The nasal septum is the partition which divides the nose into left and right nostrils. It may become crooked for a variety of reasons such as trauma or even pressure in the birth canal.
The inferior turbinates are structures that protrude into the nasal cavity from the side wall of the nose. They can become enlarged for a variety of reasons including allergies, sinusitis or irritation from various chemicals including cigarette smoke.
Surgery to correct a deviated septum is usually combined with reduction of the inferior turbinates as this enables much more effective treatment of nasal obstruction.
Indications for surgery
The most common reason for surgery is a blocked nose. This can cause problems breathing through the nose when awake, or at night resulting in snoring and / or sleep apnoea. It is also commonly performed as part of a larger procedure to treat sinusitis or nasal deformity.
Sinus surgery
Sinus surgery may be performed in combination with septoplasty and turbinate reduction in some cases. If this is “limited” sinus surgery (addressing the anterior ethmoid and maxillary sinuses), the recovery is the same as for septoplasty and turbinate reduction alone. There is an additional (very low) risk of eye injury. For more information on sinus surgery and more extensive sinus surgery, see the “sinus surgery” information sheet.
After surgery
Your surgeon will let you know if you can be discharged on the same day after surgery or whether you will need to remain in hospital overnight. Your nose will feel blocked and stuffy after surgery, as if you have a cold or a flu and you will get some blood and mucus from the nose, particularly over the first few days. Pain is not usually severe and generally managed with a combination of paracetamol and ibuprofen, with stronger pain relief if needed. In most cases soft silicone splints will be left in the nose after surgery and follow up to remove these is usually 5 or 6 days after surgery in the clinic. You should avoid heavy lifting and strenuous exercise for 1-2 weeks after surgery – walking is fine from day one. Those with sedentary jobs can usually return to work after a week, for more strenuous work 2 weeks will be needed due to the risk of bleeding.
Nasal care
You will be provided with a FLO Sinus Care or FLO Postoperative kit to douche the nose. Nasal and sinus douching is essential after surgery to clear blood clot and mucus from the nose. If blood clot is left in the nose, it can promote scarring and adhesion formation, which can cause a poor surgical result.
Nasal douching is usually continued for around 6-8 weeks after the operation as it can take this long for the normal mucus clearance mechanisms to start functioning properly.
Complications of surgery
As with any anaesthetic or surgical procedure there are always risks of complications. Whilst the incidence of serious complications is very rare, it is important you are aware of them so you can discuss them with your surgery before your operation.
Bleeding
Some bleeding is normal postoperatively but occasionally heavy bleeding may require treatment with packing in the nose or returning to the operating theatre.
Avoid aspirin, vitamin E, fish oil or herbal supplements for one week after surgery. Using an anti inflammatory such as nurofen / ibuprofen for post op pain relief is fine.
Infection / septal haematoma
If there is increasing pain and/or nasal blockage you must contact your surgeon immediately. Infection can occur in the tissues, or rarely a collection of blood can accumulate in the septum requiring drainage.
Septal perforation
Occasionally a hole may develop through the septum. This often doesn't cause any symptoms, but if it does, surgical repair may be necessary.
Sense of smell
The sense of smell is often poor while the nose is blocked during the first weeks after surgery but then recovers. However, on very rare occasions the sense of smell can become permanently distorted or lost.
Numbness or altered sensation
Numbness behind the front teeth is fairly common, but usually resolves over several months. Occasionally this can be permanent however.
Ongoing symptoms that may require further surgery
Occasionally further surgery is required for persistent symptoms. This occurs in less than 5% of cases.
Sinus surgery only - Eye complications
Swelling and / or bruising of the eyelids is uncommon and will usually resolve within 7-10 days. Since endoscopic sinus surgery takes place very close to the eye socket it is possible to encounter the following complications.
Damage to the tear duct. On rare occasions this can result in a watery eye. This may improve over time, however in some cases it may require an operation to repair. The risk of this complication is less than 1 in 100.
Bleeding into the eye socket. An artery can bleed into the eye socket requiring emergency surgery to correct. The incidence is less than 1 in 1000.
Damage to the eye muscles. This is an extremely rare complication which can result in double vision, which can be permanent.