Septoplasty & Inferior Turbinate Reduction

Septoplasty and Inferior Turbinate Reduction form the basis of functional rhinoplasty procedures.  They are often first line treatments performed by Ear, Nose & Throat specialists (Otolaryngologists), but they are also frequently required in cases where the patient can’t breathe after rhinoplasty or previous septoplasty.  Sometimes there is confusion over what these procedures really are, and what they are not.

The septum is the wall inside the nose that separates the right and left sides of the nose.  It is made out of cartilage and bone, and covered on both sides by the skin in the nose which is more properly known as “mucosa”.  Inferior turbinates are the round “ball” like structures on either side of the septum that can actually be seen if you look in the mirror and shine a flashlight up your nose.  If the septum is deviated, it can be to either the right or left side, or even to both sides.  When the septum is deviated to one side, it is extremely common for the inferior turbinate on the opposite side to grow to be enlarged.  This leads to obstruction of breathing on both sides of the nose.

Another important part of the septum is what is known as the “caudal” septum.  This is the very front part of the septum that you can easily see and touch with your hands.  It is important because correcting deviations of this part of the septum is actually the most difficult type of septal surgery to perform.  It is more difficult because it requires an external incision to access, and the techniques used are more technically challenging.  ENTs usually refer these cases to facial plastic surgeons who are more familiar with the best rhinoplasty techniques to address these kinds of septoplasties. 

CT image of the nasal septum before and after the septoplasty procedure showing the effect of straightening the septum.

How is a septoplasty performed?

In a typical endonasal (incisions completely inside the nose, with no visible scar) septoplasty, an incision is made in the mucosa overlying the septum, and the mucosa is then elevated from both sides of the septum to protect it while work is done on the middle layer of cartilage and bone.

Once the mucosa is elevated, the surgeon removes deviated segments of cartilage and bone to correct the deviated septum problem.  The surgeon must take care to keep key aspects of the septum that support the framework of the nose.  Once complete, the mucosa is placed back down and stitched closed.  The septum is now straightened and put back together.

In open septoplasty there is an incision across the bottom of the nose, just like in open rhinoplasty.  The same techniques are used, and in fact the open septoplasty is often the first part of the open rhinoplasty procedure.  

For a detailed illustration of the surgical steps of septoplasty, see our functional rhinoplasty page.

What is the recovery from septoplasty?

Recovery from septoplasty is mild to moderate on the pain scale, and the expected downtime is around 1 week.  Frequently splints are left in the nose for 1 week, which can cause congestion and irritation.  Once these are removed comfort significantly improves.

What are the risks of septoplasty?

Recovery from septoplasty is mild to moderate on the pain scale, and the expected downtime is around 1 week.  Frequently splints are left in the nose for 1 week, which can cause congestion and irritation.  Once these are removed comfort significantly improves.

Actual operative view of septoplasty procedure. The deviated septum is completely blocking the nasal cavity in the image on the left. A new airway is created by correcting the deviation.
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