Deviated Septum: Symptoms and Surgery

Deviated nasal septum is an extraordinarily common condition: it is estimated that up to 80% of the population has some degree of septal deviation, although only a fraction of these individuals experience symptoms requiring treatment. As an otolaryngologist specialising in rhinology in Malaga and Marbella, I treat this condition regularly and can confirm that, when significant, its correction dramatically improves the patient's quality of life.

What is the nasal septum

The nasal septum is the structure that divides the nose into two nasal cavities. It is formed by a cartilaginous part (in its anterior portion) and a bony part (in its posterior portion), covered by nasal mucosa on both sides. In ideal conditions, the septum sits on the midline, dividing the nasal cavities into two symmetrical chambers of similar size. However, the reality is that most people have some deviation of the septum from the midline. When this deviation is mild, it produces no symptoms and requires no treatment. When significant, it can cause airflow obstruction that considerably affects nasal breathing and, by extension, quality of life.

Causes of septal deviation

Developmental factors

The most frequent cause of deviated septum is asymmetric growth of nasal structures during development. During childhood and adolescence, the septum may grow unevenly, producing a deviation that becomes more evident as facial development is completed.

Trauma

Nasal trauma represents the second most frequent cause. Direct blows to the nose, whether from accidents, sports or falls, can fracture or displace the nasal septum. It is important to highlight that even apparently mild childhood trauma can produce deviations that manifest years later, during growth.

Congenital factors

In some cases, septal deviation may be present from birth, as a consequence of pressure during delivery or genetic factors that determine nasal anatomy.

Symptoms of septal deviation

Symptoms vary according to the severity of deviation and may include:

It is important to note that many individuals with significant septal deviation have gradually adapted to their obstruction and are not fully aware of how much their breathing has worsened. Only after surgical correction do they discover what normal breathing feels like.

Diagnosis

At our practice in Malaga and Marbella, diagnosis of septal deviation is made through a complete clinical evaluation. Anterior rhinoscopy allows direct visualisation of the anterior portion of the septum. Nasal endoscopy, performed with a flexible or rigid endoscope, provides a detailed view of the entire nasal cavity, including the posterior portion of the septum and turbinates. In complex cases or when planning surgery, a computed tomography (CT) scan of the paranasal sinuses may be requested, offering precise information about the bony and cartilaginous anatomy of the septum, as well as the condition of the paranasal sinuses. Dra. Fanjul also evaluates nasal respiratory function using rhinomanometry, a test that objectively measures airflow through each nasal cavity.

Conservative treatment

Not all septal deviations require surgery. Conservative treatment may suffice for mild deviations with moderate symptoms. Options include corticosteroid nasal sprays to reduce mucosal inflammation, nasal washes with saline solution, nasal decongestants (only for occasional use, never prolonged), and nasal dilator strips to improve nocturnal breathing. However, it is essential to understand that conservative treatment does not correct the structural deviation. It only relieves symptoms temporarily. When obstruction is significant and persistent, the definitive treatment is surgery.

Septoplasty: surgical correction

Septoplasty is the surgical procedure designed to correct deviated nasal septum. It is performed through the nasal cavities, without external incisions, so it leaves no visible scarring.

The procedure

Septoplasty is performed under general anaesthesia and takes approximately 45 minutes to one hour. The surgeon accesses the septum through an incision in the nasal mucosa, elevates mucosal flaps on both sides of the septum, identifies and corrects the deviated areas of cartilage and bone. Deviated portions may be remodelled, repositioned or partially resected. Finally, the mucosal flaps are replaced and secured. In many cases, septoplasty is combined with turbinoplasty (reduction of hypertrophic turbinates) to optimise nasal airflow. It may also be combined with rhinoplasty when the patient wishes to simultaneously improve respiratory function and nasal aesthetics.

Recovery

Recovery after septoplasty is relatively quick. During the first 48 hours, there may be significant nasal congestion and slight bleeding. Most patients can return to their usual activities within 5 to 7 days. Breathing improves progressively as internal swelling resolves, with notable improvement from 2 to 3 weeks. Avoiding intense exercise for 2 to 3 weeks and contact sports for at least 4 weeks is recommended. Nasal washes with saline solution are essential during recovery to keep the passages clean and promote healing.

Results and prognosis

Septoplasty has a very high success rate. The vast majority of patients experience significant improvement in nasal breathing that is maintained long term. Patient satisfaction is generally high, especially when there was severe prior nasal obstruction. If you suspect you may have a deviated nasal septum and reside in Malaga, Marbella, Estepona or anywhere on the Costa del Sol, I invite you to request an evaluation with Dra. Fanjul. Through a complete examination, we can determine whether deviation is the cause of your symptoms and what the best treatment for your case is.