Deviation of the bridge of the nose

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Deviated nasal septum - symptoms, signs, diagnosis, causes. Treatment of curvature: indications, contraindications for surgery

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Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor.

Anatomy of the nose

  • nostrils - entrance holes through which air enters the nasal cavity;
  • the initial section of the nasal cavity is a space that is divided into right and left halves by the vertical nasal septum;
  • nasal passages - located posterior to the initial part of the nasal cavity, there are lower, middle and upper nasal passages, which are respectively limited by the upper, middle and lower nasal concha;
  • Choanae are two openings through which the nasal cavity communicates with the nasopharynx.

Walls of the nasal cavity:

  • The anterosuperior wall is formed by the bones of the skull (maxillary process, nasal bones) and nasal cartilage.
  • The lower wall - the bottom of the nasal cavity - is formed by the palatine processes of the upper jaws (hard, or bone, palate), as well as the soft palate.
  • The lateral walls of the nasal cavity are formed mainly by the ethmoid bone.
  • The nasal septum, which divides the nasal cavity in half, is formed in the posterior part by the vomer, and in the anterior part by cartilage.

The inside of the nasal cavity is lined with mucous membrane. It is abundantly supplied with blood and secretes a large amount of mucus. In the area of ​​the upper nasal passage in the mucous membrane there are many sensitive nerve receptors - this area is called the olfactory area.

  • The superior nasal passage communicates with the posterior sinuses of the ethmoid bone and the sinus located in the sphenoid bone.
  • The middle nasal passage communicates with the anterior and middle ethmoid sinuses, with the maxillary sinuses (sinuses located in the bodies of the maxillary bones).

The ethmoid bone contains many small cavities - sinuses, which are usually divided into three groups: posterior, middle and anterior.

Functions of the nasal cavity:

  • carrying air into the nasopharynx and larynx;
  • humidification of the air with the secretion of glands located in the mucous membrane;
  • warming the air flow - the venous plexus located under the mucosa is responsible for this function;
  • protection of the respiratory tract from mechanical irritants: hairs and mucus in the nose trap dust particles and bring them out;
  • protection against infection: nasal mucus retains pathogens and removes them from the nasal cavity, has bactericidal properties;
  • The olfactory region of the nasal cavity is responsible for the reception (perception) of odors.

The main function of the nasal septum is the correct distribution of air flows between the right and left halves of the nasal cavity. The significance of this mechanism was established through a series of studies using magnetic resonance imaging and computed tomography.

Causes of a deviated nasal septum

  • Uneven growth of the skull. The human skull consists of the facial and brain sections. The facial skull is formed from the upper and lower jaw, zygomatic, palatine bones, etc. The brain section of the skull is represented by the frontal, temporal, parietal, occipital, ethmoid, and sphenoid bones. If there is uneven growth of the facial and cerebral parts of the skull, then the size of the nasal cavity also changes. It becomes “tight” for the nasal septum. As a result, the latter has to bend.
  • Hypertrophy (excessive development) of one of the nasal conchas. An enlarged concha puts pressure on the nasal septum and causes it to shift.
  • Uneven growth of the skull. The human skull consists of the facial and brain sections. The facial skull is formed from the upper and lower jaw, zygomatic, palatine bones, etc. The brain section of the skull is the frontal, temporal, parietal, occipital, ethmoid, and sphenoid bones. If there is uneven growth of the facial and cerebral parts of the skull, then the size of the nasal cavity also changes. It becomes “tight” for the nasal septum. As a result, the latter has to bend.
  • Polyps and tumors of the nasal mucosa. If they reach a large enough size, they interfere with breathing in one nostril. By deforming, the nasal septum tries to compensate for this condition.
  • Excessive development of the rudiment of Jacobson's organ. This cause of a deviated nasal septum is extremely rare. Jacobson's organ is developed in reptiles, which with its help are able to literally “taste the air.” In humans, there is only a rudiment of it, represented by a cluster of nerve formations behind the olfactory region. If this rudiment is overdeveloped, then it limits the space for the growth of the nasal septum, and curvature occurs.
  • Constant congestion of one half of the nose. The curvature of the nasal septum in this case is an attempt to adapt to breathing through one nostril, to make it more complete.

