Curvatures of the nasal septum are usually caused by different growth of the facial bones and cartilage during puberty. In some cases, they are also the result of nasal bone fractures, which can occur during birth in the birth canal.
Very often it is also necessary to remove the swelling bodies that humidify and warm the air (Nasal concha) can be reduced. This ensures free passage through both nasal passages. The turbinates are often greatly enlarged and require correction, especially in allergy sufferers.
The operation is usually performed under general anaesthetic either as an inpatient or outpatient procedure.
The mucous membrane is detached from the cartilage and bone via a small internal incision on the front edge of the nasal septum. In some cases, tension bends can be released using special incision techniques; in other cases, severe bends must be loosened, removed, straightened outside and then reimplanted between the mucosal sheets (replacement technique).
The three layers of the nasal septum should be preserved in order to maintain mucosal moisture. To stabilise the straightened nasal septum and to press the mucous membrane leading to the blood vessels back onto the cartilage and bone, silicone splints are applied on both sides. These remain in the nose for approx. 4 days.
The turbinates are also reduced in size during the same procedure. Either the method of ConchotomyThis means the sharp removal of excess tissue or various forms of energy are used to reduce tissue on or in the turbinate. Laser, monopolar or bipolar coagulation or, as a more recent procedure, bipolar thermotherapy (thermocoagulation, RFITT) are used. As the turbinates consist of tissue with a very good blood supply, it is necessary to insert a tamponade on both sides to prevent secondary bleeding.
The nasal tamponade is removed on the first or second postoperative day. The inserted silicone splints remain in the nose for a further two days and a two-week healing phase must be expected. During this time, it is important to take it easy physically in order to prevent secondary bleeding due to rising blood pressure.
During this phase, it is also important to ensure adequate mucous membrane care, including moisturisation.
The nasal septum consists of cartilage and bone. It is lined on both sides with a protective mucous membrane. The so-called nasal septum divides the inside of the nose into two areas like a partition: a left and a right half. It stabilises the structure of the nose and controls the flow of air. The nasal septum is also important for the perception of odours.
In most cases, a deviated septum is congenital. However, it can also be acquired, e.g. as a result of the posterior bony and anterior cartilaginous parts growing at different rates. In addition, diseases or injuries to the nose, such as a fracture, can lead to a curvature or bending of the nasal septum.
A deviated septum is more common than you might think! It is estimated that around 90 per cent of people suffer from a more or less pronounced curvature of the nasal septum. However, this does not cause symptoms in everyone. Patients who come to us often do not even realise that they have a deviated nasal septum.
Common diseases of the nasal septum that often require functional rhinoplasty are
A curvature or misalignment of the nasal septum causes narrowing of the nasal passages. As a result, less air can flow through one nostril than the other. Patients often find it harder to breathe, especially during physical exertion.
As a deviated nasal septum can impair breathing, many patients experience a lack of air, e.g. during physical exertion. To compensate for this, patients often (unconsciously) breathe through their mouth. This dries out the mucous membranes in the throat, making it easier for viruses and bacteria to colonise and spread. The susceptibility to respiratory infections increases.
Many of those affected therefore suffer more frequently from colds. This leads to swelling of the mucous membranes in the nose. Due to the curvature of the nasal septum, the thick mucus produced is more difficult for the body to remove. As a result, sinusitis develops more frequently than in other patients and can even become chronic.
As different as people are, so different can their nose shapes be. They can be divided into certain "categories" (e.g. broad nose, hooked nose, snub nose ...). The so-called crooked nose is common.
It has a laterally displaced, crooked shape and leans visibly to the left or right. The shape of the nose can be caused by accidents or injuries. A crooked nose is also often the result of a deviated septum and is associated with restricted nasal breathing. Surgery can provide a remedy here - both from a plastic/aesthetic point of view, as the nose is straightened visually, and from a functional point of view, as breathing is improved.
To detect a curvature of the nasal septum, we look at the nose from the outside by looking into the nostrils and lifting the tip of the nose, as well as from the inside using a nasal endoscopy. We also use nasal flow measurement to recognise whether there are differences in the airflow when breathing in and out. In some cases, an X-ray examination or CT scan may also be necessary.
For mild symptoms such as mucous membrane problems/dry nose, we generally recommend treatments with salt water rinses, sea salt nasal sprays or ointments. Increasing the humidity in the room (e.g. using an evaporator) can also have a favourable effect.
If these measures do not achieve the desired improvement or if the symptoms have persisted for a long time, an operation may be advisable. We straighten the nasal septum surgically under anaesthetic. This is known as a septoplasty.
Please do not blow your nose in the first few days after the operation, otherwise the wound may open up again. After a few weeks, you can carefully blow your nose again with your mouth open. In this way, less pressure is exerted on the inside of the nose. Avoid taking medication that thins the blood (e.g. aspirin).
It is also important that you take good care of your nose to support the healing process. This is because the self-cleaning function of the nose is still limited in the first few days and weeks after the operation. We recommend regularly moisturising the mucous membranes with seawater sprays or rinses and using special creams.
Furthermore, for a few weeks after the nasal septum operation, you should not perform any movements or activities that cause an increase in blood pressure or dilation of the blood vessels. This means: no heavy physical labour, no sport, don't lift anything heavy, don't bend over too much and stay away from extreme heat (no hot showers/baths, sunbathing or visits to the sauna or solarium).
The general and generally applicable surgical risks (e.g. thrombosis, wound infections) apply to nasal septum surgery. Bleeding under the mucous membrane with the formation of a haematoma, temporary loss of sensation in the nose, upper lip, palate and front teeth, incrustations in the nose, sensitivity to pressure at the tip of the nose and - very rarely - impaired sense of smell are also possible.
Depending on the findings, i.e. the intensity of the curvature of the nasal septum or damage to the nasal septum, you can expect the procedure to take around 45 to 60 minutes.
If the curvature of the nasal septum leads to health problems and the operation is medically necessary - i.e. it has a medical indication - the costs of the operation are covered by the health insurance company. In the case of surgery for plastic/aesthetic reasons, it is a self-payment service.
Various documents must be submitted to the health insurance company for the costs to be covered. We will help you to compile the necessary documents.
Sometimes the discomfort caused by a deviated septum can be treated with salt water rinses, sea salt nasal sprays or ointments. If the findings make surgery necessary, a turbinate operation instead of a nasal septum operation can also lead to an improvement in nasal breathing in individual cases.
The turbinate surgery can be performed with the laser on an outpatient basis under local anaesthetic and without tamponades. If desired, the operation can be performed on one side or successively on both sides. It generally has a shorter downtime. We will be happy to clarify with you in a personal consultation whether this alternative option is suitable for you.
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