Why Septum Deviation Surgery May Not Always Be Sufficient?
Septum deviation refers to the curvature of the nasal septum, the structure that divides the nose into two halves. This structure contains both cartilage in the front and bone in the back. The curvature directly affects both nasal aesthetics and nasal function. Septum deviation surgery aims to correct this curvature. However, this surgical intervention may not yield the same results in every patient. But why?
How Sufficient Is Septoplasty Surgery?
Septoplasty surgery is the most common technique applied to correct curvature in the nasal septum. In the more advanced form of this surgery, the SMR (submucosal resection) technique, a more extensive cartilage and bone removal can be performed. However, during these surgeries, it is mandatory to leave at least 1 cm of cartilage in the front and 1 cm on top to prevent the nasal structure from collapsing. This remaining structure is called the “L-strut.”
However, if the main curvature is located in this area, a classic septoplasty or SMR surgery becomes insufficient. This can cause complaints such as nasal congestion to persist.
Is the Curvature at the Back or Front of the Nose?
In common deviation types in the population, the curvature is often not only in the back bone area but also in the front cartilage part of the nose, namely in the L-strut region. This area is extremely critical for both the shape of the nose and breathing function.
If intranasal curvature is not just a bony protrusion in the back, surgeries performed without intervening in the front support structures may remain unsuccessful.
Nasal Valve Structure Determines Breathing
The internal nasal valve and external nasal valve, which are the narrowest areas of the nose, play a major role in air passage. Narrowing or collapse in these areas can continue to make breathing difficult even if septum deviation surgery is performed.
Septum curvature that narrows the internal valve angle or support loss in the external valve cannot be corrected with a classic SMR. Therefore, functional rhinoplasty techniques may be required in these patients.
Why May Nasal Congestion Not End with Deviation?
In some patients, external nasal structures can also narrow the airway. Particularly weak nasal wings, collapsed nasal tip, support loss after previous surgeries can cause inability to breathe after nasal surgery.
Therefore, before planning deviation surgery, not only internal structures but also the external appearance and durability of the nose should be evaluated.
For Which Patients Is Septoplasty Sufficient?
Septum deviation surgery can be sufficient and effective alone in the following situations:
- If the curvature is only in the back, in the bone area
- If the L-strut structure is intact and centered
- If there is no collapse or weakness in the external structure of the nose
- If the patient has not undergone nasal surgery before
This patient group constitutes a relatively small portion of the population. Additional surgical support may be required in the remaining patients.
Why May Functional Rhinoplasty Be Necessary?
Functional rhinoplasty is a surgical approach that both solves the nasal congestion problem and supports the external structure. With such interventions, the septoplasty effect is enhanced, the patient breathes better, and the risk of nasal collapse is reduced.
From Dr. Gediz Murat Serin’s Perspective: Not Every Deviation Is the Same
As Dr. Gediz Murat Serin, who has been working as an Ear Nose Throat Specialist for many years, the situation I encounter most frequently in my clinical practice is this:
The deviation problem is often not only in the bone or cartilage inside the nose, but also in the front cartilages near the nasal tip and in the external nasal structure. This makes it difficult to solve the entire problem with a classic septoplasty surgery.
Therefore, in my approach to patients, I mostly prefer the functional rhinoplasty method. This way, I both correct the internal curvature and repair the support losses in the external nasal structure, permanently improving the breathing function.
After surgery, my patients express that they not only breathe more comfortably, but also that their noses have achieved a more balanced, natural and strong form. This increases both the long-term permanence of surgical success and patient satisfaction.
Conclusion: Not Every Deviation Is the Same
Every intranasal curvature, every septum deviation, cannot be corrected with a septoplasty surgery alone. Nasal function can be preserved in the healthiest way by addressing both internal structures and external support together.
Therefore, focusing only on deviation in a patient with nasal congestion may not be sufficient. Surgical planning should be done considering both nasal valve structures and external nasal anatomy. When necessary, advanced techniques such as functional rhinoplasty should be employed.