A deviated septum is a common anatomical variation where the thin wall of cartilage and bone separating the two nasal passages is displaced off-center. While many people live with some degree of deviation, significant misalignment can obstruct airflow, leading to difficulty breathing, chronic sinus issues, or congestion. When severe symptoms do not respond to medication, the structural problem can be corrected through septoplasty. This operation straightens the septum and repositions it in the middle of the nasal cavity to restore proper function and airflow.
The Primary Surgical Specialist
The physician who most frequently performs septoplasty is the Otolaryngologist, a medical doctor commonly referred to as an Ear, Nose, and Throat (ENT) specialist. These surgeons have extensive training focused on the anatomy and function of the head and neck, and septoplasty is a routine procedure within their scope of practice. Specialization involves four years of medical school followed by a rigorous five-year residency program in Otolaryngology-Head and Neck Surgery.
During residency, a significant portion of their training is dedicated to mastering the surgical techniques required for nasal procedures, including septoplasty. The goal of septoplasty is strictly functional, involving careful realignment, reshaping, or selective removal of deviated bone and cartilage to open the nasal passages. The Otolaryngologist’s deep understanding of internal nasal structures, such as the turbinates and sinus drainage pathways, is fundamental for maximizing breathing improvement.
Following residency, many Otolaryngologists obtain board certification, demonstrating a high level of competency. Their expertise covers the full spectrum of care, from initial diagnosis confirmation to surgical repair and post-operative management. They manage potential complications and coordinate concurrent treatments, such as those for allergies or chronic sinusitis, which often contribute to breathing difficulty.
Navigating the Diagnostic and Referral Process
The journey to surgical correction typically begins with a Primary Care Physician (PCP) or General Practitioner. The PCP is the initial contact point for patients experiencing symptoms like chronic nasal obstruction or recurrent sinus infections. They conduct a thorough physical examination, often using a lighted tool like a nasal speculum or otoscope to check for visible deviation or swelling inside the nasal passages.
The PCP also takes a detailed medical history, asking about the duration and severity of symptoms, any history of nasal trauma, or associated conditions like sleep apnea. If the initial examination suggests a significant structural issue, the PCP provides a referral to an Otolaryngologist for specialized consultation. This referral is often required, depending on the patient’s health insurance plan.
In some cases, the specialist may order advanced imaging, such as a Computed Tomography (CT) scan of the sinuses, especially when the deviation is severe or if chronic sinusitis is suspected. While a physical exam is often sufficient to diagnose a deviated septum, the CT scan offers detailed cross-sectional views of the bony and cartilaginous structures. This helps the surgeon map the specific nature of the septal deformity and plan the most appropriate surgical approach.
Specialized Surgical Needs
While the general Otolaryngologist handles most septoplasty procedures, complex cases may require a surgeon with additional sub-specialty training. One such specialist is a Rhinologist, an Otolaryngologist who has completed an extra fellowship year focused on advanced diseases and surgery of the nose and sinuses. A Rhinologist is often preferred for patients with severe septal deviations, complex revision surgeries, or when septoplasty must be combined with extensive endoscopic sinus surgery.
Another scenario expanding the scope of potential surgeons occurs when the patient desires cosmetic changes to the external appearance of the nose alongside functional septal correction. This combined procedure is known as a septorhinoplasty. In these instances, the surgery may be performed by a Facial Plastic Surgeon or an Otolaryngologist who has completed a fellowship in Facial Plastic and Reconstructive Surgery.
A Facial Plastic Surgeon brings expertise in both the functional repair of the septum and the aesthetic reshaping of the nasal bone and cartilage required for the rhinoplasty component. It is important to confirm that the surgeon has substantial experience performing the combined septorhinoplasty procedure to ensure improved breathing and a satisfactory cosmetic result. Ultimately, the most appropriate surgeon depends on the severity of the deviation and whether the patient requires functional correction alone or combined functional and aesthetic improvements.