There is a thin piece of cartilage and bone called the nasal septum between the right and left side of your nose. In adults it is about 7cms long. In some people this septum is bent to one side of the causing nasal blockage. This may be due to an injury to the nose but sometimes it just grows that way. An operation can correct this and improve breathing via the nose.
Why have septal surgery? If you have a blocked nose because of a bent septum an operation will help. Sometimes we need to straighten out a bent septum to allow room to do other operations, such as sinus surgery.
The operation is not meant to change the way your nose looks. If a bend in the nasal septum is associated with a twist or change in the appearance of the nose then septoplasty is combined with an operation on the outside of the nose and this is called septorhinoplasty (cosmetic nasal surgery).
Do I have to have septal surgery? A bent septum will not do you any harm so you can just leave it alone if you want to. Often it causes no problems at all. Only you can decide if it is causing you so much nasal blockage that you want an operation. Only an operation can fix a bent septum. Sometimes the lining of the nose can swell, due to hayfever. This can cause nasal blockage that would not change with septal surgery. Nose spray or drops can help treat this swelling in the nose and occasionally turbinate reduction may also be necessary.
How is the operation done? The operation takes about 45 minutes and is performed whilst you are asleep. It is usually done as day stay surgery. The operation is performed inside your nose – there will be no scars or bruises on your face. A cut inside your nose is used to straighten out the septum (by taking away some of the cartilage and bone). The cut is then closed with some dissolvable stitches, these fall out by themselves. Very complicated cases may require an external rhinoplasty approach. This is where a cut is made across the skin, under the nose. This allows much better exposure and correction of the underlying bony skeleton.
Packs and splints: A dressing may be placed in each side of the nose to keep things in place and prevent bleeding. The dressings are called ‘packs’ and they will block your nose up so that you have to breathe through your mouth. They are taken out 6 hours after surgery (or the following morning if you stay overnight). You may get a little bit of bleeding when the packs come out – this will settle quickly. Commonly nasal packs are not necessary. Sometimes small pieces of plastic (splints) are used in your nose to prevent scar tissue from forming. T hey are called ‘splints’ and are taken after about a week.
After the operation:
Your nose will be tender for a few weeks after the surgery. Do not blow your nose for about a week, or it may start bleeding. If you are going to sneeze, sneeze with your mouth open to protect your nose. You may get some blood coloured discharge from your nose for the first two weeks or so – this is normal. Your nose will be blocked both sides like a heavy cold for 10-14 days after the operation. You will be given nose drops and spray to use after surgery (see nasal surgery discharge advice) It may take up to three months for your nose to settle down and for your breathing to be clear again. Try to stay away from dusty or smoky places.
How long will I be off work? Usually people go home on the day of surgery. However you need to rest at home for one week. If you do heavy lifting and carrying at work you should take two weeks off. You should avoid piping hot food and fluids for 2 weeks after the surgery, as this can make it more likely for you to have a nose bleed. You can take a bath or shower. You should not play football or other contact sports for 6 weeks.
What can go wrong?
Septal surgery is safe, but there are some risks. Sometimes your nose can bleed after this operation, and packs may be placed into your nose to stop it. This can happen within the first 6 – 8 hours after surgery or up to 5 – 10 days after surgery. Rarely you may need to return to the operating theatre to stop the bleeding.
Infection in your nose is rare after this operation but if it happens it can be serious, so you should see a doctor if your nose is getting more and more blocked and painful. Rarely, the operation can leave you with a hole in your septum inside the nose going from one side of your nose to the other. This can cause a whistling noise when you breathe, crusting with blockage or nosebleeds. Most of the time it causes no problems at all and needs no treatment. Further surgery can be carried out if necessary to repair a hole in the septum. Very rarely you may find that the shape of your nose has changed slightly, with a dip in the bridge of your nose. Most people do not notice any change, but if you are not happy with it, it can be fixed with surgery. Very rarely, you can have some numbness in the teeth, which usually settles with time.
Is there any alternative treatment?
Only an operation can fix a bent septum, but nose spray or drops can help treat swelling in the nose which might be making your nose feel blocked.