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# Deviated nasal septum

A bend of the wall that divides the nose. It is very common and often harmless, but it can block breathing; surgery (septoplasty) straightens it.

Updated Nov 5, 2026

On this page

- The basics What it is
- Who gets it
- Causes
- Risk factors
- Classification
- In ENT

- Clinical Symptoms and signs
- Red flags
- Diagnosis
- Differential diagnosis
- Complications
- Prognosis

- Treatment Treatment

- Study Test yourself

- Connections Connections

## What it is

A displacement of the cartilaginous or bony [nasal septum](https://durgical.com/en/anatomy/nasal-septum/) away from the midline that narrows one or both nasal passages. Minor deviation is almost universal; it matters when it causes nasal obstruction or other symptoms.

See it in 3D

- [Nasal septum](https://durgical.com/en/anatomy/nasal-septum/)
- [Nasal cartilages](https://durgical.com/en/anatomy/major-alar-cartilage/)
- [Vomer](https://durgical.com/en/anatomy/vomer/)
- [Ethmoid bone](https://durgical.com/en/anatomy/ethmoid-bone/)

## +4

- [Nasal cavity](https://durgical.com/en/anatomy/nasal-cavity/)
- [Inferior nasal conchae](https://durgical.com/en/anatomy/inferior-nasal-concha-bone/)
- [Nasal bones](https://durgical.com/en/anatomy/nasal-bone/)
- [Maxillary sinus](https://durgical.com/en/anatomy/maxillary-sinus/)

## Who gets it

Most adults have some degree of septal deviation, but only a minority have symptoms. It is one of the most common reasons for nasal surgery, and in children and young adults it often follows a nasal injury.

## Causes

- Developmental: unequal growth of the septal cartilage and bones
- Birth trauma
- Nasal trauma, including nasal fracture
- Previous nasal surgery

## Risk factors

- Nasal injury from sports, falls, fights or traffic accidents
- Contact sports
- Untreated nasal fracture or septal haematoma

## Classification

- By shape: C-shaped, S-shaped, or a spur (crest)
- By site: anterior (caudal cartilage, near the nasal valve) or posterior (bony septum)
- Caudal dislocation of the septum out of the maxillary crest
- Anatomical classifications (such as Mladina's) describe the pattern for surgical planning

## Symptoms and signs

- Nasal obstruction, on one or both sides, often worse when lying down
- Mouth breathing and snoring
- Recurrent nosebleeds from dry mucosa over the deviation
- Recurrent sinusitis or postnasal drip
- Facial pain or headache from contact between the septum and a turbinate
- Visible deviation of the nose when there is external deformity

## Red flags

- Septal haematoma after nasal trauma (soft, bluish swelling of the septum): needs drainage the same day
- Unilateral obstruction with bloody discharge, a mass or facial numbness (rule out a tumour)
- Septal perforation, crusting or saddle nose (consider cocaine use or granulomatosis with polyangiitis)
- Severe sleep apnoea symptoms

## Diagnosis

**Clinical**
Anterior rhinoscopy and nasal endoscopy show the type and site of deviation, the turbinates and any polyps; the effect of a decongestant separates mucosal swelling from fixed deviation. The Cottle manoeuvre (pulling the cheek laterally) improves breathing when the nasal valve is narrow.

**Tests**
Usually none. Rhinomanometry or acoustic rhinometry are used in some centres to measure airflow; allergy testing when allergic rhinitis coexists.

**Imaging**
Not needed for diagnosis. Sinus CT when chronic rhinosinusitis is suspected or before combined septal and sinus surgery.

## Differential diagnosis

- Allergic or non-allergic rhinitis with turbinate hypertrophy
- Nasal polyps and chronic rhinosinusitis
- Nasal valve collapse
- Adenoid hypertrophy in children
- Nasal foreign body or tumour (unilateral symptoms)

## Treatment

**Conservative**
No treatment when there are no symptoms. Saline irrigation and external nasal dilator strips can relieve mild obstruction.

**Medical**
Intranasal corticosteroid sprays, and antihistamines when allergic, treat coexisting rhinitis; a medical trial usually comes before surgery. Long-term decongestant sprays are avoided (rebound congestion).

**Surgical**
Septoplasty, usually endonasal, removes or reshapes the deviated cartilage and bone, often with turbinate reduction, when obstruction persists and affects quality of life; referral to otolaryngology.

**Surgical**
Septorhinoplasty when the external nose is also deviated. In children surgery is usually delayed until facial growth is complete unless obstruction is severe.

**Acute**
After nasal trauma, a septal haematoma is drained urgently to prevent abscess and septal collapse.

## Complications

- Chronic mouth breathing, poor sleep and snoring
- Recurrent sinusitis and epistaxis
- After surgery: bleeding, septal haematoma or abscess, septal perforation, saddle nose, adhesions, and rarely cerebrospinal fluid leak or loss of smell

## Prognosis

Good. Many people never need treatment. Septoplasty improves nasal breathing and quality of life in most well-selected patients; some still have symptoms when rhinitis is the main problem.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the first-line approach to a symptomatic deviated septum with rhinitis?

A trial of medical treatment (saline and intranasal corticosteroid), with septoplasty if obstruction persists.

## What does a positive Cottle manoeuvre suggest?

Narrowing or collapse of the internal nasal valve.

## Which complication of nasal trauma must be ruled out because it can destroy the septal cartilage?

Septal haematoma, which needs urgent drainage.

## Why is septoplasty usually delayed in children?

Because the septum is a growth centre of the midface; surgery is reserved for severe obstruction until growth is complete.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/deviated-nasal-septum/)

## In ENT

- [Septal surgery: septoplasty and submucous resection](https://durgical.com/en/ent/septal-surgery-septoplasty-and-submucous-resection/)

## Connections

## Related conditions 8

- [Nasal fracture and septal haematoma](https://durgical.com/en/conditions/nasal-fracture-and-septal-haematoma/)
- [Chronic rhinosinusitis and nasal polyps](https://durgical.com/en/conditions/chronic-rhinosinusitis-and-nasal-polyps/)
- [Allergic rhinitis](https://durgical.com/en/conditions/allergic-rhinitis/)
- [Acute rhinosinusitis](https://durgical.com/en/conditions/acute-rhinosinusitis/)
- [Obstructive sleep apnoea](https://durgical.com/en/conditions/obstructive-sleep-apnoea/)
- [Epistaxis (nosebleed)](https://durgical.com/en/conditions/epistaxis/)
- [Granulomatosis with polyangiitis](https://durgical.com/en/conditions/granulomatosis-with-polyangiitis/)
- [Cocaine and sympathomimetic toxicity](https://durgical.com/en/conditions/cocaine-and-sympathomimetic-toxicity/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Septoplasty](https://www.ncbi.nlm.nih.gov/books/NBK567718/) (StatPearls (NCBI Bookshelf), 2022).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/conditions/deviated-nasal-septum/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/deviated-nasal-septum/