Deviated Septum and Septoplasty
The Nasal Septum and the Deviated Septum
We have all heard about the “deviated nasal septum” but what exactly is it? Should every nasal septum be completely straight? If I can’t breathe is it the result of this deviated septum? First, let start with the definition of a nasal septum.
What Is A Nasal Septum?
The wall of bone and cartilage covered with moist soft tissue that divides the left and right side of your nose is the nasal septum. It starts in the front of your nose and divides your nostrils and continues until in the back into your nose it ends and the breathing passages join again. The nose normally will swell on one side and decongest on the other side (the nasal cycle) so it is normal for breathing to “flip back and forth” between sides of the nose.
What Is A “Deviated Nasal Septum”?
All nasal septums have bends in them. There is no such thing as a perfectly straight septum. A septum is termed “deviated” when it is crooked enough to block the breathing on one or both sides of the nose. If you don’t have trouble breathing then you don’t have a “deviated nasal septum”. It may be bent, but if that doesn’t bother you then you don’t need to do anything about it.
Are There Other Reasons Not To Breathe Well?
Yes. You may also have inferior turbinate hypertrophy which is swelling of the tissue on either side of the inside of your nose that can block your breathing. Nasal valves have been shown to be a common as a cause of nasal obstruction as the deviated nasal septum. These are the narrowest areas where air passes inside the nose and opening the valves can improve airflow and breathing. Other causes include allergies, nasal polyps, nasal tumors, trauma, congenital defects, autoimmune diseases, and others. Your otolaryngologist can look into your nose with an endoscope and let you know if there are blockages.
Why Is A Deviated Septum Important?
Humans are designed to normally breathe through our noses. Nasal obstruction can lead to difficulty sleeping and working out and can be the cause of snoring. Sleep apnea is caused by severe airway obstruction and can cause high blood pressure, heart and lung failure and even heart attacks. Being able to breathe better from your nose can dramatically improve your quality of life.
Preparation For A Deviated Septum
You will meet with Dr. Mourad where he usually spends an hour going over everything related to your surgery. He will evaluate and make sure that he can specifically tailor a custom care plan to your exact needs. During the consultation, Dr. Mourad will determine the exact nature of your complaints and the exact causes. He may prescribe medications that will assist in your complaints. Once a tailored plan is made, Dr. Mourad and his staff will take you through all the necessary information needed to make sure that your surgery happens without issue. We take care of the details so that you can have the most enjoyable experience.
Dr. Mourad views treating his patients to be nothing short of a privilege and an honor and enjoys taking the time to get to know his patients and fully understand their issues. Dr. Mourad’s office provides a boutique experience that takes you out of the mindset of being at the doctor’s office. It is a warm, comfortable environment, providing a bespoke experience.
Will Medications Help My Deviated Septum?
If you have a mild septal deviation then yes. Nasal steroids like Flonase can give you just enough decongestion to make you breathing better. Antihistamines will help with allergies that may improve your breathing as well. Nasal saline rinses feel good for many patients and may rinse away stagnant mucus, allergens, and impurities. Singulair can be effective in decreasing nasal congestion. Other decongestants in pill or liquid form can decongest the nose but the pills can increase blood pressure and the sprays can be addictive and give more congestion after just using a couple of days. No medicine will actually straighten the cartilage and bone that may be obstructing your nose. Ask your doctor before beginning a longer course of medication.
How Can I Straighten A Deviated Nasal Septum?
The only way to physically make the septum more even inside your nose is with a surgical procedure called a septoplasty. The surgery you have will depend on where you have a deviation and where you have your obstruction. If your septum deviates deeper inside of your nose then all otolaryngologists are trained to remove the deviated portion and give you a straighter septum. If you have a very anterior septal deviation, near your nostrils or even extending into your nostrils, you may want to have a facial plastic surgeon correct your septum. Facial plastic surgeons have extensive training in the cosmetic and functional front of your nose.
How Is The Recovery From A Septoplasty?
The recovery is not fun at all although it is generally not very painful. Most patients do have obstruction of both sides of the nose that lasts for most of the week or even until you see your doctor. Dr. Mourad provides pain medication if you need it but most of the time Tylenol or no medication is used. You return to our office one week after your procedure and your nose is decongested with any crusts removed from inside of the nose. Most patients are breathing better within a couple of weeks as the swelling inside of the nose improves.
- Anesthesia: Depending on the type of anesthesia administered, patients may have a reaction. This is exceedingly rare, and it is important to discuss your personal risk with your anesthesiologist.
- Infection: In rare circumstances patients may develop an infection following septoplasty procedures. These are usually managed with intraoperative and postoperative antibiotics.
- Bleeding: Although rare, patients may have bleeding episodes following nasal surgery. Your surgeon will likely order blood work to make sure you are healthy enough to undergo the procedure. Your surgeon should also go over all medications and supplements that you take to minimizing bleeding risk.
- Need for secondary and revision surgeries: Depending on the complexity of the surgery, sometimes multiple surgeries are required to ensure the best aesthetic and functional outcomes.
- Scarring and Poor wound healing: Some patients with underlying medical conditions or more prone to poor wound healing and scarring. It is important to understand these risks prior to embarking on a treatment strategy.
- Local Reactions: Sometimes you may experience local reactions to the ointments, sutures, taping material, and nasal packing used during surgery and postoperatively. This is rarely seen, but may occur. If you have any allergies to certain materials or adhesives you should discuss with your surgeon.
- Changes in nasal sensation: Patients may experience altered sensations in their nose (pain or numbness). This is exceedingly rare, and if it occurs it is most often temporary.
- Persistent or Recurrent Nasal Airway Obstruction: Although the goal of surgery is to enhance breathing, sometimes patients may develop persistent or recurrent airway problems. This is rare, but oftentimes is due to poor wound healing or scarring (see above). This may require secondary surgeries to optimize outcomes.
- Continued need for medical therapies: If you have breathing complaints related to medical causes (e.g. allergies), then you may continue to require medical nasal therapies (e.g. nasal steroids and sprays).
- Nasal Septal Perforation: A hole in the septum may develop. Oftentimes these do not cause any problems. Other times however, they may cause crusting, bleeding, and breathing difficulties. These require secondary surgeries for repair.
Can I Have Other Procedures With My Deviated Septum Surgery?
Yes. You can have a turbinate reduction or valve repair to further improve breathing. You can also have sinus surgery or removal of polyps to improve sinus function. If you have a bump or other areas of your face that you would like addressed then you can have cosmetic surgery at the same time.
Does Insurance Pay For Deviated Septum Surgery?
Most insurances will pay for functional surgery of the nose, that is, surgery that improves the ability of your nose to work well. Our office will check your benefits for you and let you know what your responsibility will be. We don’t believe in patient surprises and will keep you informed throughout the process. You may have co-pays, deductibles, and co-insurance which we will tell you about. We try to keep our services affordable as we all have financial responsibilities. Of course, cosmetic surgery is never covered by insurance.
How Can Dr. Mourad Help Me With My Deviated Nasal Septum?
Most patients who come into our office have been on all of the medications and may still not breathe well. We will discuss all the options for treatment with you. We feel that educated patients are happier and more realistic about their treatment. Our office will check your benefits and deal with insurance as much as possible. Dr. Mourad is an expert at all forms of nasal surgery and is happy to discuss your care with you. Please let us know how we can help you.
Select Relevant Publications
Kadakia S, Mourad MW, and Ducic Y. Supraclavicular Flap Reconstruction of Cutaneous Defects Has Lower Complication Rate than Mucosal Defects. Journal of Reconstructive Microsurgery. 2017 May; 33(4):275-280. Link to Article.