Septoplasty is the corrective surgical procedure for a deviated nasal septum, the cartilaginous and bony partition between the two nasal cavities. The septum can be displaced congenitally, due to facial trauma, or by adjacent vomerine spurs and crests, leading to chronic nasal obstruction, recurrent sinusitis, epistaxis, and sleep-disordered breathing. Indications include functional symptoms refractory to medical management with imaging or endoscopic confirmation of significant deviation impacting at least one nasal cavity.
The classical Killian or hemitransfixion incision is followed by elevation of mucoperichondrial and mucoperiosteal flaps, removal or repositioning of obstructing cartilage and bone (vomer, ethmoid plate, maxillary crest), and preservation of an L-shaped dorsal and caudal strut at least 1 cm wide to maintain nasal tip support. Endoscopic septoplasty offers magnified visualization, targeted spur resection, and combined functional endoscopic sinus surgery (FESS). Concurrent inferior turbinate reduction (submucous resection or radiofrequency) is frequently performed to address mucosal hypertrophy contributing to obstruction.
Postoperative care includes intranasal saline irrigation, avoidance of nose blowing for one week, and limited physical activity for 2-3 weeks. Splints, if placed, are removed at 5-7 days; packing is generally avoided in modern practice. Most patients experience marked improvement in nasal airflow within 2-6 weeks. Complications include septal hematoma or abscess, septal perforation (1-3%), saddle nose deformity from over-resection, anosmia, persistent obstruction (10-15% revision rate), and rarely cerebrospinal fluid leak. Outcomes are generally durable when conservative cartilage preservation principles are followed.