Septoplasty and septorhinoplasty

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What is septal surgery?

The septum is a thin piece of cartilage and bone inside the nose between the left and right sides. It is about 7cm long in adults. In some people this septum is bent into one or both sides of the nose which can lead to blockage. This may be due to an injury to the nose, or sometimes it just grows that way. We can operate to straighten the septum. The procedure may sometime be combined with a rhinoplasty which involves surgery to the nasal bones at the top of the nose.

Why do I need septal surgery?

If you have a blocked nose because of the deviated septum, this operation will help. Sometimes we need to straighten out a bent septum to give us room to do other things, such as sinus surgery.

What can I expect before the operation?

The procedure is usually done under general anaesthesia, you will have to attend a pre assessment clinic before your operation with one of the nursing staff. You will be screened for MRSA and have some routine blood tests and a heart trace (ECG).

You will be asked not to eat anything for 6 hours prior to coming into hospital (including chewing gum, mints etc) and be asked not to have anything to drink except clear fluids for 2 hours prior to coming into hospital (clear fluids = water, black tea, black coffee).

If you have special requirements related to religion or to an allergy/disability then you may wish to discuss this further with one of the nurses at your pre assessment clinic.

What happens on the day of my operation?

You will be admitted onto the ward on the day of your procedure, if it scheduled for the morning operating list you will be asked to come to the surgical ward for 7.30am. This means that you operation will take place between approximately 8.00am and 1.00pm depending on the order of the operating list.

If it scheduled for the afternoon operating list you will be asked to come in for 11.30am. This means that your operation will take place between approximately 1.30pm and 5.00pm.

You will be seen by the anaesthetist and the surgeon who will go through the procedure and give you the opportunity to ask any questions. Your surgeon will then ask you to sign a consent form.

What does the operation involve?

The operation usually takes about 30 to 45 minutes. You will probably be asleep, although some cases can be performed with just the nose anaesthetised. A small cut will be made inside your nose and the bent cartilage will be removed or straightened.

You will have some small dissolvable stitches left inside your nose. If you are having a septorhinoplasty this is a slightly bigger operation which will take about 1 hour to 1.5 hours. It involves manipulation of the nasal bones in order to change their shape or position, there are several different techniques which can be used in order to do this.

What are the risks?

Septal surgery is safe, but there are some risks. Sometimes your nose can bleed after this operation, and we may have to put packs into your nose to stop it. This can happen within the first 6-8 hours after surgery or up to 5 to 10 days after surgery.

Infection in your nose is rare after this operation, but if it happens it can be serious, so you should see a doctor if your nose is getting increasingly blocked or painful.

Rarely, the operation may leave you with a hole in your septum inside the nose going from one side of your nose to the other. This can cause a whistling noise when you breathe, nasal crusting with blockage or nosebleeds. Most of this time this causes no problems at all and needs no treatment. Further surgery can be carried out if necessary to repair a hole in the septum.

Very rarely, you may find that the shape of your nose has changed slightly, with a dip in the bridge of your nose. Most people do not notice any change, but if this does occur and you are not happy with it, it can be fixed with surgery.

What can I expect after the operation?

You will be seen by either the surgeon of another member of the team who will explain how the operation has gone. You will most likely go home the same day.

We may give you some nasal drops or a spray to help your breathing and an antibiotic cream to take home with you.

There will be some stitches inside your nose – these will dissolve and usually fall out by themselves. You will need to take at least a week off work to allow the nose to heal.

Your nose will be a bit painful for a week or so, simple paracetamol or ibuprofen should be enough to relieve this pain.

For the next 2 weeks:

• Breathe gently through your nose; do not blow or sniff as this will not relieve the feeling of blockage and may
• increase the swelling
• If you are going to sneeze, sneeze with your mouth open to protect your nose
• Avoid lifting heavy weights or doing strenuous exercise as this increases the swelling and risk of bleeding
• You may get some blood coloured watery fluid from your nose for the first two weeks or so – this is normal
• Your nose will be blocked both sides as if you have a heavy cold

If you are having a rhinoplasty as well as a septal surgery you will likely be left with a protective splint over the nose, this will stay in place for one week after which it will be removed in outpatient clinic.

What about follow up?

We will most likely see you in the outpatient clinic between 4 and 8 weeks after the operation to check your symptoms have improved and you are happy with the results of the surgery.

Is there any alternative treatment?

Only an operation can fix a deviated or bent septum, but nasal sprays and drops can help treat swelling in the nose which might be making your nose feel blocked. If septal deformity is the cause of your nasal blockage there is no other treatment other than surgery.

If you have vision, mobility or access issues please contact the ENT secretaries for further advice and information.

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