Disorders that occur when the nasal septum is deviated

Difficulty in nasal breathing

Pathological mechanisms that lead to difficulty in nasal breathing when the nasal septum is deviated:

  • Narrowing of the nasal passage on the side of the convex septum. Reducing the volume of space on one side leads to difficulty in the passage of air flow, up to the complete inability to breathe through one nostril.
  • Disruption of air dynamics inside the nasal cavity. Normally, during inhalation, the air in the nose rises and passes through the middle and partially upper nasal passage. During exhalation, it is directed into the lower nasal passage. When the nasal septum is deviated, disruption of air flow even through one nasal passage leads to difficulty breathing. Despite the fact that the other two nasal passages on the same side may have normal clearance.
  • Narrowing of the nasal passage and difficulty breathing on the side of the concavity of the deformed nasal septum. Often the symptoms here are even more pronounced than on the side of the convexity. As a result of the expansion of the nasal passage, compensatory hypertrophy (growth) of the nasal concha occurs. Over time, they become so large that they begin to make breathing difficult.
  • The reaction of the nerve endings (receptors) of the mucous membrane of the nasal cavity. Normally, the air flow in the nose is uniform. When the nasal septum is deviated, turbulence occurs in it. They irritate sensitive receptors located in the mucous membrane. A reflexive defensive reaction occurs: the vessels of the mucous membrane dilate, swelling occurs, and a large amount of mucus is released.
  • Suction of the wing of the nose to the septum. This is often noted when the septum is deviated in the anterior part. The wing of the nose is constantly tightly adjacent to the septum, as a result, the passage of air is greatly hampered.

Changes in the nasal mucosa

Rhinitis develops - runny nose, constant nasal congestion.

Oxygen starvation of organs and tissues

Mouth breathing

  • Air that is not humidified or warmed enters the lungs: as a result, gas exchange in the alveoli is not as efficient as with nasal breathing. Less oxygen enters the blood.
  • The protective properties of nasal mucus are disabled. The likelihood of developing a respiratory infection increases.
  • Mouth breathing can eventually lead to adenoiditis - inflammation of the pharyngeal tonsil.

Nervous disorders

  • Bronchial asthma is a type of disease, the main cause of which is a neuropsychic imbalance.
  • Spasms of the larynx, manifested in the form of short attacks of suffocation.
  • Headache.
  • Convulsive epileptic seizures.
  • Reflex sneezing and coughing.
  • Dysmenorrhea in women is a violation of the frequency and duration of menstruation.
  • Disorders of the eyes, heart and other organs.

Violations from neighboring organs

  • Disorders of the Eustachian tube and middle ear. The nasal cavity passes into the nasopharynx, on the mucous membrane of which there are pharyngeal openings of the auditory, or Eustachian, tubes on the right and left. The Eustachian tube connects the nasopharynx with the middle ear cavity (tympanic cavity, which contains the auditory bones: incus, stapes, malleus). A chronic inflammatory process as a result of a deviated nasal septum leads to the fact that mucus and infectious agents can enter the auditory tube and the tympanic cavity.
  • Inflammation of the paranasal sinuses - sinusitis. A direct connection has been proven between a deviated nasal septum and the development of inflammatory processes in the paranasal sinuses. Such patients often develop sinusitis (inflammation of the mucous membrane of the maxillary, or maxillary sinus) and frontal sinusitis (inflammation of the frontal sinus).
  • Inflammation of the tear ducts and lacrimal sac. Tears, which are produced by the lacrimal glands, normally flow into the nasal cavity through the nasolacrimal duct. It can serve as a route for spreading infection.

