Nasal septum surgery

For improved nasal functionality in the case of a deviated septum

Breathing through the nose is such a natural thing for us humans that we don't even realise it in our daily lives. However, if nasal breathing is restricted, we feel it immediately and find it very discomforting. 


We are all familiar with this condition, at least in the context of upper respiratory tract infections, when the nose is swollen shut. At this point, not only breathing is restricted, but also our sense of smell suffers greatly, as the scents no longer reach the olfactory cells in the nasal mucosa of the olfactory groove. We have to use our mouth for breathing if we do not have decongestant nasal drops at hand, or even worse, if this is a permanent condition. 


In such cases, a surgery may be required - possibly even the so-called nasal septum straightening or septoplasty.

Cross-section of the nose
Cross-section of the nose

Nasal septum curvature / deviated septum – a common diagnosis

The nasal septum is just a few millimeters thin, it divides the inner nose into two symmetrical halves and is an important pillar for the shape of the outer nose.


The nose is made of cartilage in the anterior part and solely of bone in the posterior part and is lined with mucous membrane so that it can move. The very upper part adjacent to the base of the skull contains a large number of fine olfactory fibres for the perception of scents. When we get older, the posterior parts of the cartilage ossify more and the cartilage becomes thinner. 


At the same time, the nasal septum continues to grow throughout its entire lifetime - just like the nose as a whole. 


There are many blood vessels, especially in the area of the nasal entrance, which are supposed to regulate the temperature and humidification of the inhaled air (the main source of sudden nosebleeds, by the way).


The cartilage of the nasal septum is not directly supplied with blood. The nourishment of the cartilage cells takes place via the so-called diffusion. This is an important aspect in nasal septum surgery, which will be explained in more detail below. 

What is the cause of the curvature?

Many people have a deviated septum without noticing it in the form of nasal breathing obstruction. 

It usually develops at the end of the body's growth phase, at the earliest, and then usually in the further course of development. That' s because the cartilage of our nose keeps growing throughout our entire lives. It can be observed in the fact that older people often have large noses and big ears as well. This quality is also evident here. 

The nasal septum continues to grow throughout life

Just as the nose grows externally, so does the nasal septum. This can result in an initially slight curvature becoming more and more prominent. Exostoses, such as a spur or a groin on the nasal septum, can affect the passage of the air through the nose and lead to obstructions or a complete blockage of the flow. Chronic headaches or a sense of pressure can be the consequence in some cases. 

Injuries as the cause

Injuries inflicted on the nose during sports or, for example, due to a fall in early childhood, may also lead to a curvature of the nasal septum. In the latter case, the nose can subsequently grow crooked as part of the body's process of growth. 


It cannot yet be reliably determined whether a nasal hump is caused by excessive growth of the nasal septum or whether it only follows the outer shape.

Straightening by septoplasty

While a deviated septum is not significant in many cases, it can only be straightened by surgery - nasal septum surgery or septoplasty. The procedure usually takes about 30 minutes. 


In a nasal septum surgery, the bones and cartilage are deliberately straightened without impairing the essential supportive function of the outer nasal shape. 

Procedure of the nasal septum surgery

First of all, the mucous membrane is detached from the nasal septum in order to be able to make any adjustments. Now the adequate adjustments can be performed: the crooked position is straightened, a spur or a groin is removed, tensions are reduced by targeted incisions into the cartilage. 

The objective here is not to obtain a maximally straight nasal septum, but to reinstate the air flow through the inside of the nose to the best extent possible.  


The nasal septum surgery is performed as part of the cosmetic rhinoplasty, as our patients always have a desire for some aesthetic modifications. 


Once the nasal septum has been straightened, fine silicone foils (the so-called splints) are sutured onto the mucous membrane at the end of the procedure. It is important to prevent the formation of haematoma between the mucous membrane and the cartilage of the nasal septum in the first few days after the operation. 


If this would happen, there could be a nutritional deficiency in the supply of the cartilage, with consequent loss. In the worst case scenario, the nose may lose stability and a saddle nose or a hole in the nasal septum may develop. Thus, these foils have to be placed in the nose for 2-4 days in any case. Irrespective of this, we still refrain from inserting tamponades and it is possible to breathe through the nose. 

When should the nasal septum be straightened?

Unfortunately, the nasal septum surgery is performed in Germany quite frequently, despite the fact that in many cases there is no real or any other reason for nasal obstruction. Many surgeons have only limited experience in corrective surgery and tend to ignore some different and crucial aspects.  

First of all, a detailed examination and a targeted anamnesis are essential. 

Indications for surgical intervention

The correction of the deviated septum should only be carried out if the following symptoms occur and the curvature of the nasal septum can be clearly considered as the actual cause for:

  • permanent nasal breathing obstruction 
  • chronic mouth breathing with throat discomfort such as scratchiness, dryness, etc.
  • frequent nosebleeds
  • chronic snoring (rhonchopathy) with sleep apnoea, if applicable
  • severe nasal congestion
  • reduction of olfactory sensation in case of nasal congestion
  • headache or tenderness in the face area
  • frequent sinusitis due to restricted ventilation

In females, the nasal septum surgery should not be performed before the age of 17, in males not before the age of 18, as the process of body growth must be completed.

Specific issues related to a deviated septum

If breathing through the nose is restricted to such extent that the mouth is chronically used for breathing instead, especially at night, the mucous membrane in the mouth and throat can dry out and symptoms of a scratchy throat with recurring infections may occur.


Chronic mouth breathing can also promote night-time snoring (rhonchopathy): if the restricted airflow through the nose requires more breathing effort, there is increased negative pressure in the upper airway tract when breathing in. The result is a suction effect that causes the soft palate and/or pharynx to vibrate - snoring.  

The risks of nasal septum surgery

The nasal septum surgery is a very safe procedure when performed by a competent expert. Problems such as a saddle nose, a septum perforation (hole in the nasal septum), a permanent encrustation of the nasal mucosa or injuries to the eyes, olfactory centre or skull base are only of theoretical nature. Nevertheless, a residual risk can never be ruled out, as is the case with any operation. Cartilage is soft tissue, so there is no complete guarantee that it will not become curved again over time.


We are specialists in otorhinolaryngology and have extensive experience in this field. Septoplasty is a safe procedure that we frequently perform as part of aesthetic rhinoplasty procedures. 

Costs of the surgery

Medically justified surgical interventions are usually covered by health insurance in our health care system. This also applies to the nasal septum surgery. 


We will inform you if a functional improvement is scheduled for you as part of the aesthetic correction surgery. If you are a patient with statutory health insurance, we will settle the bill directly with the health insurance company and you will not be required to take any further action in this regard. If you have private insurance, we will submit a separate invoice for the functional part, which you can then present to your insurance company for payment.