Signs of failed septoplasty and its danger to breathing

If you or a relative have recently undergone a septoplasty (nasal septum surgery), you may be wondering: Was the surgery truly successful? Are there any signs that indicate it might have failed?Septoplasty is one of the most common procedures to improve breathing and reduce nasal obstruction. However, like any surgery, it can sometimes encounter complications or partial failure.In this we will explain the main signs of septoplasty failure, the possible causes, and when you should consult your doctor. We will also discuss the potential risks of the procedure and the symptoms that require immediate attention.

Is Septoplasty (Nasal Septum Surgery) Dangerous?

Many people worry about septoplasty because of potential risks and often have questions like:

Is the surgery dangerous?
Can the deviation affect hearing?
Will it cause dizziness?

The truth is, the surgery is not dangerous at all. It’s a simple procedure that usually takes 30 to 90 minutes, and recovery typically lasts only about one week.

What is Nasal Septum Surgery?

Septoplasty is a surgical procedure to correct a deviated septum inside the nose. Its goals include:

Improving breathing and reducing nasal obstruction.
Sometimes treating snoring or chronic sinus infections.

When Does a Doctor Recommend the Surgery?

The procedure is necessary in cases such as:

Chronic nasal blockage that doesn’t improve with medication.
Breathing problems during sleep or snoring.
Frequent nosebleeds due to deviation.
Recurrent headaches associated with the nasal septum.

How is Septoplasty Performed?

Performed under local or general anesthesia depending on the patient.
The surgeon adjusts the deviated cartilage or bone without any external incisions.
The entire procedure is done inside the nose.

How Long Does Septoplasty Take?

Usually between 30 minutes to 1.5 hours, depending on the severity of the deviation and the complexity of the case.

What to Expect After Surgery?

Postoperative symptoms are usually mild and include:

Nasal congestion or blockage for several days.
Mild swelling or bruising around the nose or eyes.
Minor bleeding on the first or second day.
Pain is usually mild and can be managed with regular painkillers.

Home Care Instructions

Avoid frowning or forceful nose blowing for two weeks.
Avoid strenuous exercise or heavy lifting for 2–3 weeks.
Keep the nose clean using saline solution if prescribed.
Follow the doctor’s instructions regarding painkillers or antibiotics.

Potential Complications

Most cases recover without issues, but complications may include:

Bleeding or hematoma.
Minor infection.
Slight changes in nasal shape in some cases.
Very rarely: septal perforation or loss of sensation at the tip of the nose.

When Will the Final Results Appear?

Usually after 3–6 months, as internal swelling gradually subsides and breathing improves fully.

Is the Surgery Painful?

Pain is generally mild, easily tolerable for most patients, and regular painkillers are sufficient.

Can It Be Combined with Rhinoplasty?

Yes, in some cases, a septorhinoplasty can be performed to improve both nasal shape and breathing simultaneously.

Does Septoplasty Change the Nose Shape?

For septoplasty alone, the external shape usually does not change unless combined with cosmetic surgery.

Is Septoplasty Suitable for All Ages?

Typically recommended for adults over 18 years old. In exceptional cases, it can be performed on teenagers after careful evaluation.

Can a Deviated Septum Be Treated with Medication?

Medications like nasal sprays or decongestants can relieve symptoms temporarily but do not correct the deviation itself.

How Long Before Returning to Normal Life?

Most patients resume normal activities within 7–10 days, while avoiding strenuous activities for 2–3 weeks.

Will Patients Need to Change Dressings or Splints After Surgery?

Some surgeons place internal splints or small dressings for a short period (1–3 days).
In some cases, splint-free techniques may be used.

Is There a Risk of Losing Sense of Smell?

Very rare. In most cases, the sense of smell returns gradually after full recovery.

Can the Surgery Be Done in Patients with Chronic Conditions Like Hypertension or Diabetes?

Yes, but chronic conditions should be well-controlled and discussed with the anesthesiologist prior to surgery to minimize risks.

Will a Second Surgery Be Needed?

In rare cases, if breathing does not improve or a new deviation occurs, revision surgery may be considered after full recovery.

Can Children Undergo the Surgery?

Only in very exceptional cases and after careful evaluation, as a child’s nose is still growing.

Does the Surgery Affect Snoring?

Yes, correcting the deviation often reduces snoring caused by nasal obstruction, but it does not treat snoring caused by other factors such as the palate or mouth.

Stages of Nasal Septum Deviation

Septum deviation develops with age or after injuries, affecting symptom severity and treatment options:

Infancy and Childhood (0–10 years)
- Most children have a small, flexible septum.
- Deviation may be very mild or not noticeable.
- Usually hereditary at this stage.
Adolescence (11–18 years)
- The nose grows significantly, and the septum becomes firmer.
- Any imbalance in bone or cartilage growth can cause noticeable deviation.
- May lead to partial nasal obstruction or breathing issues.
Early Adulthood (19–25 years)
- Bones and cartilage stabilize into their final shape.
- Deviation becomes more obvious, possibly causing permanent obstruction in one or both nostrils.
- Injuries or fractures during this period can worsen the deviation.
Adulthood (After 25 years)
- Changes are usually minor, such as increased deviation due to cartilage weakening or surrounding tissue changes.
- Can lead to chronic breathing problems or sinus infections.

Causes of Nasal Septum Deviation

Deviation can be hereditary or acquired due to external factors:

Hereditary Causes
- Some people are born with a congenital septum deviation.
- Often linked to genetics; if a family member has deviation, children have a higher chance of developing it.
Acquired Causes
a. Injuries and Trauma
- Any direct blow to the nose, such as accidents or falls, can cause deviation.
- Untreated old fractures may lead to later deviation.
  b. Uneven Growth During Childhood
- Uneven bone or cartilage growth during adolescence can cause septal deviation.

