Background: The main cause of chronic nasal obstruction in ENT practice is represented by the deviated nasal septum. Septoplasty remains the gold standard treatment, performed using either conventional or endoscopic techniques. Methods: A narrative review of the literature was conducted using PubMed and Google Scholar for studies published between May 1999 and October 2024. Eligible studies included adult patients (≥16 years) undergoing conventional or endoscopic septoplasty, with at least one reported outcome measure: NOSE, VAS, or SNOT-22 scores; operative time; or complication rates. Results: Across multiple clinical studies, both conventional and endoscopic septoplasty provided significant improvements in nasal airflow and symptom relief. Endoscopic septoplasty was consistently associated with superior intraoperative visualization, more precise correction of posterior deformities and isolated septal spurs, and lower rates of intraoperative and postoperative complications. Complication rates were low overall for both approaches. Conclusions: Current evidence supports both conventional and endoscopic septoplasty as effective treatments for nasal obstruction due to septal deviation. However, endoscopic septoplasty offers distinct advantages in terms of visualization, operative efficiency, and safety, making it an increasingly preferred technique.