Deviated septum (septal deviation)

The nasal septum is the wall that divides the nasal cavity into two. The front part of the septum is made of cartilage and the back part of bone. The ideal situation is when the septum is exactly in the middle and both nasal cavities are of the same width. In 80% of people the septum is not exactly on the midline, but in most cases this does not cause any complaint. Deviation of the septum away from the midline is called septal deviation.

What are the causes of septal deviation?

The causes of septal deviation vary. Rarely, some babies are born with a septal deviation due to a curved development of the septum in the womb. Sometimes the septum is bent as the newborn passes through the birth canal. During childhood and adolescence, collisions, falls, trauma and sports injuries can cause septal deviation. Septal deviation can also arise during growth as a result of the bony and cartilaginous parts of the septum developing at different rates.

What are the symptoms of septal deviation?

The most common consequence of septal deviation is difficulty breathing through the nose. Nasal obstruction mostly occurs on the side where the septum is deviated, but it may also cause difficulty breathing on both sides, either constantly or sometimes on the right and sometimes on the left.

Main complaints:

• Unilateral or bilateral nasal obstruction
• Recurrent nosebleeds
• Recurrent sinusitis
• Sometimes facial pain, headache, postnasal drip
• Difficulty breathing during sleep (especially in children).

In people with mild septal deviation, complaints appear only during a cold. As a result of the swelling caused by respiratory tract infections, the normally mild nasal obstruction increases further, and the complaints pass once the patient recovers.

How is septal deviation diagnosed?

After listening to your complaint, your doctor will ask whether you have had any nose-related trauma or surgery. Then the condition of the inside of the nose and the septum will be examined. This is done with an instrument used to open the nostrils, or with optical devices called endoscopes. No other examination is needed to diagnose septal deviation. However, if your doctor thinks that your complaints are related to sinusitis or allergy, appropriate tests and laboratory analyses may be requested.

How is septal deviation treated?

The treatment is surgical, and the operation is called septoplasty. This operation can be performed under either general or local anaesthesia. In the operation the septum is corrected through an incision made inside the nostrils that is not visible from the outside after surgery. The operation lasts 1–1.5 hours. At the end of the operation, a silicone splint is placed in the nasal cavity to support the corrected septum and hold it in place. It is removed within a few days after surgery.

After septoplasty:

• Because of the splints placed after the operation, your nose may be partly or completely blocked, and you may breathe through your mouth.
• After the operation, nasal secretion will increase, and there will be a reddish discharge both from the front and from the back of the nose. This is not bleeding; it will gradually decrease after the operation and will continue until the splints are removed.

What should you pay attention to after septoplasty?

• The patient spends the first few hours after the operation at the clinic. You can go home after your doctor's examination and advice.
• At first there may be a very small, bloody nasal discharge. Later the colour of the discharge will become lighter.
• There is no dietary restriction related to the operation. After the operation there may be mild nausea. This is due to the blood discharge you have swallowed. This discharge irritates the stomach and can cause vomiting.
• Do not touch or move your nose.
• Use the medicines prescribed by your doctor correctly. Discomfort after the operation is individual. A painkiller is given when needed. You should use it as soon as you have pain.
• Do not use aspirin at all for 1 week before and 1 week after the operation, because aspirin increases the likelihood of bleeding.
• Do not draw tap water into your nose.
• You may bathe, as long as it is not for a long time and not too hot.
• After the operation, dryness and crusting may form in the nose. To reduce them, use a steam device or breathe in the steam of boiled water 3–4 times a day.

Recovery is completed in 2–6 weeks. During this time, attend your doctor's follow-up examinations.

When should you contact your doctor?

• If your temperature is above 38 degrees
• If you have pain that cannot be controlled with medication
• If you have severe bleeding.