What is a septoplasty?

A septoplasty is a surgery that straightens the thin wall that splits your nose into two separate nostrils. The medical team call this part of your body the nasal septum. It is made from bone and cartilage. If this wall isn’t right in the middle of your nostrils, it is called a deviated septum.

A septoplasty operation aims to straighten the nasal septum to help the flow of air through both of your nostrils. The operation is done inside your nose. You will not have any cuts on the outside. That means that your nose should not change its appearance and you will not have any scars on the outside of your nose.

Septoplasty is one of the most common nose operations in the UK. It is done by Ear Nose and Throat (ENT) surgeons

Why do I need a septoplasty?

The most common reason for needing a septoplasty is a deviated septum.

Some people are born with a deviated septum. Some people have a deviated septum because they have injured their nose. This could be during sport, a fall or an accident.

This can cause one or more of the following problems:

• Difficulty breathing through one or both sides of your nose
• A blocked nose. Some people keep getting a blocked nose. Others have a blocked nose all the time.
• Nosebleeds. This is because one side of the nasal septum is dry.
• Noisy breathing.
• Snoring when you are asleep.
• This may increase your risk of sinus infections (sinusitis).
• Sleeping difficulties. Broken sleep.
• Lower sense of smell.

Some people with a deviated septum have no symptoms and do not need an operation. Doctors usually suggest surgery only if you have symptoms that affect the quality of your life. They also consider it if other treatments, like nose sprays or decongestants, have not worked.

Deciding to have a septoplasty

It is up to you to decide if you want surgery. Your surgeon will help you make the decision. They will explain the possible benefits and the risks. This will help you to make an informed choice. If you decide to go ahead with surgery, it is important that you feel comfortable with your decision.

You have the right to make an informed decision about your care. Your surgical team should give you the information that you need in a way that you can understand. If anything is unclear, please ask them to explain it again.

Questions you may want to ask your surgeon

• What are the benefits of this operation for me, in my situation?
• What are the risks for me?
• What are my other options?
• What will happen if I decide not to have this operation?
• How many times have you done this operation?
• How well is it likely to work? What will the results be?
• Do I need to take any time off work?
• Will I have a general anaesthetic?
• How long will I be in hospital?

Some people find it helpful to take a friend or family member with them to see the surgeon. You can ask for extra time to think before you decide. You do not have to make a decision during the consultation. You are also allowed to change your mind. You can withdraw your consent, even after you have signed the consent form.

Preparing for a septoplasty

When you choose to go ahead with the operation, your surgical team will give you instructions. Follow these carefully.

• You will be asked not to eat or drink for about 6 hours before the operation. Your surgical team will tell you the exact timing.
• Tell your surgeon if you are taking any medicines. This includes things you can buy over the counter like decongestants, supplements and vitamins. You should also tell them about medicines that you have been prescribed. If you take blood thinners like aspirin, you may need to stop taking them for a short time before the operation. Your doctor will tell you exactly what to do.
• If you smoke, you will be asked to stop. Smoking stops you from healing properly. It can also put you at risk of complications.
• You will not be able to drive yourself home after the operation. Arrange for a responsible adult to take you home.
• Make sure you have someone to stay with you for the first 24 hours after the operation.
• Get your home ready for your recovery, for example: Have some simple meals ready or food that is easy to prepare; Keep a good supply of tissues nearby; Make sure you have enough of all your prescribed medicines at home.

You may be invited to have a pre-assessment before the operation. The team will check your health, do blood tests and look over your medicines. This is a good time for you to ask any other questions you might have.

What happens during the operation?

Most people get a general anaesthetic for this surgery. That means you will be asleep the whole time. Some people have a local anaesthetic. That means you are awake during the operation. You will be given sedation to make you calm, relaxed and sleepy.

• The surgeon makes a small cut inside your nostril. No cuts are made on the outside of your nose.
• They lift up the lining of the nasal septum.
• Then they can move, reshape or remove the bone and cartilage causing the blockage.
• Then they put the mucosa back in position.
• They secure it in place using stitches that melt away on their own. Sometimes they use small splints in your nose instead of stitches.
• They may put a soft pack inside your nose. This helps to stop bleeding.

