This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.
Overview of Procedure
The nasal cavity is divided by the nasal septum into the left and right partitions that join each other in the post-nasal space. The nasal septum is formed mainly by two bones (vomer and perpendicular plate of ethmoid) and one septal cartilage.
Nasal septal deviation is common and more than 60% of normal people have a degree of septal deviation. This could be present since birth or occurred as a result of a previous nasal trauma.
Septoplasty is a surgery where a deviated septum is straightened to allow for adequate nasal breathing, whereby the cartilage and/or bone is cut, resected, realigned, and/or scored. Whilst for most a direct approach can be taken via the anterior nares, external approaches are sometimes required for complex deviations and may be combined with rhinoplasty.
Figure 1 – Lateral view of the side of the nasal septum
Complications
Intraoperative
|
Complication |
Description of Complication | Potential Ways to Reduce Risk |
| Haemorrhage | Use local anaesthetic with adrenaline and ensure identification of the correct plane of dissection (subperichondrial-subperiosteal) | |
| Injury to surrounding structures | A rare but serious complication is injury to the skull base with potential CSF leak; injury to the front face of sphenoid is also possible | Ensure the perpendicular plate of ethmoid is divided before force is applied onto the septum |
| Anaesthetic Risks | Includes damage to the teeth or throat and reaction to anaesthetic medications. |
Early
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Bleeding | Post-operative bleeding could happen in the first few hours to days, however typically is mild and requires conservative measures only, including nasal packing | Ensure the use of haemostatic nasal packing at the end of the procedure |
| Septal haematoma or abscess | Blood collection under the lining of the septum; if untreated, it may get infected and become an abscess, therefore needs urgent drainage to avoid loss of the septal cartilage | Placement of quilting sutures to obliterate the dead space in the septum |
| Infection | Adequate nasal hygiene post-operatively |
Late
| Complication | Description of Complication | Potential Ways to Reduce Risk |
| Septal perforation | A hole in the nasal septum could occur in about 5% of patients, commonly asymptomatic however can lead to a whistling sound with breathing | Preserve the integrity of the perichondrial-periosteal flaps during dissection and avoid excessive cartilage resection |
| Change in the shape of the nose | Very rarely, a dip in the nasal bridge may occur as a result of lost septal support to the nasal dorsum | Avoid excessive cartilage or bone resection and preserve the integrity of the septal flaps |
| Dental numbness | Rarely (<1%) injury to the nasopalatine nerve leads to temporary or permanent numbness to the upper central incisors | Avoid excessive dissection on the antero-inferior part of the septum and electrocautery on the floor of the nasal septum |
| Recurrence | There is a potential for further surgery due to recurrence of the deviation | |
| Adhesions | Adhesions between the nasal septum and the opposing lateral nasal wall can occur if septoplasty was accompanied by turbinate reduction surgery | Preserve the mucosa on the medial surface of the inferior turbinate and avoid excessive surface cauterisation |