Key points
- Nasal congestion is a symptom commonly seen by ear, nose, and throat (ENT) specialists, and the nasal airway is made up of the septum together with the nasal valves and the inferior turbinates [1, 2].
- Septoplasty is one of the methods used for snoring and sleep apnea as well, when the cause is judged to be an abnormality that can be corrected with surgery [3].
- When the septal deformity is severe, extracorporeal septoplasty, in which the septum is removed and replaced with a newly constructed one, is sometimes used [4].
- After septal surgery, a hole in the septum (perforation) can develop as a complication [1].
- Nose surgery performed in outpatient procedure rooms is increasing, but there is still little evidence on the best way to perform it [5].
What is a deviated septum?
The septum (nasal septum) is the wall that divides the inside of the nose into left and right sides. Its front part is made of cartilage and its back part of bone. When this wall bends to one side, it is called a deviated septum (septal deviation), and depending on how much it bends and where, it can cause a blocked nose on one or both sides.
The passage you breathe through is not made up of the septum alone. One review explained that the nasal airway consists of the internal and external nasal valves, the septum, and the inferior turbinates (ridges of tissue along the side walls inside the nose), and that there are various techniques for each of these areas [1]. So when you have nasal congestion, other structures are examined along with the septum.
When is surgery considered?
Nasal congestion is a symptom that ENT doctors commonly encounter [2]. Surgery is discussed when a deviated septum is judged to be the cause of symptoms and is interfering with daily life.
For snoring and obstructive sleep apnea as well, surgical treatment is considered when the cause is judged to be an abnormality that can be corrected with surgery [3]. Many patients choose surgery when nonsurgical treatment does not work or is hard to tolerate, and functional rhinoplasty, septoplasty, and inferior turbinate surgery (turbinoplasty) are described as being used more and more [3]. The same review stressed the importance of multidisciplinary care in cooperation with sleep medicine specialists [3].
Types of surgical methods
In a typical septoplasty, the lining inside the nose is lifted, part of the bent cartilage and bone is straightened or removed, and the structure that supports the nose is left in place.
A severe septal deformity is considered one of the most difficult problems in nose surgery [4]. Extracorporeal septoplasty, which is used in such cases, is also called subtotal septal reconstruction, and in this method the deformed septum is removed and replaced with a newly constructed septum [4]. Several modified techniques have been reported, and it can be performed through an external incision or from inside the nose [4].
Surgery performed in outpatient procedure rooms is also increasing. It can be considered for patients who want prompt treatment while avoiding the side effects of general anesthesia, operating room costs, and scheduling delays, and the procedures presented include inferior turbinate surgery, septoplasty, and nasal valve repair [2]. However, because this is a newly emerging approach, there is described as being little evidence on the best way to perform it [5].
Complications and recovery
Complications of septal surgery include a hole in the septum (septal perforation), and both nonsurgical and surgical treatments for it are described [1]. Other general postoperative problems, such as bleeding, infection, swelling, and temporary nasal blockage, can also occur.
One review described rhinoplasty as a double-edged sword for the nasal airway. When done well it can improve the airway, but when not, it can seriously harm it [1]. When surgery to change the shape of the nose is planned together with surgery to improve breathing, it is important to check separately how it will affect function.
How much nasal blockage improves after surgery can depend on whether the cause was the septum alone or whether other structures, such as the nasal valves or inferior turbinates, were also involved. The length of recovery and the degree of discomfort also vary from person to person.
When do children and teenagers have surgery?
The timing of nose surgery in children has long been debated. Out of concern that operating on growing facial structures could cause lasting facial deformities, a conservative approach of waiting until the nose stops growing after puberty is described as having been the norm [6].
A recent review summarized that there is evidence that nose surgery in children does not harm facial growth, and that leaving a severe nasal deformity uncorrected can lead to mouth breathing, which may in turn cause abnormal facial growth [6]. The review concluded that nose surgery before puberty is safe and may even prevent facial deformities in some patients [6]. This does not mean that every child needs surgery, so the decision should take into account both the severity of symptoms and the child's stage of growth.
What to check during your consultation
Even with similar nasal congestion, the cause and severity differ from person to person. It is best to describe your symptoms in specific terms and decide on treatment after an examination confirms the cause.
- Whether the blockage is on one side or both, and whether it is constant or comes and goes
- Whether you snore or have breathing problems during sleep
- Whether you also have problems with the nasal valves or inferior turbinates besides the septum
- The type of anesthesia and where the surgery will take place
- The possibility of complications such as septal perforation
Frequently asked questions
- If my septum is deviated, do I have to have surgery?
- Surgery is discussed when a deviated septum is judged to be the cause of symptoms and the discomfort is significant. For snoring and sleep apnea as well, surgery is described as being considered when the cause is judged to be an abnormality that can be corrected surgically [3]. The decision is based on both your symptoms and the examination findings.
- Can it be done as an outpatient procedure under local anesthesia?
- Nose surgery performed in outpatient procedure rooms is increasing, and septoplasty is presented as one of the options [2]. However, because this is a newly emerging approach, there is described as still being little evidence on the best way to perform it [5]. The appropriate anesthesia and setting depend on the severity of the septal deformity and any other surgery done at the same time.
- My child has severe nasal congestion. Do we have to wait until growth is complete?
- In the past, a conservative approach of waiting until the nose stopped growing was common [6]. A recent review pointed out that leaving a severe nasal deformity untreated can lead to mouth breathing and abnormal facial growth [6]. Whether and when to operate should be discussed with a specialist based on the severity of symptoms and the child's stage of growth.
References
- Sonneveld KA, Sinha PK. Correction of Septal Perforation/Nasal Airway Repair. Oral Maxillofac Surg Clin North Am. 2021.PubMed 33153892DOI
- Kao R, Rabbani CC, Ting JY, et al. In-office Functional Nasal Surgery. Otolaryngol Clin North Am. 2019.PubMed 30905568DOI
- Tanna N, Smith BD, Zapanta PE, et al. Surgical Management of Obstructive Sleep Apnea. Plast Reconstr Surg. 2016.PubMed 27018680DOI
- Wu PS, Hamilton GS 3rd. Extracorporeal Septoplasty: External and Endonasal Techniques. Facial Plast Surg. 2016.PubMed 26862960DOI
- Bikhazi N, Atkins JH. Office-Based Procedures for Nasal Airway Obstruction. Otolaryngol Clin North Am. 2018.PubMed 30017095DOI
- Gary CC. Pediatric nasal surgery: timing and technique. Curr Opin Otolaryngol Head Neck Surg. 2017.PubMed 28509670DOI
This article is an English translation of general health information that DOY JUN Plastic Surgery compiled in Korean from the summaries (abstracts) of papers in international academic journals. Treatment methods and results vary depending on each person's condition, so please consult a specialist for an accurate diagnosis and treatment plan.