Most people can go home the same day. If you need to stay in hospital overnight, your surgeon will tell you before the operation.

The operation usually takes between 30-90 minutes. The exact time depends how complicated the operation is. It may also take longer if you are having another procedure at the same time. This could be

• A turbinate reduction. This is when the surgeon makes your turbinates smaller. The turbinates are small bones inside your nose. They filter and regulate the airflow. If they are too big, they can get blocked.

Recovery

Most people take about 10 days off work to recover. It depends on the type of work you do. It can take a few months for your nose to heal completely.

In the first few days you may

• Have some swelling inside and around your nose.
• You may get a blocked nose. This may last a few days to a couple of weeks
• You may get some bleeding.
• There may be a little pain or discomfort. You can take paracetamol to help.
• You may not be able to smell for a few days.

You should

• Sleep with your head raised. This can help to reduce the swelling.
• Use saline to rinse your nose passages. Your surgical team will show you how to do this.
• Try not to blow your nose for at least a week after the operation.
• ·Not do any strenuous exercise or heavy lifting for about 2 weeks.
• Not go swimming or put your head under water. Wait until your surgeon tells you it is OK to do this.
• Not travel by plane until your surgeon says it is safe for you.

You will be asked to go back to see the surgical team for a check-up. This is usually about four weeks after the operation. They will check that you are healing well. They will also make sure that the operation has worked.

If you are worried before your check-up, get in touch with the surgical team right away. This could be if you get bad pain, unusual discharge or you have difficulty breathing,

Most people find it easier to breathe through their nose once the swelling has settled. After a few months, when everything has healed, you should be able to breathe normally.

Risks

Septoplasty is normally a safe operation. Most people recover well, but there are some things that can happen. Everyone is different. Your doctor will talk with you about what these risks might mean for you.

Common risks

• Blocked nose and swelling
• Mild bleeding including nose bleeds
• Mild pain or discomfort

These symptoms should get better in a few days. They are temporary.

Uncommon risks

• Infection. You may need to have a course of antibiotics to get rid of the infection.
• A collection of blood under the lining of the septum. Doctors call this a ‘septal haematoma’. You may need to go back to the operating theatre as soon as possible to have it treated. This would be done under general anaesthetic.
• Change in your sense of smell. This is usually temporary.
• Numbness in your teeth, nose or lips. This is usually temporary.
• Some people see that their nose changes a bit after the operation. Most people do not notice any change. If you are not happy with the shape of your nose, talk to your surgeon. You may be able to have an operation.

Rare risks

• A hole in your nasal septum. Doctors call this a perforation of the septum. It can happen if you get a blood clot or an abscess after the operation.
• Sometimes the surgery may not improve your symptoms fully. Your nasal septum may bend again after surgery. This can happen if you bump your nose soon after surgery. You can get scarring inside the nose, or parts of the inside of the nose stick together. If these things happen, you might need more treatment or surgery.
• You may have a reaction to the general anaesthetic.

After your operation, contact your surgical team or go to the nearest A&E right away if you have:

• Heavy bleeding that does not stop
• Signs of an infection. These are things like a high temperature, a lot of pain, a yellow or green discharge from your nose
• Difficulty breathing

Costs of a septoplasty

Most private health insurance plans cover septoplasty surgery.

If you are paying for the surgery yourself, the costs can range from about £3,000 to £6,000.

If you need to have a turbinate reduction as well as septoplasty, the costs are approximately £4,000 to £7,500

References

A. Musleh Septoplasty with or without Inferior Turbinectomy: A Declaration of Clinical Consensus International Tinnitus Journal. 2023;27(2):203-210

S. Carrie et al. Clinical effectiveness of septoplasty versus medical management for nasal airways obstruction: multicentre, open label, randomised controlled trial BMJ 2023;383:e075445

Pendolino A, Randhawa P, Unadkat S et al. Septoplasty for nasal obstruction. The Lancet, 395493