Septoplasty: straightening the nasal septum, risks and recovery

The septum divides the two sides of the nose. In many people it is slightly bent and causes no trouble. Septoplasty is relevant when one side is persistently blocked, and the blockage can be traced to the bend rather than to swollen turbinates, allergy or infection.

ENT UK notes that nasal steroid sprays or drops can reduce swelling and that the septum causes no harm if left alone. A Royal Cornwall leaflet says that if blockage is due to the shape of the septum, septoplasty should improve it, and that sprays offer limited benefit when the structure is the root cause.

It is not a cosmetic operation: it aims to improve breathing rather than the outside appearance of the nose. If you also want the outside shape changed, that is rhinoplasty, which is a separate decision.

Before surgery you will usually have tried sprays, and your surgeon will have looked inside the nose with a small camera. Pre-assessment covers fitness for general anaesthetic and fasting instructions.

Stop smoking if you can, as it slows healing in the nose. Tell the team about blood thinners and aspirin, and plan two weeks away from work and crowds.

The Royal Cornwall leaflet gives 30 to 45 minutes under general anaesthetic, with all cuts inside the nose. The surgeon lifts the lining, reshapes or removes bent cartilage and bone and repositions the septum in the midline. Self-dissolving stitches are common, and sponge packs or thin splints may be placed to support the septum and limit bleeding.

Many people go home the same day.

ENT UK lists nosebleeds as a normal occurrence, collection of blood in the septum (haematoma), infection, a hole in the septum (perforation), tissue bridges inside the nose (adhesions), numbness of the teeth or lips that usually settles, and re-deviation in one out of ten cases. General anaesthetic carries its own uncommon risks, which are set out by the anaesthetist.

The Cornwall leaflet adds crusting, which resolves within one to two months, plus less commonly reduced smell and altered nose shape.

Expect a blocked, sore nose for the first days, with blood-stained discharge. ENT UK advises not blowing your nose in the first two days; the Cornwall leaflet says to avoid blowing for a week and to sneeze through the mouth. Splints come out at seven to ten days. Two weeks off work is advised in both, with strenuous sport avoided for three weeks (Cornwall) and contact sport for two months (ENT UK).

Breathing can continue to improve for up to three months as swelling and crusts settle.

• Bright red bleeding or large clots: seek medical help urgently.

• Increasing pain and increasing blockage after a few days, which can mean infection or a collection of blood in the septum.

• Fever, or green foul-smelling discharge.

• Severe bleeding that does not stop with pressure: call 999 or go to A&E.

• Is my blocked nose caused by the septum, the turbinates or something else?

• What are the chances the operation will help, and of needing a second one?

• Will packing or splints be used and when do they come out?

• Do you also recommend turbinate reduction?

NHS commissioners often require evidence that medical treatment has been tried before funding septoplasty, and some areas restrict it. Private care may be quicker to arrange. In either setting, the best predictor of benefit is a clear link between the bend and your blockage, so ask for that explanation.