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What is deviated nasal septum?

nasal cavity without deviated septum
View of right nasal cavity.The septum is straight and the inferior turbinate has a characteristic puffy appearance. Air flows freely throughout the nasal cavity.
The nasal septum is the structure inside the nose that separates the two nostrils and nasal cavities. It is composed of bone and cartilage, and is lined on both sides by a soft tissue lining called "mucosa." The septum is considered “deviated” when its natural contour is crooked, and causes narrowing of one or both nasal cavities that results in nasal obstruction (airflow that is blocked in either one or both of the nostrils). A deviated septum won’t always cause nasal obstruction, so not every deviated septum requires treatment. The septum can be deviated in different locations as well, and the site of deviation determines the side(s) of the nasal obstruction and whether it causes a change to the external appearance of the nose.

More commonly, a deviated septum is found on the inside of the nose, so it’s not uncommon to have a deviation that causes nasal obstruction, but the nose looks normal on the outside. Conversely, some patients can have a crooked nose on the outside, but have a straight septum on the inside, and therefore breathe fine. Consulting with your physician will determine where your deviation is and if you require treatment.

Deviations of the nasal septum may be congenital (you are born with it), or can be caused by nasal trauma, such as from an accident or injury, or from prior nasal surgeries.

Deviated nasal septum symptoms

The primary symptom of deviated nasal septum is nasal obstruction, meaning that airflow is blocked through either one or both of the nostrils. Nasal obstruction can also be a symptom of inferior turbinate hypertrophy, and it’s very common to have both a deviated septum and inferior turbinate hypertrophy together.

Other symptoms may include nosebleeds if the nose gets dried out, or even sleep issues, and can cause problems in patients with obstructive sleep apnea.

Deviated nasal septum treatment options

nasal cavity after surgery
Figure B: View of a right nasal cavity (from Fig. A). Surgery to straighten the septum (endoscopic septoplasty) and reduce the inferior turbinate (inferior turbinate reduction) now allows air to flow freely throughout the nasal cavity (no nasal obstruction).

nasal cavity with deviated septum and inferior turbinate enlargement
Figure A: View of a right nasal cavity. Airflow is blocked (known as nasal obstruction) due to a deviated nasal septum and swelled inferior turbinate (hypertrophy).
A deviated nasal septum only requires treatment if it is causing nasal obstruction in one or both sides of the nose. In addition, patients with obstructive sleep apnea who have difficulty using a continuous positive airway pressure device (CPAP), may better tolerate the device if they undergo treatment.

If a patient is a candidate for treatment, medical options include:

  • Nasal steroid spray
  • Breath-right strip
  • Nasal saline spray or high-volume irrigation

If the nasal obstruction does not improve enough with medical treatment, surgery may be an option. The most common procedure is called a septoplasty. A septoplasty involves removing the deviated portions of septal bone and cartilage while keeping the tissue linings (mucosa) of the septum intact to prevent a hole in the septum. The end result of this procedure is the widening of the nasal cavity inside the nose where the septum was blocking airflow, resulting in increased airflow through one or both sides of the nose. This procedure should not affect the external appearance of the nose.

Depending on the patient’s anatomy, location of the nasal obstruction, and whether or not the patient wants the external appearance of their nose to be altered, a rhinoplasty may be more appropriate than a septoplasty. Patients should always talk with their rhinologist (doctor specializing in sinus and nasal care) who can refer them to a facial plastic surgeon.