A deviated septum occurs when the thin wall of bone and cartilage separating the nasal passages is displaced, making one nasal airway smaller than the other. This condition can impede airflow, leading to difficulty breathing through the nose. Many individuals have some degree of septal deviation, though it often causes no noticeable symptoms. Septoplasty is a surgical procedure designed to correct a significantly deviated septum, improving nasal airflow and alleviating associated breathing difficulties.
Reasons for Re-Deviation
While septoplasty is generally effective in correcting a deviated septum, re-deviation is possible. One primary reason is subsequent trauma to the nose. An injury, even minor, can cause the corrected septum to shift out of alignment again, particularly in the initial months following surgery when nasal structures are still healing and stabilizing.
Another contributing factor is an incomplete initial correction or residual deviation from the first surgery. If the original procedure did not fully straighten the septum or address underlying structural issues, parts of the deviation might persist or become more apparent. The inherent “memory” of cartilage also plays a role, as it tends to revert to its original, deviated shape despite surgical efforts. Surgeons often employ techniques to counteract this, but it remains a biological challenge.
Scar tissue formation during the healing process can also contribute to re-deviation. As the body repairs the surgical site, scar tissue develops; excessive or uneven scarring can exert a pulling force, gradually drawing the septum back into a deviated position. In younger patients, continued growth and development of facial bones and cartilage after septoplasty can also influence septal position, potentially leading to a new deviation.
Signs of a Re-Deviated Septum
If a septum re-deviates after surgical correction, symptoms often resemble the original deviation. The most common sign is persistent or recurring nasal obstruction, affecting one or both nostrils and sometimes alternating sides. This obstruction makes it difficult to breathe comfortably through the nose, particularly during physical activity or at night.
Individuals might experience chronic nasal congestion, a feeling of stuffiness or fullness. Frequent nosebleeds can occur if re-deviation exposes the septal lining to drying air currents, leading to irritation and crusting. Recurrent sinus infections are another common symptom, as a re-deviated septum can impair normal sinus drainage, creating an environment conducive to infection.
Other signs include facial pain or pressure, often localized around the nose or forehead, resulting from blocked sinuses or direct pressure from the deviated structure. Noisy breathing during sleep, snoring, or worsening sleep apnea symptoms may also indicate re-deviation, as restricted airflow during sleep becomes more pronounced.
Management of Recurrence
When a re-deviated septum is suspected, consulting an ear, nose, and throat (ENT) specialist is important for proper diagnosis. The specialist will conduct a thorough physical examination, often utilizing a nasal endoscope for a detailed view of the nasal passages and septum. Imaging studies like a CT scan may be performed to assess the extent and nature of the re-deviation, particularly if it involves deeper bony structures.
Management depends on the re-deviation’s severity and its impact on quality of life. For mild re-deviations causing minimal symptoms, observation may be recommended. Medical management can help alleviate symptoms, though it does not correct the underlying structural issue. This may include nasal corticosteroid sprays to reduce inflammation and swelling, or decongestants and antihistamines to manage congestion and allergy-related symptoms.
For significant re-deviations causing bothersome symptoms despite medical management, revision septoplasty may be considered. This second surgical procedure aims to re-straighten the septum. Revision surgeries can be more complex than initial septoplasties due to altered nasal anatomy, scar tissue from the previous operation, and potentially limited cartilage for grafting. Surgeons may utilize techniques like spreader or batten grafts, often sourced from the patient’s own cartilage or a donor, to provide additional support and maintain the septum’s new position.