The septum is the bone and cartilage that separates the left and right passages of the nose. This cartilaginous partition is bendable in spite of its firmness and should ideally lie at the center of the nose so that both passages are equal in size. But unfortunately, this isn’t always the case. The septum can shift and become off-center—either at birth or later in life due to injury or trauma. This condition is referred to as a deviated septum.
A deviated septum is an abnormality wherein the nasal partition is misaligned, making one passage smaller than the other. This misalignment can obstruct the nasal passage and cause difficulty breathing, increased chances of sinus infections, frequent nosebleeds, sleep apnea, and other issues.
What Causes a Deviated Septum?
Nasal trauma is the most common cause of a deviated septum. Both kids and adults can sustain nasal injuries from various activities or accidents, and if the trauma is severe enough, it can cause the nasal septum to become displaced. Therefore, a deviated septum can be developed from tripping, contact sports, playground activities, traffic accidents, and more.
There are also cases when septal deviation occurs during fetal development. Birthing problems can contribute to a deviated septum, particularly with larger newborns or during particularly difficult deliveries. Since the nose sticks out from the face, it is typically subjected to compression and rotational forces during intrauterine development—and in some cases, this can lead to the infant developing a deviated septum. Congenital deviation usually has a C-shape or S-shape and is often found on the front part of the nose.
Symptoms of a Deviated Septum
Some people go through life unaware that they have a deviated septum as the condition doesn’t always present with obvious symptoms. And even if it does, the symptoms are often mistaken for an allergy, a nasal infection, or even a simple cold.
To find out if you have a deviated septum, common symptoms include the following:
- Nasal obstruction: With a deviated septum, breathing through the nose may be difficult due to the obstruction of one or both nostrils. If you have a cold or an allergy, the obstruction will become even more evident because of the swollen nasal passages.
- Headaches and facial pains: If you often experience headaches or migraines, this can also be a sign of septal deviation. The pain comes from the built-up pressure, which happens when the air is not able to flow freely through the nasal passages. Facial pains may also occur due to the extra pressure in the sinuses.
- Chronic sinus infections: A sinus infection or sinusitis, which is characterized by inflamed nasal tissues, is typically caused by bacteria, viruses, or allergies. However, it can also be caused by an abnormal nasal structure that creates chronic blockage. People who experience recurring sinus infections often have nasal congestion caused by a deviated septum, which can sometimes interfere with drainage and make it difficult for the sinus to flush out fluids.
- Chronic nosebleeds: A deviated septum makes it hard for air to flow properly through the nasal passages, which can cause the membranes to dry out. This makes you more prone to nosebleeds, particularly if the humidity levels in the surrounding environment are particularly low.
- Snoring or sleeping problems: Noisy snoring or loud breathing while sleeping can be indicative of a deviated septum. Some people who suffer from this condition often have trouble sleeping as the crookedness of the septum can make it difficult to breathe through the nose. In severe cases, people can experience sleep apnea, which is a serious sleep disorder that causes interrupted breathing during sleep.
How to Fix a Deviated Septum
When you visit your doctor, you will be asked if you’ve ever had any of the symptoms mentioned. Once your symptoms (or lack thereof) have been discussed, the doctor will ask if you have had any history of nose injuries or nasal surgery. To confirm whether you do in fact have a deviated septum, your doctor will then perform a physical examination of the internal structures of the nose.
If you do have a deviated septum, you may be prescribed decongestants, antihistamines, or nasal sprays to help manage the symptoms. However, for a more long-term solution, your doctor will likely recommend corrective surgery. Below are the surgical procedures that can be performed to straighten the septum:
Patients with septal deviations typically undergo septoplasty to correct the crookedness of the septum. This reconstructive procedure is performed under local or general anesthesia and involves straightening or repositioning the septum using a variety of techniques.
A septoplasty procedure will usually include the following steps:
- Anesthesia is administered.
- Incisions are made to access the septum—either within the nasal cavity when using the closed approach, or on one side of the columella during an open approach procedure.
- The membrane covering the surface of the septum, which is called the nasal mucosal lining, is carefully lifted away.
- The septum is removed and reinserted in the correct position; in some cases, the bone and/or cartilage may be trimmed before being restored.
- The mucosal lining is repositioned over the septum and sutured into place.
- Nasal packing or splints are installed to stabilize the newly fixed septum.
This procedure may also be combined with other surgeries, such as cosmetic rhinoplasty (a combination known as “septorhinoplasty”) or sinus surgery.
Another procedure that can remedy any nasal issues caused by septal deviation is functional rhinoplasty. Unlike septoplasty, this procedure does not just focus on the septum. It usually involves modifying more of the nasal structure to address a wider range of nasal problems.
The present state of the nose and the severity of your nasal problems, among other factors, determine the scope and complexity of the procedure. Like septoplasty, functional rhinoplasty incorporates various techniques to attain the desired results. Certain techniques and combinations of them are going to depend on the patient’s specific nasal issues.
To learn more about the various surgeries designed to address aesthetic or functional nasal problems, check out our Nose Procedures page.