Deviated Septum FAQs

A deviated septum, caused either by traumatic injury or be present at birth, may need to be fixed if there are any symptoms that the deviation may cause like airflow restriction through the nose. Sometimes, a deviated septum may also restrict the sinus area and worsen sinus conditions, but this is less common a problem. If the septum is deviated either by physical examination or by a radiograph, like a CT scan, and there are no symptoms, then the deviation need not be fixed. In fact, if there are no symptoms whatsoever, the deviated septum should not be corrected.

The only true way to correct a deviated septum is through septoplasty, that is, surgical correction. However, if the nasal obstruction is caused by surrounding tissues that are inflamed further narrowing the nasal cavity, then non-surgical methods may be helpful to improve nasal airway without performing a surgical septoplasty. For example, the inferior turbinate can become enlarged and swollen with severe seasonal allergies. The enlarged turbinate may not impact breathing but if it is close to a deviated septum it may block the airway partially or entirely. Accordingly, nasal decongestant sprays like Afrin (oxymetazoline) and nasal steroid sprays may help with breathing. However, Afrin is very dangerous to be used for more than several days because it can cause one to be addicted to the product leading to what is known as rhinitis medicamentosa, meaning an inflamed nose that stays that way unless it receives the spray. Long-term use of African can also cause a restriction of nasal blood flow making a septoplasty and/or rhinoplasty dangerous until someone has stopped that product for several months’ time.

There is no easy way to know that you have a deviated septum without a physical exam and/or a radiographic image like a CT scan. There may be other anatomic issues causing the deviation. Going to your general family physician, an ear nose and throat specialist, or a facial plastic surgeon can help you diagnose the problem with a simple intranasal evaluation using a headlight and a speculum. A speculum is a metallic device used to spread open the nostril for a better view inside.

A deviated septum is caused, as mentioned above, either due to trauma, like a broken nose, or you were simply born that way. Sometimes the deviation can worsen over time as one grows since the septum itself is a major growth center and enlarges as one becomes older during puberty.

A deviated septum appears to be a bend or buckling inside the nose and can involve the anterior cartilage and/or posteriorly (toward the back of the nose) involving the bony portion. Sometimes if the deviation is very far forward it can cause the bottom of the nose, that is the nasal tip, to appear deviated to one side. A deviated septum can also be part of a deviated nasal bridge with broken/deviated nasal bones and/or nasal cartilages on the bridge. To straighten the septum, a more involved cosmetic/functional rhinoplasty may be needed to address all of the surrounding areas of deviation beyond the deviation of the septum alone.

In short, yes. A deviated septum can cause sleep apnea, which means you stop breathing during the night. That being said, just a deviated septum alone will most likely not be the only cause of apnea but be part of a larger spectrum of problems manifesting as apnea. For example, there can be enlarged turbinates or other nasal problems along with excessive throat tissues, especially if you are overweight. In most cases, just fixing a deviated septum will be insufficient to significantly improve apnea but can be one part of a strategy to help alleviate symptoms and improve your condition. A CPAP (continuous positive airway pressure) device may work better when the septum is straight and the airflow through the nose is better. A formal sleep study can help you determine the severity, cause, and source of the problem of your apnea as part of a diagnostic evaluation to guide you on the right surgical and/or non-surgical therapies to help you sleep better and live a longer life with improved quality.

A deviated nasal septum may be covered by your insurance. However, Dr. Lam does not accept insurance. That being said, he will correct your deviated septum at no extra charge during his rhinoplasty procedure. He actually does not recommend for you to fix your septum first before coming to see him if you are interested in a cosmetic rhinoplasty for several reasons. First, as mentioned, he will be correcting the septum as part of his rhinoplasty procedure so that you only need one surgery meaning less cost and one combined recovery. Second, he needs the septum, if possible, to be used as grafting material. Third, not having a prior septoplasty will reduce scar tissue and make rhinoplasty easier since he anchors the nasal septum to the nasal tip using an extended caudal septal extension graft. Finally, he believes that the nasal septum may not be the only cause of the problem in that the internal nasal valve consisting of the septum, upper lateral cartilage (on the nasal bridge), and the inferior turbinate may be involved, meaning it is far easier for him to fix all components at once. For example, to help with the internal nasal valve, he may fix the deviated septum, insert a spreader graft at the top of the septum, straighten the nasal bones and cartilage, and move the inferior nasal turbinate over. If part of a septoplasty has already been performed, it makes the procedure harder to undertake. To diagnose internal nasal valve collapse, Dr. Lam may use a cotton-tipped applicator (a Q-tip) in your nose to make that evaluation, which is known as a modified Cottle maneuver.

You cannot push a nasal septum back to midline. That can cause a serious problem including a collapsed nasal bridge. The “L-strut” component which is the L shape of the septum along the bridge and the bottom of the nose must be kept intact or the nose will collapse or saddle downward. That is what you can sometimes see in boxer’s noses with collapsed bridges. You can also inadvertently create a septal hematoma or blood clot in the septum through trauma leading to a loss of blood supply to the septum and then collapse of the nose over time. In short, you cannot move a deviated septum back into place with any kind of non-surgical pressure. Instead, only a qualified surgeon can help achieve this goal. Dr. Lam is board certified in both ear, nose, and throat (otolaryngology-head and neck surgery) as well as facial plastic surgery, so he is uniquely qualified to help you with your deviated septum. That being said, if you only have a standard deviated septum without evidence of other major functional abnormalities like a pinched internal nasal valve or deviated/broken nasal bridge and you do not want a cosmetic change to your nose, he will most likely refer you to an ENT specialist that he trusts to perform your procedure.

In general, no. He has done so for his patients who refuse to go elsewhere, but he encourages them to go to a provider that accepts insurance to perform an isolated septoplasty. That being said, sometimes a deviated septum is only one part of a complicated nasal airway problem that an ENT surgeon may be incapable of improving. As mentioned, if the internal nasal valve is collapsed or pinched either due to a deviated nasal bridge or narrow septal angle (the angle between the septum and the bridge), then Dr. Lam would be the better option to correct your septal problem.

Dr. Lam will carefully evaluate your turbinate size and position and determine whether a turbinoplasty would be a complementary procedure to undertake. In principle, he does not believe in removing the inferior turbinate, even partially since the turbinate contributes to warming, cleaning, humifying the air and also improves laminar flow (smooth, non-turbulent) airflow. However, he will adjust the turbinate position when needed as part of the procedure.

On both sides of the central cartilage and bone structure lie mucoperichondreal flaps, that is, mucosal tissue, that must be delicately elevated off of the cartilage. Then the deviated cartilage and bone are carefully reshaped and/or removed. Finally, Dr. Lam sutures (sews) the two flaps back together, always taking care to leave a generous L-strut support (see above) to ensure that the septum has great strength, resilience, and resists collapse.