Septoplasty is a surgical procedure used to correct deviated nasal septum, primarily aimed at improving airway obstruction caused by abnormal nasal septum structures. This surgery involves adjusting the deviated cartilage or bone to make both nasal cavities symmetrical, thereby alleviating symptoms such as breathing difficulties, sleep apnea, or recurrent sinusitis. The procedure is often combined with treatments for nasal allergies or polyps but mainly targets anatomical structural issues rather than the underlying disease.
Deviated nasal septum can cause unilateral nasal congestion, leading to long-term mouth breathing, severe snoring during sleep, and even chronic headaches. The goal of the surgery is to remove abnormal tissue and reshape the nasal septum to a centered position, providing support to the nasal cavity and restoring normal ventilation. This surgery is primarily reconstructive rather than cosmetic, although it can occasionally be performed simultaneously with rhinoplasty for aesthetic purposes.
Septoplasty mainly divides into two surgical approaches: "Open" and "Closed". Open surgery requires an incision on the columella, allowing direct visualization of the nasal septum but may leave a scar; closed surgery is performed entirely within the nasal cavity, with less visible incisions but more limited indications. The mechanism involves removing excess deviated cartilage or bone fragments and realigning the remaining tissue to form a straight septum.
The surgery is usually performed under general anesthesia or local anesthesia, lasting approximately 1 to 2 hours. Surgeons use tools such as osteotomes and cautery devices to precisely reshape the structure, and may use absorbable sutures to fix tissues. Postoperative nasal packing with hemostatic material may be placed and removed after 24-48 hours.
Main indications include:
Secondary indications may include recurrent sinus infections caused by nasal septum issues or psychological stress due to long-term nasal congestion. After ruling out other factors such as climate or allergens, surgical treatment can be considered.
The procedure is typically performed in an ENT operating room, with anesthesia chosen based on age and health status. The steps include:
Postoperative care involves strict adherence to instructions, such as avoiding nose blowing, using saline nasal sprays for cleaning, and possibly applying steroid sprays to reduce swelling. Recovery usually takes 1-2 weeks, with full stabilization occurring over several months.
Main benefits include:
The advantage of surgery lies in directly addressing anatomical issues, with most effects being permanent. Compared to medication, it can fundamentally resolve obstruction problems but carries surgical risks. Some patients may also experience improved nasal symmetry, indirectly enhancing appearance.
Common short-term risks include:
Serious complications may include septal perforation, loss of smell, or infection. Long-term risks include tissue re-deviation, with an incidence of about 1-5%. Elderly patients or those with coagulation disorders should be particularly cautious about bleeding risks.
Contraindications include:
Preoperative assessment should include nasal endoscopy and CT scans. Postoperative care requires avoiding strenuous activity for at least 2 weeks and refraining from touching nasal sutures. Patients with diabetes or bleeding disorders should adjust medications accordingly, such as stopping anticoagulants.
Interactions with medications include:
Combined treatments with other surgeries include:
Clinical studies show that 85-90% of patients experience more than 50% improvement in ventilation function at 6 months post-surgery, with an average 70% reduction in sinusitis episodes. Long-term follow-up indicates that 95% of patients are satisfied with breathing improvements, though about 3-5% may require secondary surgery due to tissue recoil.
Functional nasal endoscopy images reveal an average improvement of 40-60 degrees in septal deviation angle postoperatively. International ENT organizations consensus states that surgery is the preferred treatment for anatomical nasal obstruction, with higher success rates than medication.
Non-surgical alternatives include:
Surgical alternatives may include:
What special preparations are needed before surgery?
Patients should undergo nasal debridement and receive antibiotic infusions preoperatively to reduce infection risk. Discontinue anticoagulant medications such as aspirin 3 to 7 days before surgery. Additionally, inform the doctor of any allergies and current medications, and complete blood tests and nasal endoscopy to assess the degree of septal deviation.
How long does it take to return to normal activities after surgery?
Generally, rest for 24 to 48 hours post-surgery, avoiding strenuous activities or heavy lifting during the first week to prevent nasal bleeding. Full restoration of ventilation function usually takes 4 to 6 weeks, during which mild nasal swelling or discharge may occur. Ice packs and prescribed pain medication are recommended. Those exposed to dust or chemicals at work should rest for at least 2 weeks.
Will there be permanent scars after surgery?
Traditional open surgery may leave small scars on the outside of the nose, but modern endoscopic minimally invasive techniques are performed entirely within the nasal cavity, with no visible external scars. Mucosal redness and swelling may occur for several months, but complete tissue healing occurs within 6 to 12 months, with scars naturally hidden within the nasal mucosa.
What if nasal congestion persists after surgery?
If severe nasal congestion persists beyond 3 weeks, it may be due to mucosal swelling or blood clots obstructing the nasal passages. Immediate follow-up with a doctor is recommended. The physician may suggest steroid nasal sprays, nasal irrigation, or adjustment of nasal splints. Rarely, secondary revision surgery may be needed, but this occurs in less than 5% of cases.
Does surgery improve sleep apnea?
If nasal septal deviation causes significant nasal obstruction, surgery can markedly improve airway patency and indirectly reduce snoring. However, for patients with severe sleep apnea, CPAP therapy is recommended, and a multidisciplinary evaluation by ENT and pulmonology specialists is advised. Surgery is usually part of a multi-stage treatment plan.
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