healing. Although the wound heals rapidly, and most patients can return to normal activities of daily living after one week, the overall healing process of the septum can take up to six months to a year. The septum may take some time to settle into its final shape and form. The improvement in breathing should be noticeable after the first clinic visit (once the splints are out and the nose has been cleaned by your surgeon). The patient should expect further improvement in breathing with time as the septum heals.

Are there any food restrictions after Septoplasty?

Although there is no evidence that any particular food will affect your recovery or the outcome of your surgery, it is advisable to avoid hot and spicy food and excessive alcohol intake in the first week after surgery. The increased blood flow associated with facial flushing may theoretically increase the risk of bleeding from the incompletely-healed tissues of the nose.

When can I resume heavy physical activity?

As the healing process varies from person to person, it is generally advised that patients should avoid any heavy physical activity (e.g. weight lifting, intense aerobic exercises) for at least 2 weeks after the surgery.

If you suspect you have a deviated septum or are experiencing related symptoms, consult an ear, nose, and throat (ENT) specialist for evaluation and recommended treatment options.

Best wishes,

Dr Gan Eng Cern
ENT Specialist Singapore