Septoplasty is a common procedure designed to correct a deviated septum, the wall of bone and cartilage that divides the nasal passages. The primary goal of this surgery is to improve nasal breathing by straightening the septum and optimizing airflow. While the majority of patients experience significant improvement, surgical outcomes are never guaranteed, and it is possible for a septoplasty to be unsuccessful in fully resolving symptoms. Understanding the potential for failure and the subsequent steps is important for anyone considering the procedure.
Defining Septoplasty Failure
“Failure” in the context of septoplasty is generally defined in two ways: the persistence of the original symptoms or the development of new complications after the procedure. The most common indication of an unsuccessful surgery is the continuation of nasal obstruction, meaning the patient still struggles to breathe through the nose. This lack of resolution suggests the initial cause of the breathing difficulty was not fully corrected or was misidentified.
A surgical failure can also involve complications that create new problems in the nasal airway. Examples include a septal perforation, a hole in the septum that can cause whistling noises, crusting, or nosebleeds. Another complication is the formation of synechiae, internal scar tissues that physically block the air passage. Studies indicate that approximately 1.1% to 3.2% of patients may require a revision surgery to address a failed outcome.
The definition of success is often subjective, relying heavily on the patient’s perception of improved breathing. Surgeons may measure success by objective metrics like airflow tests, but the patient’s experience of persistent congestion ultimately determines satisfaction. Failure is not confirmed until the nose has fully healed, which typically takes six to twelve months post-operation when all residual swelling has resolved.
Primary Reasons for Failure
A primary technical reason for septoplasty failure is an insufficient correction of the deviation, particularly in areas difficult to access. If the surgeon does not adequately address a deviation deep in the posterior part of the septum or a spur high up on the bony-cartilaginous junction, the structural blockage remains. Failure to recognize and treat a caudal septal deviation, the deviation closest to the nostrils, is another common cause, as this area is structurally important for supporting the nasal tip.
Another frequent cause of persistent nasal blockage is the failure to simultaneously address other anatomical issues, such as enlarged turbinates. The turbinates are structures that warm and humidify the air, and if they are enlarged (hypertrophied), they can continue to obstruct the airway even after a perfectly straight septoplasty. The surgeon must often perform a turbinate reduction along with the septoplasty to achieve a clear breathing passage. If the nasal valve, the narrowest part of the airway, is weak or collapses upon inhalation, a septoplasty alone will not fix the issue, leading to perceived failure.
Biological factors during the healing process can also contribute to an unsuccessful result. Cartilage has a natural tendency known as “memory” and may gradually spring back toward its original deviated position over time, especially if it was severely bent and not fully stabilized during the procedure. Post-operative complications such as a septal hematoma, a collection of blood under the lining of the septum, can lead to infection and subsequent cartilage damage or collapse. Excessive scar tissue formation (synechiae) between the septum and the nasal side wall is a healing complication that physically narrows the airway, causing new blockage.
Addressing Persistent or Returning Symptoms
When a patient experiences persistent breathing difficulties several months after septoplasty, the first step is a thorough diagnostic evaluation to pinpoint the exact cause of the remaining obstruction. This typically involves a complete physical exam, including nasal endoscopy, to visualize the entire nasal passage and identify any residual deviation, scar tissue, or untreated issues like chronic allergies or inflammation. Doctors usually wait at least six to twelve months before confirming a surgical outcome as a true failure, allowing post-operative swelling to disappear entirely.
Non-surgical management options are often attempted first to manage any residual symptoms. These include nasal steroid sprays or antihistamines if underlying allergies or chronic inflammation are contributing to the congestion. Saline rinses can also help to clear crusting and reduce inflammation in the nasal passages. This medical management may be enough to improve breathing without requiring further intervention, particularly if the remaining obstruction is minor.
If non-surgical treatments prove ineffective and a structural issue is confirmed, a revision septoplasty may be necessary. Revision surgery is often more challenging than the initial procedure because the surgeon is working with altered anatomy and scar tissue, which makes dissection more difficult. It may involve more advanced techniques, such as using cartilage grafts taken from the ear or rib to provide structural support and prevent the septum from bending again. The decision to pursue a second operation is made jointly between the patient and surgeon after a careful assessment of the risks and potential benefits.