Anatomy / Physiology

The dividing partition between the left and right nostril is called the nasal septum. It is composed of both cartilage (soft and flexible) in front and bone (solid and inflexible) further back.

The nasal septum is lined with a tightly adherent mucoperichondrium that supplies it with nutrients. It has a number of growth centres from birth that continue with growth until the late teenage years therefore it is sensible not to operate in this area unless there is good reason to do so.

The cartilage is necessary for the support of the nose and surgery to the cartilage may affect this support. The cartilage is sensitive to trauma that can occur at birth and any point afterwards.

If the cartilage or the bone of the nasal septum is deviated it may produce symptoms of nasal obstruction. It is surprising how often people have an asymptomatic deflection of the nasal septum and also the fact that the nasal septum can be deflected in more than one direction. It is for this reason that a septoplasty can be useful in the correction of the symptom of nasal obstruction. Occasionally a septoplasty is used for access in the nose such as with Functional endoscopic sinus surgery.

Septoplasty

An incision is made in the mucoperichondrium of the nasal septum and this layer is carefully dissected off the cartilage below. The forwardmost strut of cartilage is preferably preserved to maintain support of the nasal structures together with a strut of cartilage under the midline portion of the nose.

Whatever cartilage is deflected should be augmented, resected or scored in order to straighten the nasal septum. Once this has been achieved then the mucoperichondrium should be replaced and is often stitched back to the nasal septum to firmly replace it and prevent blood from accumulating in the pocket that has been created for the operation.

The nose is not infrequently packed with a soft nasal pack that stays in the nose only for a few hours.

If performed alone this case can be discharged on the same day. This surgery however, is often performed with other procedures in the nose such as turbinate surgery.

Post-operatively the patient will feel very blocked in the nasal cavities and it takes approximately 7-10 days before the swelling goes down and people start to get the benefit from the surgery.