Otorhinolaryngology focuses on the ear, nose, and throat. Learn about the diagnosis and treatment of hearing loss, sinusitis, tonsillitis, and voice disorders.
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Once a deviated septum is diagnosed and determined to be the cause of significant symptoms, the discussion moves to treatment. For structural problems involving bone and cartilage, medication can only do so much. Sprays and pills might reduce swelling, but they cannot straighten a bent wall. Therefore, surgery is the primary treatment for a deviated septum. The procedure known as SMR (submucous resection) or septoplasty is the standard solution.
This section details what happens during the treatment phase. It includes the prep, anesthesia, surgery steps, and other procedures that may be combined with SMR for the best outcome. The goal is to demystify the operating room experience and explain the process in a way that reduces anxiety. Knowing what to expect allows the patient to approach the surgery with confidence.
Preparation begins weeks before the actual surgery date. Your doctor will provide a list of instructions to ensure your body is ready. One of the most important rules is to avoid medications that thin the blood. Drugs like aspirin, ibuprofen, and certain herbal supplements can increase bleeding. You will likely be asked to stop taking these for a week or two before the procedure.
On the day of surgery, you will typically need to fast. This means no food or drink after midnight the night before. This is a safety requirement for anesthesia. Having an empty stomach prevents complications like aspiration (breathing stomach contents into the lungs) while you are asleep. You should wear comfortable, loose-fitting clothing to the surgery center. It is also essential to have a family member or friend ready to drive you home, as you will not be allowed to drive after anesthesia.
When you arrive at the hospital or surgery center, you will be taken to a pre-op area. Here, a nurse will check your vital signs, ask about your fasting, and start an intravenous (IV) line in your arm or hand. The anesthesiologist will come to talk to you, explaining how they will keep you asleep and comfortable. This is the time to ask any last-minute questions to ease your mind.
Patient comfort is a top priority. SMR is almost always performed under anesthesia so that the patient feels no pain and has no memory of the procedure. There are two main types of anesthesia used, depending on the complexity of the case and the surgeon’s preference.
The most common is general anesthesia. This means you are completely asleep. Medications are given through your IV, and you drift off quickly. You will wake up in the recovery room when it is all over. The other option is local anesthesia with intravenous sedation. In this method, the nose is numbed completely with injections, and you are given strong relaxing medicine through the IV. You are in a “twilight” state—groggy and relaxed, but breathing on your own. Most patients prefer general anesthesia, as it ensures they are totally unaware of the sensory experience of the surgery.
With general anesthesia, a breathing tube is placed to protect your airway. This is removed before you fully wake up. It is the safest way to ensure you do not move during the delicate work inside the nose. Modern anesthesia is very safe, and side effects like nausea are much better controlled than in the past.
Local anesthesia is less common for a full SMR but might be used for minor adjustments. The doctor injects numbing liquid directly into the septum. It stings for a moment, then the area goes numb. The patient might feel pressure and pushing during the surgery but no sharp pain. This kind of procedure is usually reserved for patients who cannot have general anesthesia due to other health reasons.
The surgery itself typically takes between 30 and 90 minutes. The surgeon begins by entering through the nostrils. There are no cuts made on the face. A small incision is made inside the nose on the mucous membrane covering the septum.
Using specialized instruments, the surgeon carefully lifts the mucous membrane away from the cartilage and bone. This exposes the deviated framework. The surgeon then removes the crooked pieces of cartilage and bone or reshapes them to be straight. In an SMR, specifically, the most deviated parts are often resected (removed). Once the obstruction is cleared, the mucous membrane is laid back down. Because the membrane is preserved, the inner surface of the nose remains functional. The two sides of the lining are often stitched together with dissolving sutures to prevent blood from collecting between them.
Often, a deviated septum is not the only cause of blockage. The turbinates—the finger-like structures on the side walls of the nose—may be swollen. This condition is called turbinate hypertrophy. If the septum is straightened but the turbinates remain enormous, the airway might still feel narrow.
Therefore, surgeons frequently perform a turbinate reduction at the same time as the SMR. This involves shrinking the size of the turbinates. It can be done by trimming a small amount of tissue or using radiofrequency energy to shrink them from the inside. Combining these procedures to address septoplasty, SMR, and turbinate issues together maximizes the airflow and provides the patient the best chance of breathing freely. It adds very little time to the surgery and does not significantly change the recovery process.
While SMR is a functional surgery, some patients choose to have cosmetic changes made at the same time. This combination is called septorhinoplasty. If you want to remove a nose hump or refine the tip, both can be done at once.
However, it is important to distinguish between the two. SMR is usually covered by medical insurance because it treats a medical condition. The cosmetic portion (rhinoplasty) is usually not covered and requires out-of-pocket payment. If you want this, you must talk to your surgeon early, as the surgical planning is different.
SMR is considered a very safe routine procedure. However, like any surgery, it carries some risks. Bleeding is the most common risk, but serious bleeding is rare. Infection is also possible, which is why instruments are sterile and antibiotics may be prescribed.
There is a small risk of a septal perforation. This is a small septum hole that can occur if the membrane is torn in the same spot on both sides during surgery. Small holes often cause no symptoms, but larger ones can cause whistling or crusting. Experienced surgeons take extreme care to avoid this. Another rare risk is a change in the shape of the nose if too much structural support is removed, but this is avoided by leaving a strong “L-strut” of cartilage to support the bridge and tip.
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The procedure usually takes about 60 to 90 minutes, depending on how crooked the septum is.
Most patients are under general anesthesia, meaning they are completely asleep and unaware of the procedure.
No, SMR does not involve breaking the nasal bones. It involves trimming and straightening the cartilage and bone inside the nose.
No. The anesthesia stays in your system for several hours, making it unsafe to drive. You must have someone take you home.
Because SMR corrects a medical functional problem (breathing), it is typically covered by medical insurance, unlike cosmetic nose surgery.
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