Endoscopic Septoplasty: Surgical Correction of a Deviated Nasal Septum

Introduction

Septal deviation refers to a displacement of the nasal septum — the wall of bone and cartilage that separates the two nasal cavities. While minor deviations are common and asymptomatic, significant septal deviation can lead to nasal obstruction, sinus infections, snoring, and impaired airflow.

Endoscopic septoplasty is a minimally invasive surgical procedure that corrects the deviation using an endoscope, avoiding external incisions and offering a clearer, magnified view of the septal anatomy.

Anatomy of the Nasal Septum

The septum consists of:

Anterior cartilage (quadrangular cartilage)
Posterior bony part (vomer and perpendicular plate of the ethmoid bone)

Deviation may occur in one or both parts, causing narrowing of one nasal passage.

Indications for Septoplasty

Chronic nasal obstruction not responding to medication
Recurrent sinusitis due to impaired drainage
Difficulty breathing during exercise or sleep
Nosebleeds caused by turbulent airflow
Headaches related to nasal pressure
Cosmetic correction combined with rhinoplasty

Why Endoscopic Septoplasty?

Compared to traditional (open) septoplasty:

Minimally invasive
No external scars
Better visualization of deep-seated deviations
Lower postoperative pain
Faster recovery

Surgical Procedure Overview

1. Anesthesia

Typically performed under general anesthesia or local with sedation

2. Endoscopic Access

A rigid endoscope is inserted through the nostril for enhanced visualization
Deviated portions of cartilage and bone are precisely identified

3. Septal Correction

A small incision is made inside the nose
Mucoperichondrial flaps are elevated to access the septal framework
Deviated bone/cartilage is excised or reshaped
Flaps are repositioned and sutured if needed

4. Nasal Packing (optional)

Absorbable or non-absorbable packing may be used to prevent bleeding or septal hematoma

Postoperative Care

Nasal irrigation with saline
Avoid nose blowing for at least one week
Mild pain or congestion for a few days
Most patients return to normal activities within a week

Risks and Complications

Bleeding or infection
Septal hematoma
Septal perforation (rare)
Change in sense of smell (temporary)
Residual or recurrent deviation

Outcomes

Endoscopic septoplasty has a high success rate, with significant improvement in nasal airflow, quality of sleep, and overall breathing function. It may also be performed in conjunction with turbinate reduction or sinus surgery for combined nasal issues.