How is Septum Deviation Surgery (Septoplasty / SMR) Performed?
Prof. Dr. Gediz Murat Serin – Ear Nose and Throat Specialist | Teşvikiye ENT Group
What is Septum Deviation?
Septum deviation is the curvature or deviation from the midline of the cartilaginous and bony wall that separates the two nostrils.
This curvature disrupts the airflow inside the nose and leads to complaints such as nasal congestion, snoring, recurrent sinusitis attacks, and mouth breathing in patients.
It is quite common in the population and the permanent solution is usually surgical correction, namely septoplasty (or SMR – submucous resection) surgery.
For Whom is Septoplasty a Suitable Surgery?
The same surgery may not be sufficient for every patient with nasal congestion. If we think of the nose as a tunnel:
- Inside the tunnel, that is, if there is only a curvature inside the nose, the external nose shape is straight and the tip is not low →
Closed septoplasty is a very effective solution for these patients. - However, outside the tunnel, that is, if there is curvature in the external nose, drooping at the tip, or structural weakness →
In this case, open technique functional rhinoplasty is required. Because in these surgeries, the shape of the nose is also corrected along with the airway.
In other words, what is commonly called “open septoplasty” is actually a procedure that falls into the rhinoplasty group.
How is Septoplasty (SMR) Surgery Performed?
Septoplasty is an operation that is performed entirely from inside the nose, leaving no external scars.
The goal is to correct the curvature, increase airflow, and permanently ease breathing.
1-) Anesthesia
In most patients, the surgery is performed under general anesthesia.
2-) Access to the Septum
The surgeon reaches the curved area by making a small incision inside the nose.
Since this incision remains completely inside, it is not visible from the outside.
3-) Correction of the Curvature
The cartilage and bone pieces at the back that form the curvature are carefully removed or reshaped.
The anterior-superior support (L-strut) that allows the nasal structure to stand upright is preserved.
This area is the basic skeleton that holds the roof of the nose upright.
If the L-strut itself is curved, standard septoplasty is not sufficient; then open technique and graft support (for example, spreader or batten graft) may be necessary.
4-) Placement of Silicone Splints
At the end of the surgery, breathable silicone plates (splints) are placed inside the nose.
These plates are easily removed after 3–7 days.
Since classic, painful tampons are no longer used, the patient can breathe through the nose even after surgery.
Why is Inferior Turbinate (Nasal Flesh) Treatment Necessary?
On the opposite side of the nasal curvature, the inferior turbinate, which we call nasal flesh, grows reflexively.
This situation can prevent the complete opening of the airway even after surgery.
Therefore, in most septoplasty surgeries, turbinate reduction procedure is also performed in the same session.
The goal in turbinate reduction is to reduce volume without damaging the mucosa. For this:
- Radiofrequency (RF) applications,
- Submucosal resection or
- Methods such as Lateralization (laying the turbinate to the side) are used.
These procedures significantly increase the success of the surgery.
Post-Surgery Process
During the first few days, congestion, mild pain, or watery discharge may be seen in the nose.
These findings are a natural part of the nose’s healing process.
- Blows to the nose should be avoided.
- Blowing the nose is not recommended.
- The sprays and washes recommended by the doctor should be done regularly.
Breathing becomes significantly easier within approximately 2–3 weeks.
The complete resolution of internal nasal edema and renewal of the mucosa usually takes 2–3 months.
Benefits of Septoplasty Surgery
- Comfortable and balanced breathing
- Better sleep and feeling rested
- Reduction in snoring and sinusitis attacks
- Higher performance in sports and daily activities
- Elimination of mouth breathing and throat dryness
Possible Risks
As with any surgical procedure, there may be some low-rate risks in septoplasty:
- Mild bleeding or crusting
- Infection
- Temporary reduction in smell
- Very rarely, formation of a small hole in the septum (perforation)
However, thanks to preservation of the L-strut, mucosa-respecting techniques, and modern surgical approaches, these risks are extremely low.
