Septoplasty: what to expect before, during and after the procedure

Septoplasty, also known as a septal reconstruction, is a surgical procedure to straighten or correct a deviated nasal septum. Normally, the septum should run down the centre of the nose but for some people it can be crooked and cause difficulty breathing. Mr Florian Bast, a leading otolaryngologist and facial plastic surgeon in London, explains to us what happens during the surgical procedure and what the recovery process is like for his patients.

What happens during the consultation before the procedure?

If you come in regards to a septoplasty, we first assess your medical history. We go through all the possible reasons for your breathing problem, including rhinosinusitis, allergies or rhinitis.

We assess if there are further symptoms such as post nasal dripping, nasal discharge and check how your sense of smell is, if you have any allergies or you suffer from asthma. After assessing these, a detailed examination of the nose is carried out.

Firstly, we start with assessing the external nose and checking if there are any deformities and if you have ever had any surgery that resulted in a deviation of the whole nose. We’ll also check if there are any other deformities such as a cleft lip and palate. After this, an internal examination is done, starting with an anterior rhinoscopy.

A small instrument is placed inside the nostril to assess the front part of your nasal cavity and a posterior rhinoscopy is then carried out with the use of a small camera, which is placed into your nasal cavity to check if there are any polyps or other anatomical structures that could contribute to a nasal breathing problem.

What happens during the procedure?

If the septoplasty is performed purely for functional reasons, it is a very short and straightforward procedure.

The procedure is normally performed under general anaesthetic. Before we start with the surgery, I use a lot of local anaesthetic, and also local infinitive blocks, to reduce the post-operative pain for the patients. I then, with a tiny incision inside the nasal cavity, lift off the skin from the cartilage so I can assess the cartilage properly. After that, I'll reduce the deviated parts of the cartilage and the bone, step by step, until the left-over cartilage is straight in the midline.

When we perform this surgery, we have two main goals. The first goal is to improve breathing and the second goal is to not change the shape of the nose. The closure of this little incision, and also the stabilisation inside the nose, is done with sutures. I do not place any packets or silicon splints inside the nose.

What is recovery like?

After septoplasty, as it's done under general anaesthetic, you will feel slightly tired, especially within the first 24 hours. Normally, the pain after a septoplasty is very minimal. You will feel a bit of pressure and tightness in the nose, especially due to the stitches that were used during the procedure, but this can be managed easily with paracetamol or ibuprofen.

Like with all surgery, you experience swelling afterwards. So you will experience some swelling inside the nasal cavity. This swelling can lead to an impairment of the ability to breathe properly, but I provide you with nasal spray to reduce the swelling for the first 72 hours after surgery. I also provide a saline douche to rinse out the nose and antibiotic ointment to create a suitable wound healing environment.

How do you manage patient expectations?

Managing patient expectation starts with the first consultation in the clinic. I have to make sure that the septum is the main contributor to the nasal breathing problems. I have to exclude anything else that can contribute to breathing problems including problems with the inferior turbinates. This includes swelling due to allergies, chronic rhinosinusitis or polyps that can contribute to nasal breathing problems.

We have to make sure there is free post nasal space, for example free of adenoids. We also have to assess the nasal valve properly to check there is no valve collapse that can contribute to breathing problems afterwards. If we have excluded everything and the septal deviation is the main contributor to your nasal breathing problems, I'm very confident that with a septoplasty, with straightening the septum and reopening your nasal breathing passages on both sides, I can improve your breathing and overall quality of life.

If you are interested in learning more about this procedure, visit Mr Florian Bast's profile and book an appointment to see him.