Septum is the midline support structure of the nose that separates both nasal cavities. Septum deviation is the most common cause of nasal congestion. In addition to nasal obstruction, it causes cosmetic deformity and many functional disorders in nose.

Although some people with septum deviation have described nasal trauma in their past, there is often no explanation for the cause. Minor fractures that occur during or after birth in early childhood may be responsible for future septum deformities.

It is the first physical examination to be performed following the anamnesis in people with complaints of nasal congestion. With light and endoscopic examination, the diagnosis of septum deviation can be made to a large extent. Imaging methods are rarely preferred in the diagnosis of septum deviation, if used, imaging should be computed tomography.

With the correct diagnosis and maneuvers, septoplasty is a surgery that provides an improvement in the quality of life due to the complaint of nasal congestion. Apart from nasal congestion, it is a procedure that can be added to treatment in cases such as obstructive sleep apnea, chronic rhinosinusitis and epistaxis.

This operation can be performed under local or general anesthesia. The current approach in septoplasty is to perform cartilage protective procedures as much as to completely correct the deformity. This includes incisions, liberation, removal of cartilage and bone fragments. Then, the mucous membrane opened at the beginning of the surgery is closed with sutures. Fusible sutures are preferred. At this stage, the operation can be terminated.

Plates and bumpers made of different materials can be placed in the nose to support stabilization and healing. If a tampon is used, it is usually taken within 1-2 days. There is no compromise for the time of receipt of splints, but it can stay up to 7-14 days.

Antibiotic treatment after septoplasty is controversial. Although antibiotics are not used, the rate of postoperative inflammation is low. Isotonic and hypertonic salt water and intranasal decongestants can be used to reduce postoperative swelling and congestion complaints and to prevent pain and decreased smell.

Open septoplasty
Especially severe fractures affecting the back of the septum and correction of the pathologies at the end of the cartilage are not always possible with conventional septoplasty. In this case, it is necessary to support the pathological septum with grafts, sometimes take it out of the body and correct it, and place the reconstructed septum skeleton inside the nose. This surgery is called open septoplasty.

The most important feature of this surgery is the wide release of the septum from the ligaments and adjacent structures to be corrected. This requires accurate and robust re-detection of the corrected septum at the end of the surgery.

Endoscopic septoplasty
In endoscopic septoplasty, which is a new technique, successful results are obtained with the help of telescopes and some special tools.

The surgeon sees the tissue plans more easily. Another advantage is that it provides the opportunity to intervene in limited pathologies, especially in deviations or spiky protrusions at the back. At the beginning of endoscopic sinus surgery, if the septum is seen to restrict access to the sinuses, relief is provided by removing a limited cartilage or bone.

Procedures to correct the disorder do not differ from traditional septoplasty. Closure phases and patient follow-up are similar.

Note: The above information was compiled from the book "Current Nose and Sinus Surgery", of which editorship was conducted by Prof. Dr. Selim Sermed Erbek. It is for purpose of informing the patients and patients should consult an Otorhinolaryngologist for diagnosis and treatment details.