Types of deviated nasal septum:

  • actual curvature of the nasal septum
  • crest
  • thorn
  • a combination of two or three types of curvature

Varieties of the actual curvature of the nasal septum:

  • in a vertical or horizontal plane
  • in the front or back of the nasal septum
  • one-sided and two-sided
  • with the capture of the cartilaginous part of the septum (so-called dislocations of the cartilage occur, when it is torn from the bone), the vertical plate of the ethmoid bone (forms the anterior part of the bony nasal septum) or the vomer (forms the posterior part of the nasal septum)
  • S-shaped, C-shaped, in relation to the bony crest of the upper jaw.

The development of complications with a deviated nasal septum depends on the severity and type of deformation. Almost every adult has a slight curvature, but it does not lead to breathing problems. There are cases where significant deformations do not prevent normal air flow.

Deviations of the nasal septum in the anterior part occur more often. The opener located behind is less often caught. The rear edge of the opener is almost always exactly vertical.

Symptoms of a deviated nasal septum

Complaints that patients with a deviated nasal septum make when visiting a doctor:

  • Difficulty in nasal breathing. The symptom can be of varying degrees: from a slight disturbance to a complete inability to breathe through the nose (in this case, the patient breathes through the mouth). However, the absence of this complaint is not a sign that there is also no deviated nasal septum. If the deformation occurs at a young age, the body can compensate for it over time. The patient has no complaints of difficulty in nasal breathing. If the nasal cavity is large, then no difficulties arise either.
  • Chronic rhinitis - runny nose. Manifests itself in the form of nasal congestion and constant mucous discharge. Sometimes the patient does not see a doctor for a long time, because he believes that he has frequent colds, and the whole point is a decrease in immunity.
  • Allergic reactions. The changes that occur in the nasal cavity as a result of the curvature of the nasal septum are always accompanied over time by a violation of local protective mechanisms and immunity. This manifests itself not only in a decrease in resistance to infections, but also in the appearance of allergic reactions. Allergic rhinitis is a common problem among people with a deviated septum. Chronic rhinitis is a pre-asthma - a condition against which bronchial asthma often develops. The patient complains to the doctor that nasal congestion and discharge occur mainly during contact with some allergen, for example, pollen from certain plants.
  • Headache. A spike, ridge, or deviated nasal septum may come into contact with the lining of the nose and put pressure on it. Constant irritation of nerve receptors leads to the development of reflex headaches.
  • Dry nose, discomfort and unpleasant sensations during nasal breathing. A symptom that develops as a result of prolonged irritation and inflammation in the nasal cavity.
  • Nosebleeds. They are also the result of irritation of the mucous membrane. On the side where there is a bulge on the nasal septum, the mucous membrane is very thin. Even with minor impact it is easily damaged.
  • Snoring at night as a result of impaired nasal breathing.
  • Increased fatigue, decreased performance, decreased resistance to physical activity. These symptoms are associated with impaired nasal breathing and insufficient oxygen supply to the blood from the lungs.
  • Frequent infections that occur with symptoms of acute respiratory infections (runny nose, cough, sneezing), increased body temperature.
  • Symptoms of chronic inflammation of the pharynx and larynx: sore throat, dryness and pain, cough.
  • Symptoms of inflammation in the middle ear: pain, hearing loss.
  • Violation of the shape of the nose. This symptom is characteristic of a deviated nasal septum of traumatic origin.
  • In severe cases, the patient and his relatives note periodic convulsive epileptic seizures, blurred vision, heart pain and increased blood pressure, shortness of breath and other symptoms. They can also be associated with deformations of the nasal septum.
  • Deterioration of memory, thinking, absent-mindedness. Schoolchildren with a deviated nasal septum experience decreased school performance over time.

Diagnosis of a deviated nasal septum

Visual inspection

Assess the appearance of the patient's nose. With a traumatic curvature of the nasal septum, it is changed.

Rhinoscopy

There are anterior and posterior rhinoscopy. An anterior rhinoscopy is most often performed. Rear - according to indications.

The doctor asks the patient to raise his head slightly, lifts the tip of his nose and inserts the instrument into the nostril. Using a button probe (see picture), the otolaryngologist can better examine the nasal cavity and assess the consistency of the formations inside.

Anterior rhinoscopy is performed separately for each nostril.

