Septoplasty Surgery: Indications, Techniques, and Outcomes

Abstract

Septoplasty is a surgical procedure performed to correct a deviated nasal septum, a condition that can result in chronic nasal obstruction, impaired sinus drainage, and reduced quality of life. This essay explores the anatomical basis of septal deviation, indications for surgical correction, operative techniques, postoperative care, complications, and outcomes. Septoplasty remains a safe and effective intervention when conservative management fails, and is often combined with other procedures, such as turbinate reduction or rhinoplasty, to optimize nasal function.

Introduction

The nasal septum is a critical anatomical structure composed of bone and cartilage, separating the left and right nasal cavities. A deviation of this septum—whether congenital or acquired—can significantly impair nasal airflow and predispose individuals to a host of sinonasal complications. Septoplasty is the primary surgical technique used to realign the septum and restore functional nasal breathing. It is among the most frequently performed otolaryngologic procedures worldwide.

Anatomy and Pathophysiology

The nasal septum consists of the quadrangular cartilage anteriorly, the perpendicular plate of the ethmoid bone superiorly, and the vomer inferiorly. A deviated septum may involve any or all of these components and can be classified as cartilaginous, bony, or mixed.

Septal deviation often results in:

• Airflow obstruction, leading to mouth breathing or sleep-disordered breathing

• Altered sinus drainage, causing recurrent sinusitis

• Turbinate hypertrophy on the contralateral side due to compensatory changes

• External nasal deformity in severe cases

Indications for Septoplasty

Septoplasty is indicated when conservative management, such as intranasal corticosteroids or decongestants, fails to alleviate symptoms. Common indications include:

• Chronic nasal obstruction not responding to medical therapy

• Recurrent sinus infections due to impaired drainage

• Epistaxis (nosebleeds) related to septal deviation

• Nasal trauma with septal deformity

• Obstructive sleep apnea in conjunction with other interventions

• Facilitation of other intranasal procedures (e.g., endoscopic sinus surgery)

Preoperative Evaluation

A thorough history and physical examination are crucial. Anterior rhinoscopy and nasal endoscopy allow visualization of the septum and associated pathology. Imaging studies (e.g., CT scan) may be useful when evaluating sinus disease or complex anatomical variations.

Key considerations include:

• Patient’s symptoms and quality of life

• Degree and location of deviation

• Coexisting conditions (e.g., allergic rhinitis, turbinate hypertrophy)

Surgical Technique

Anesthesia and Preparation

Septoplasty can be performed under local or general anesthesia, depending on patient factors and surgeon preference. The procedure is typically done as an outpatient surgery.

Surgical Steps

1. Incision: A hemitransfixion or Killian incision is made inside the nasal cavity.

2. Elevation of mucoperichondrial flaps: These are carefully elevated to expose the septal cartilage and bone.

3. Correction: Deviated segments are either excised, repositioned, or reshaped.

4. Stabilization: The septum may be sutured or supported with splints to maintain its new position.

5. Closure: Incisions are closed using absorbable sutures.

In some cases, submucous resection or endonasal septoplasty is performed, and adjunctive procedures like inferior turbinate reduction or functional endoscopic sinus surgery (FESS) may be combined.

Postoperative Care

• Nasal packing (if used) is typically removed within 24–48 hours.

• Intranasal splints are removed in 5–7 days.

• Saline nasal irrigation is encouraged to reduce crusting and promote healing.

• Avoidance of nose blowing, strenuous activity, and nasal trauma for 1–2 weeks is advised.

Follow-up visits are essential for monitoring healing and addressing complications early.

Complications

While septoplasty is generally safe, complications may occur, including:

• Bleeding and hematoma

• Septal perforation

• Infection or abscess formation

• Persistent nasal obstruction

• Changes in nasal shape or tip support

• Adhesions (synechiae) between the septum and turbinates

• Anosmia or hyposmia (rare)

Meticulous surgical technique and proper postoperative care reduce the risk of complications.

Outcomes and Prognosis

Numerous studies report high patient satisfaction following septoplasty. Success rates for symptom improvement range from 70% to 90%. Long-term relief from nasal obstruction, better sleep quality, and fewer infections are commonly noted. However, up to 15% of patients may require revision surgery due to incomplete correction or postoperative deviation.

Conclusion

Septoplasty is a cornerstone procedure in the management of nasal obstruction caused by septal deviation. It requires precise anatomical knowledge and careful patient selection. While complications are uncommon, a thorough understanding of surgical principles and postoperative care is essential to ensure optimal outcomes. Continued advancements in endoscopic techniques and imaging have enhanced the safety and efficacy of this time-tested operation.