A deviated septum is a condition where the thin wall of cartilage and bone separating the nasal passages is crooked, restricting airflow and causing difficulty breathing. The procedure to correct this is called a septoplasty, which aims to straighten the septum and restore proper nasal function. While this surgery is highly successful for most people, new or returning symptoms are possible, though they are rarely caused by the original deviation itself.
The Nature of Septal Recurrence
The concept of a true recurrence, where the surgically corrected septum snaps back to its initial severe deviation, is rare following a properly performed septoplasty. The procedure typically involves reshaping, repositioning, or removing the most severely bent portions of the cartilage and bone. Once the bone is altered, it remains stable, but the cartilage component can pose a challenge.
Nasal cartilage possesses “cartilage memory,” which is its natural tendency to revert to its original, deviated shape over time. Surgeons account for this by using techniques like scoring or careful suturing to break this memory and stabilize the cartilage in a straight position. Even with these measures, a minor shift or re-warping of the cartilage can happen, especially in the caudal (front) part of the septum.
While the structural integrity of the newly straightened septum is stable, a new deviation can occur if the nose suffers a significant injury post-surgery. The rate of true re-deviation is relatively low, but the overall success rate for eliminating all breathing obstruction is not 100%. Many cases of perceived recurrence are related to other factors that affect nasal airflow, rather than the septum physically bending back into its former state.
Factors Contributing to Post-Operative Symptoms
Many patients who feel their breathing problem has returned are experiencing symptoms caused by factors other than a true septal recurrence. The most common cause of persistent symptoms is often a residual deviation, meaning the initial surgery did not fully correct a complex bend or left a difficult-to-reach area, such as the back of the septum, untouched. The caudal septum, which is the part closest to the nostril opening, is a frequent location for this type of persistent deviation.
Another significant factor is compensatory turbinate hypertrophy, the swelling of the turbinates—the structures that warm and humidify the air. Before surgery, the turbinates on the side opposite the deviation may have shrunk due to lack of airflow. Once the septum is straightened, the rapid increase in airflow can cause the turbinates on the now-wider side to swell excessively, creating a new obstruction.
The natural healing process can also lead to problems, scar tissue formation or synechiae. As the nasal lining heals, it can form bands of scar tissue between the septum and the side walls of the nose, which physically narrow the passage. An injury to the nose after the initial procedure, even a minor bump, can cause the still-healing cartilage to shift, leading to a new, secondary deviation.
Assessing Subsequent Septal Issues
It is helpful to distinguish between normal post-operative swelling and a persistent structural issue by monitoring the timeline of your symptoms. Significant swelling following a septoplasty is normal and can take several months to resolve, with some minor changes continuing for up to a year. If severe breathing difficulties persist beyond the first six to twelve months, it may indicate a deeper problem.
Symptoms that warrant professional attention include chronic, persistent blockage, especially if focused on one side of the nose, or an ongoing feeling of congestion despite using non-surgical treatments. Not all nasal obstruction is due to the septum; chronic allergies or inflammation can mimic the original symptoms.
The definitive assessment requires consultation with an ear, nose, and throat (ENT) specialist who can perform a thorough physical examination. This examination often involves nasal endoscopy, where a small camera is used to visualize the entire nasal cavity. This allows the specialist to differentiate between residual deviation, scar tissue, or other issues like turbinate swelling. In some cases, a CT scan may be used to provide a detailed view of the bony structures and sinuses to pinpoint the exact cause of the persistent obstruction.
Management and Treatment of Persistent Deviation
If the persistent symptoms are caused by inflammation or turbinate hypertrophy, non-surgical management is the first step. Treatment may include prescription nasal steroid sprays to reduce swelling and address underlying chronic conditions like allergic rhinitis. Addressing allergies can significantly improve airflow without the need for further intervention.
When a structural issue like a significant residual or recurrent deviation is confirmed, a revision septoplasty may be necessary. This secondary procedure is more complex than the first because the anatomy has been altered, and the amount of available septal cartilage may be limited. The surgeon might need to employ advanced techniques, such as using grafts (often cartilage taken from the ear or rib) to reinforce and stabilize the septum.
Revision surgery requires a highly experienced surgeon skilled in complex nasal reconstruction. Techniques like septal cartilage traction suturing or the placement of a caudal batten graft are used to correct the persistent deviation and prevent further shifting. The goal is to create a stable, straight septum that allows for optimal nasal breathing.