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A deviated septum (also known as septal deviation) is an anatomical abnormality inside the nose. The septum is a partition that divides the nose into two separate passages. If the septum is deviated it means that it has areas of abnormal angulations and curvatures that obstruct one or both sides of the nasal passage. In revision rhinoplasty, a deviated septum, if present, can be problematic for two reasons. The first is that a deviated septum can cause significant nasal airway obstruction and needs to be properly addressed at the same time as revision rhinoplasty. The second problem is that if the nose is crooked, the deviated septum is often a contributing factor and should be corrected to improve nose asymmetry.
A deviated septum is quite common and in most people it is not the result of any injury or fracture. Septal deviation may at times be the result of facial injury resulting in a broken nose (nasal fracture). If nasal injury occurs in childhood, while the septum and nose are still growing, the injury may send the septum off its normal growth pattern and result in deviation of the growing septum. Mild deviation of the septum is typically not problematic and although one nasal passage may be partially obstructed, the other will often compensate. Moderate to severe septal deviations often result in nasal obstruction and are at times be associated with sinus problems, nosebleeds, snoring, nasal dryness and crusting.
Correction of a deviated septum is called septoplasty. Like rhinoplasty, septoplasty is an outpatient procedure and is performed with IV sedation or general anesthesia. Septoplasty can be performed at the same time as rhinoplasty or revision rhinoplasty. The septum has a special type of internal skin (called mucosa) covering both sides of it. During septoplasty this internal skin is peeled off the septum from both sides and the cartilage and bone are reshaped and straightened and the internal skin is placed back over the septum. The incisions are internal and are closed with dissolving sutures. The more advanced techniques of septoplasty don't require placing any packing inside the nose.
For most individuals having septoplasty a weekend (2 days) is adequate recovery for returning to basic activities (work, school, driving, shopping). No packing is needed but nose blowing and exercise should be avoided for 1-2 weeks.