The nasal septum is the cartilaginous and bony wall dividing the nasal cavity into halves; it is composed of a central supporting skeleton covered on each side by mucous membrane. The front portion of this natural partition is a firm but bendable structure made mostly of cartilage and is covered by skin that has a substantial supply of blood vessels. Ideally, the septum would be exactly midline, separating the left and right sides of the nose into passageways of equal size.
However, approximately 80 percent of all nasal septums are deviated off-center and usually do not cause any problems. A "deviated septum" occurs when the septum is severely shifted away from midline. The most common symptom from a badly deviated septum is nasal obstruction resulting in difficulty breathing through the nose. The symptoms are usually worse on one side, and sometimes actually occur on the side opposite the bend. In some cases the crooked septum can block the natural drainage pathways of the sinuses and predispose one to chronic or recurrent sinusitis. Septal deviations can be congenital or caused by trauma.
A deviated septum may cause one or more of the following:
- Blockage of one or both nostrils
- Nasal congestion, sometimes one-sided
- Frequent nosebleeds
- Frequent sinus infections
- At times, facial pain, headaches, postnasal drip
- Noisy breathing during sleep (in infants and young children)
Patients with even mild septal deviations can experience symptoms when they have an upper respiratory tract infection or “cold”. In these individuals, the respiratory infection triggers nasal inflammation that temporarily increases any mild airflow problems related to the already compromised nasal airway.
Diagnosis of a deviated septum involves examination of the general appearance of your nose, including the position of your nasal septum. This will entail the use of a bright light and a nasal speculum to inspect the inside surface of each nostril and further into the nasal airway.
Sometimes a telescope may be used for detailed examination.
Surgery may be the recommended treatment if patients are symptomatic from the deviation.
“Septoplasty” is the preferred surgical treatment to correct a deviated septum. This procedure is not generally performed on minors, because the cartilaginous septum grows until around age 18.
Septoplasty is usually performed through the nostrils, accordingly, no bruising or external signs occur. The surgery might be combined with a rhinoplasty, in which case the external appearance of the nose is altered and swelling/bruising of the face is evident. Septoplasty may also be combined with sinus surgery. Newer minimally invasive endoscopic septoplasty techniques may also be utilize in certain patients. During the surgery, badly deviated portions of the septum may be removed entirely, or they may be readjusted and reinserted into the nose.
The time required for the operation averages about one to one and a half hours, depending on the severity of the problem. It can be done with a local or a general anesthetic, and is usually done on an outpatient basis. After the surgery, stents may be placed to prevent scarring and promote proper healing. The procedure is generally well tolerated.