  • mucosal polyps
  • hematomas - hemorrhages under the mucous membrane, which, reaching large sizes, can impede nasal breathing
  • tumors in the nasal cavity
  • abscess - abscess.

If anterior rhinoscopy is difficult due to severe swelling of the nasal mucosa, the doctor first instills a 0.1% solution of adrenaline into the patient’s nostrils. It constricts the blood vessels and makes the nostrils free for inspection.

Additional instrumental studies for deviated nasal septum

  • assessment of the condition of the paranasal sinuses;
  • identification of anomalies in the bones of the skull;
  • identification of existing deformations after a nasal injury.

    • It is carried out using a rhinoscope - a thin probe, at the end of which there is a miniature video camera. It is inserted into the nostril and moved a little deeper. Most patients tolerate the study well. Local anesthesia of the nasal mucosa is performed using anesthetic sprays.

    Laboratory research methods for deviated nasal septum

    Treatment of deviated nasal septum

    Indications for surgery for deformities of the nasal septum:

    • Difficulty in nasal breathing on one or both sides. Surgical intervention is absolutely indicated provided that the difficulty in breathing is caused precisely by a deformation of the nasal septum.
    • Chronic rhinitis is inflammation of the nasal mucosa.
    • Otitis and eustachitis (inflammation of the middle ear and auditory, or Eustachian, tube), the initial cause of which is a violation of the shape of the nasal septum.
    • Inflammation of the paranasal sinuses (sinusitis): sinusitis, ethmoiditis (inflammation of the cells of the ethmoid bone). Surgery is indicated if these complications are caused by a deviated nasal septum.
    • Frequent, recurring headaches.
    • External cosmetic defects. Sometimes, in rare cases, after fractures, the bridge of the nose is straightened and septoplasty is performed.

    Contraindications to septoplasty for deviated nasal septum:

    • Senile age. With age, breathing problems caused by a deviated nasal septum are partially compensated. Therefore, the symptoms of the disease become less pronounced. In older people, atrophy of the nasal mucosa occurs, so the operation is difficult and the risk of complications is high.
    • Blood clotting disorder. For example, septoplasty is contraindicated in people with hemophilia.
    • Severe diseases of the cardiovascular system.
    • Diabetes.
    • Mental illnesses.
    • Malignant tumors.
    • Severe infections.
    • General serious condition of the patient.
    • Children and people over 48 years of age can undergo surgery, but the indications for it at this age are narrowed.

    Preparation for septoplasty

    Surgery for deviated nasal septum

    • minimal tissue trauma;
    • blood loss during surgery is minimized;
    • the laser has antiseptic properties;
    • rehabilitation measures in the postoperative period are minimized.

    The main disadvantage of the laser is that it is not able to eliminate all deformations of the nasal septum, especially its bony part.

    Postoperative period

    • the formation of large hematomas (hemorrhages) under the mucous membrane;
    • nosebleeds;
    • perforation of the nasal septum - the formation of a hole or defect in it;
    • formation of an abscess under the mucous membrane - an abscess;
    • purulent sinusitis;
    • deformation of the nose - most often the back of the nose becomes retracted as a result of the fact that the surgeon performed a resection of the septum too high.

    Is it possible to treat a deviated nasal septum without surgery?

    Is it possible to prevent deviated nasal septum?

    How does a deviated nasal septum manifest in children? What are the treatments?

    • Injuries during childbirth;
    • A blow to one side of the nose;
    • Discrepancy between the growth rates of the bone and cartilaginous parts of the nose in adolescence.

    Signs of pathology. Externally, changes may not be visible and both sides of the nose appear symmetrical. Upon examination, the doctor discovers that one side of the child’s nose is narrowed, and there is practically no air circulation in it. This is accompanied by swelling of the mucous membrane of the respiratory tract, which gradually loses its protective properties. Due to a decrease in local immunity, the child suffers from prolonged runny nose and otitis media.