C. Surgery-Related Factors
Previous nasal surgeries or imprecise surgical interventions can lead to changes in the septum’s position or cause a new deviation.

D. Chronic Diseases or Infections
Chronic rhinitis or enlarged internal cartilage can put pressure on the septum over time, leading to deviation.

What Are the Symptoms of a Deviated Septum?

Symptoms vary depending on the severity of the deviation and often include:

Difficulty Breathing
- Blockage in one or both nostrils, usually on one side.
- Breathing becomes more difficult during sleep or exercise.
Frequent Nasal or Sinus Infections
- Continuous blockage can lead to chronic sinusitis.
- Recurrent headaches due to sinus pressure.
Frequent Nosebleeds
- Dry mucous membranes caused by the deviation can result in repeated nosebleeds.
Snoring and Sleep Problems
- Severe deviation may cause snoring or difficulty sleeping due to airway obstruction.
Pain or Pressure
- Some patients feel mild pressure or pain in the nose or face, especially with significant deviation.
Changes in Nose Shape
- In some cases, deviation can affect appearance, such as tilting the nasal tip or uneven nostrils.

Causes of Septoplasty Failure

Septoplasty failure can occur for various reasons, related to surgical technique, septum anatomy, or post-operative factors:

Surgical Issues During the Operation
- Incomplete removal or correction of the deviated septum.
- Incorrect repositioning of bones or cartilage, leading to continued obstruction or new deviation.
- Preoperative planning errors, such as incomplete nasal assessment or complex deformities.
Patient-Related Factors
- Continued bone or cartilage growth in young patients may cause new deviation.
- Chronic infections or allergies affecting septum healing, increasing failure risk.
Post-Operative Problems
- Adhesions or scars inside the nose causing partial or complete obstruction.
- Trauma during recovery may reintroduce deviation.
- Not following medical instructions, such as avoiding strenuous activity or not taking prescribed medications.
Rare Factors
- Natural tissue changes with age, like cartilage weakening or bone changes, can lead to new deviation over time.

Types of Septum Deviation

Deviation types vary based on the septum’s shape and location, affecting symptom severity and treatment options:

Anterior Deviation
- Deviation occurs in the front part of the septum, near the nostrils.
- Often causes noticeable blockage in one or both nostrils.
- Common in hereditary cases or early injuries.
Posterior Deviation
- Deviation occurs in the back part of the septum, near deep internal nasal passages.
- Symptoms are usually less obvious than anterior deviation but may cause internal breathing difficulties and chronic sinusitis.
C-Shape Deviation
- Septum curves like the letter “C.”
- Typically affects one side and often obstructs one nostril.
S-Shape Deviation
- Septum curves like the letter “S.”
- Deviation occurs in two opposite directions and may cause partial blockage in both nostrils.
Tilted or Total Deviation
- Septum is fully tilted to one side.
- Often causes severe obstruction and breathing problems, sometimes affecting the external nose shape.

Diagnosis of Septum Deviation

Diagnosis is usually based on clinical examination and imaging to determine deviation location and severity, including:

Clinical Examination
- External and internal nose inspection using a nasal endoscope.
- Assess deviation location, severity, and airway impact.
- Note any swelling, obstruction, or enlarged internal cartilage.
Medical History
- Ask about previous nasal injuries or fractures.
- Identify current symptoms such as breathing difficulty, nosebleeds, or chronic sinusitis.
- Check for hereditary deviation in the family.
Imaging Tests
- X-Ray: Detect clear deviations or old fractures.
- CT Scan: Used in complex or chronic cases to provide a detailed image of septum and cartilage.
Breathing Function Assessment
- Sometimes airflow is tested to determine how the deviation affects breathing.
- May include oxygen level measurements during sleep if deviation causes severe problems or snoring.

Nasal Septum Surgery (Septoplasty)

Septoplasty is a surgical procedure to correct septum deviation, improve breathing, and prevent complications, including:

Purpose of Surgery
- Correct septum deviation.
- Improve airflow and reduce nasal obstruction.
- Reduce chronic infections or sinus problems caused by deviation.
- In some cases, improve external nose shape if the deviation is severe.
Types of Surgery
A. Traditional Septoplasty
- Incision inside the nose to access the deviated septum.
- Remove or reshape bones and cartilage causing deviation.
- Sutures placed inside the nose, usually leaving no visible scars.
B. Endoscopic Septoplasty
- Uses a small camera and instruments to correct the septum.
- Less invasive than traditional surgery, with better visualization of deep areas.
- Reduces post-operative swelling.
Steps of the Procedure
- Anesthesia: Local with sedative or general, depending on patient and complexity.
- Make an incision inside the nose to access the septum.
- Identify and remove or reshape the deviated cartilage and bone.
- Stabilize the septum using internal sutures or a small splint.
- Close the incision and place dressing or internal splint as needed.
Recovery Period
- Days 1–7: Mild swelling and bruising, pain manageable with analgesics.
- Weeks 2–3: Swelling gradually decreases; light activities may resume.
- Months 1–3: Nose begins to stabilize; final shape appears after 3–6 months.
Post-Operative Care
- Avoid pressure on the nose or forceful blowing.
- Keep the nose clean using saline solution if prescribed.
- Follow doctor’s instructions regarding painkillers and antibiotics.
- Avoid strenuous activities or trauma.