Deviated Septum and Septoplasty

What is a nasal septum and what are turbinates?

The nasal septum is the cartilage and bone that divides the inside of your nose into a left and a right half. The turbinates are bony swellings on the outer walls of the nasal cavities. Both the nasal septum and turbinates are covered with a delicate mucosal tissue that regularly swells to control airflow in the nose. The purpose of the septum and turbinates is to purify, warn and moisturize the air we breathe before it gets to the even more delicate lungs.

Straight Nasal Septum

What is a deviated septum and what are enlarged turbinates?

A deviated nasal septum is when the dividing bone or cartilage of the middle of the nose is twisted to one or both sides and blocks the nose. Turbinate hypertrophy (enlarged turbinates) are excessive swelling of the turbinates that block the nose. Nasal congestion can be caused by allergies, viral infections, dust or an anatomical obstruction inside the nose. These conditions can make breathing difficult, cause sinusitis, create snoring, daytime fatigue, and sleep apnea. Nasal congestion can sometimes be successfully treated with over the counter (OTC) and prescription oral medication or nasal sprays.

Deviated Nasal Septum

What is a septoplasty and what is inferior turbinate reduction?

Septoplasty is a surgery to correct a deviated nasal septum that is bent to a degree that it blocks normal breathing or prevents healthy sinus function. During septoplasty, your deviated nasal septum is straightened and repositioned into the middle of your nose. If the turbinates are large enough to block normal airflow inside the nose, then removing or outfracturing the turbinate bone and shrinking the tissue around the bone can improve the airway and is called a turbinate reduction.

When does a deviated septum need surgery?

Fixing a crooked or fractured nasal septum is termed a septoplasty. Turbinate reduction is called a turbinoplasty. You may need these procedures if you have tried appropriate medical management for your congestion that has not given you adequate breathing improvement. The purpose of the surgeries is to improve breathing, correct sleep apnea, or to decrease or eliminate sinus infections. The procedures are performed through the nostrils to reduce the enlarged turbinates and straighten the deviated nasal cartilage and bone.  No external incisions are needed. The operating time is usually less than an hour and can be performed in the office, hospital, or ambulatory surgery center. You probably don’t want to be awake so general anesthesia is usually used. Patients recover and generally get to go home an hour or two later. Breathing may be noticeably improved as soon as one week after the procedure. Breathing continues to improve over the next 12 months.

Are a deviated septum and turbinate hypertrophy related?

Yes. If the septum is crooked you will have a higher likelihood of inferior turbinate hypertrophy as well. A septal deviation will allow turbinate hypertrophy because the structures inside the nose tend to grow to fill any open area. A deviated septum to the right will make a space for the left turbinate to grow. Both septal deviation and turbinate hypertrophy can be addressed during surgery. If you were to just straighten the septum without reducing the turbinates, you could create an obstruction on the opposite side.

Turbinate hypertrophy from a Deviated Septum

Is a deviated nasal septum congenital?

Was this something I got from my parents? One theory is that when a baby’s head passes at birth the pressure causes microscopic bone and cartilage fractures in the nasal septum that twist as we grow. Any trauma during adolescence and adulthood, such as a nasal fracture, to the nose can cause a crooked nose or nasal septum. As we all get older, the cartilage and connection between the different cartilages in our nose will stretch and grow. It’s not your imagination that your nose looks different than when you were younger. You may have the exact same nose on the inside and outside as one of your parents from the genetic code.

I don’t want my nose packed.

Good. Dr. Bennett doesn’t either. Routine packing of the nose causes discomfort and scar tissue that is not necessary. Dr. Bennett finds that packing the nose is very rarely required. Surgical techniques continue to evolve and have  advanced exponentially in the past 20 years. Today, doctors have a much greater understanding of how the nose functions and heals. Packing placement and removal cause trauma to the delicate nasal mucosa. Packing does not prevent bleeding but will prevent topical decongestants from reaching bleeding sites. Packing also keeps nasal saline from cleaning the inside of the nose. Just because your parents had packing, and hated it, doesn’t mean you will suffer the same treatment.