The cartilage and bone partition that divides the nasal cavity in two is called the septum. It rarely sits exactly in the middle; most people have some degree of deviation, and most of it causes no symptoms.
When symptoms do appear the picture changes: one-sided blockage, sleeping with the mouth open, snoring, frequent nosebleeds and reduced sense of smell all affect daily life. Septoplasty is the operation aimed at relieving those symptoms.
What is a deviated septum?
A deviated septum is a partition inside the nose that has shifted to one side. It may be present from birth or develop after an injury in childhood or adult life.
| Symptom | Underlying cause |
|---|---|
| One-sided nasal blockage | Narrowing of the airway on the tighter side |
| Sleeping with the mouth open, dry mouth | Inadequate nasal breathing |
| Snoring, poor sleep quality | Increased upper airway resistance |
| Frequent nosebleeds | Drying of the mucosa over the deviated area |
| Facial and headache | Contact between the septum and the side wall |
| Reduced sense of smell | Airflow not reaching the olfactory region |
| Recurrent sinusitis | Impaired ventilation of the sinus openings |
How is the decision made?
The decision follows the symptoms, not the appearance. Nobody needs surgery simply "because the septum is deviated".
The order of assessment:
- Defining the complaint — how long it has been present, which side, day or night
- Examination — septum, turbinates and nasal valve assessed separately, endoscopically
- Excluding allergic and inflammatory causes — where present, medical treatment is tried first
- Assessing the response to medical treatment
- The surgical decision — if structural narrowing persists and affects quality of life
The clinical indicators for septoplasty published by the American Academy of Otolaryngology–Head and Neck Surgery suggest a similar sequence: surgery is planned on the basis of documented obstruction with accompanying symptoms.
Surgery or medication?
This question has been studied extensively.
- A multicentre pragmatic randomised controlled trial in the Netherlands (The Lancet, 2019) reported that septoplasty gave better results than medical management in adults with nasal obstruction due to a deviated septum.
- The NAIROS trial in the United Kingdom (2024) showed that septoplasty produced clear improvement in patient-reported nasal symptoms compared with medical management.
- A systematic review and meta-analysis pooling randomised trials reached a similar conclusion.
These findings show that a structural deviation will not resolve with medication. Where allergy, rhinitis or sinusitis accompany the picture, however, their treatment is planned before or alongside surgery.
How is the operation performed?
Septoplasty is usually carried out under general anaesthesia and takes 30–60 minutes.
- An incision inside the nose — nothing is cut externally
- Elevating the mucosa — reaching the cartilage and bone of the septum
- Straightening the deviated portions — corrected in place, or removed, straightened and replaced
- Preserving the supporting framework — enough cartilage is left to prevent collapse of the nose
- Turbinate reduction where required
- Replacing and securing the mucosa
Because no external incision is made, septoplasty alone does not change the outward appearance of the nose.
Septoplasty or septorhinoplasty?
| Septoplasty | Septorhinoplasty | |
|---|---|---|
| Purpose | Breathing only | Breathing + external shape |
| Incisions | Inside the nose | Inside the nose (± columella) |
| External appearance | Unchanged | Changed as planned |
| Duration | 30–60 minutes | 2–3 hours |
| Splint | Usually not needed | Required |
Where there is both a breathing complaint and a concern about shape, doing both in one session is preferred, as it avoids a second operation and a second recovery. For details, see the rhinoplasty page.
How does recovery progress?
| Period | What to expect |
|---|---|
| First 2–3 days | Blockage, light oozing, crusting |
| Days 3–5 | Packing removed if used, breathing begins to ease |
| Week 1 | Return to desk-based work |
| Weeks 2–3 | Clear improvement in breathing |
| Months 1–3 | Healing inside the nose completes |
During recovery:
- Regular saline rinsing reduces crusting.
- Blowing the nose is avoided in the first days.
- Heavy exercise is postponed for 2–3 weeks.
- Hot showers, saunas and steam baths are not advised in the first weeks.
What are the risks?
Septoplasty has a well-documented safety profile, but like any operation it carries risk:
- Bleeding
- Infection
- Perforation of the septum
- Adhesions (synechiae) inside the nose
- Symptoms partly persisting or not improving as much as hoped
- Temporary change in the sense of smell
- Change in the shape of the dorsum from loss of support (if too much cartilage is removed)
This list is not exhaustive; risks specific to you are discussed separately during examination and the informed consent process.
The degree of relief achieved after surgery varies between individuals. Where conditions such as allergic rhinitis persist, medical treatment may need to continue after surgery as well.
