The nasal septum is the thin wall separating the left and right nasal passages, composed of bone in the back and cartilage in the front. When this partition is displaced from the center, it is medically termed a deviated septum, often colloquially referred to as a crooked septum. A significant portion of the population has some degree of deviation, though for many, the misalignment is slight enough to cause no functional issues. When the deviation is substantial, however, it can lead to breathing difficulties and other health concerns that necessitate intervention. The available options range from managing the resulting symptoms with medication to surgical correction of the underlying structure.
Understanding a Deviated Septum and its Causes
The structure of the nasal septum relies on septal cartilage in the flexible front portion and the ethmoid and vomer bones for rigid support posteriorly. A deviation occurs when these components shift laterally, narrowing one or both nasal passages. This structural issue may be present from birth, known as a congenital deviation, sometimes resulting from pressure during fetal development or trauma sustained during delivery.
The more common cause is acquired trauma sustained later in life. A direct impact to the nose from contact sports, accidents, or falls can forcibly displace the septum. Deviations may also develop or worsen during adolescence due to asymmetrical growth rates between the septum and the surrounding facial skeleton.
Common Symptoms and Diagnosis
The most frequent symptom of a significant septal deviation is nasal obstruction, resulting from reduced airflow through the narrowed passage. This blockage is often more pronounced on one side but can affect both, especially when the nasal lining swells due to colds or allergies. The altered airflow can also lead to frequent nosebleeds, as the mucosal surface on the narrower side becomes excessively dry and irritated.
Patients may also experience loud breathing or chronic snoring during sleep because the restricted passage forces air through a smaller space. Diagnosis typically begins with a physical examination by an otolaryngologist, often called an ENT specialist. The specialist uses a nasal speculum or a nasal endoscope to visually inspect the internal structures and determine the location and severity of the septal misalignment.
Non-Surgical Management Options
Non-surgical methods manage the symptoms caused by a crooked septum but do not physically correct the deviation. These treatments focus on reducing inflammation and clearing congestion to maximize available airflow space. Topical nasal steroid sprays are frequently recommended due to their powerful anti-inflammatory effects on the nasal lining, shrinking swollen tissue.
Decongestant medications, available as oral tablets or nasal sprays, reduce swelling by constricting blood vessels within the nasal mucosa. Nasal decongestant sprays should be used for only a few days to avoid rebound congestion, a condition where symptoms worsen upon stopping the medication. Saline rinses flush out excess mucus, allergens, and debris, improving the function of cilia that maintain clear airways.
Surgical Correction Septoplasty Procedure
For individuals whose symptoms are not adequately managed by conservative measures, the definitive treatment option is a surgical procedure known as septoplasty. The purpose of a septoplasty is functional: to straighten the septum and improve nasal breathing without altering the external appearance of the nose. This procedure is generally performed on an outpatient basis under local anesthesia with sedation or general anesthesia, depending on the extent of the correction needed.
During the procedure, the surgeon makes a small incision entirely within the nose to access the septum, ensuring there are no external scars. The surgeon carefully lifts the mucosal lining away from the underlying bone and cartilage. Once exposed, the crooked portions of the cartilage and bone are reshaped, trimmed, or selectively removed and repositioned in the center of the nasal cavity. The mucosal lining is then laid back over the straightened framework and secured with dissolvable sutures.
A septoplasty is often combined with a turbinate reduction to optimize breathing. Turbinate reduction addresses enlarged nasal tissues that also contribute to blockage. Turbinates warm and humidify inhaled air, and if they are swollen, they can obstruct the airway even after the septum is straightened. Combining the procedures ensures that both the structural and soft-tissue components contributing to breathing difficulty are addressed during the single operation.
Recovery Expectations and Long-Term Results
Following the septoplasty procedure, patients typically experience congestion and mild discomfort for the first few days, similar to a severe cold. The surgeon may place soft silicone splints or packing inside the nose to support the newly straightened septum and control bleeding; these are removed at a follow-up appointment within the first week. Most people can return to light activity and desk work within one week, although two weeks is advised before resuming strenuous activities.
Patients are instructed to avoid activities that increase blood pressure, such as heavy lifting or intense exercise, for several weeks to minimize the risk of post-operative bleeding. The initial improvement in nasal breathing is often noticeable shortly after the splints are removed, though this is often masked by internal swelling. The internal tissues continue to heal for several months, with the full functional benefit of the septoplasty typically realized between three to six months post-surgery.