    • Breathing problems on the affected side. Parents note that periodically one nostril is completely blocked. In some cases, this causes the baby to sleep on only one side to optimize breathing.
    • Prolonged or chronic runny nose. Frequent sinusitis and sinusitis are associated with increased susceptibility of the mucous membranes to infection. Hypertrophied (overgrown and thickened) mucosa is the basis for the formation of a polyp - a growth that blocks the nasal passage.
    • Frequent nosebleeds. Dryness of the mucous membrane leads to the formation of cracks in it.
    • Otitis. Blockage of the eustachian tube impairs ventilation and cleaning of the tympanic cavity and causes inflammation of the middle ear.
    • Frequent colds and viral infections: ARVI, sore throat, laryngitis. Mouth breathing reduces the protective properties of the pharyngeal mucosa, making it susceptible to viruses and bacteria.
    • Snoring. Parents note noisy breathing during sleep even in healthy children. The narrowed cavity of the nasal concha becomes an obstacle to the passage of air. Its turbulence causes vibrations in the walls of the respiratory tract, which produces a characteristic sound.
    • Enlarged adenoids. Due to frequent infections, the nasopharyngeal tonsil (adenoids) become enlarged, which can cause snoring and coughing.
    • A headache is a sign that the central nervous system is experiencing oxygen deficiency.
    • Impaired sense of smell. It develops gradually and is associated with damage to sensitive receptors on the nasal mucosa.

    Treatment of deviated nasal septum in children. Not all children with a deviated nasal septum need treatment. Correction of the defect is necessary if the child’s breathing is significantly impaired, and there is evidence that the curvature leads to frequent otitis media and sinusitis.

    • Intranasal glucocorticosteroids (Mometasone, Fluticasone, Beclomethasone) eliminate allergic rhinitis and medicinal rhinitis caused by prolonged use of vasoconstrictor drops. Use once a day, preferably in the morning.
    • Cromons. Cromoglin - cromoglycic acid in the form of a spray is used to treat allergic rhinitis 4 times a day.
    • Antibacterial drugs (Isofra, Polydex, Bioparox) - local use of antibiotics stops the growth and reproduction of bacteria on the mucous membrane and in the sinuses.
    • Mucolytic sprays - (Sinuforte, Rinofluimucil) are used to thin mucus and facilitate its removal from the sinuses.
    • Moisturizing sprays - (Salin, Aqua-Maris) moisturize the mucous membrane, cleanse it of microorganisms, and help strengthen local immunity.
    • Vasoconstrictor drops and sprays - (Naphthyzin, Farmazolin, Noxprey). They constrict blood vessels, reducing swelling of the mucous membrane, and restore nasal breathing. Drops reduce swelling of the nasal tissues, increasing the lumen through which air passes.

    Surgical treatment of deviated nasal septum in children. In childhood, they try to avoid surgery, fearing that it may affect the formation of the nose in the future. Doctors recommend postponing surgery until later. The earliest age of patients is 6 years. Surgery is resorted to when it is not possible to restore nasal breathing by other methods.

    What is the cost of surgery for a deviated nasal septum?

    How does it feel after surgery on a deviated nasal septum?

    • Consequences of general anesthesia (anesthesia):
      • dizziness;
      • shiver;
      • nausea;
      • headache;
      • confusion;
      • fainting state;
      • pain in the back and muscles.

      Unpleasant sensations can last from 30 minutes to 2 days. These complications occur quite often in 1 in 10 patients. Their appearance is associated with the effect of anesthesia on the cells of the central nervous system. Deep, slow breathing can reduce their manifestation. The exhalation should be 2 times longer than the inhalation.

    • After premedication and local anesthesia, minor adverse reactions are possible:
      • short-term nausea;
      • vomiting and dizziness;
      • dry mouth;
      • rash on the face and chest.

      To avoid vomiting, avoid eating or drinking anything after surgery. You can drink a sip every 5-10 minutes, then the liquid has time to be absorbed into the blood and does not linger in the stomach.

    • Moderate pain begins to be felt after the effect of the anesthetics wears off, the most pronounced pain is in the nose, where the tissue is damaged. Your head may hurt and your eyes may water. To reduce pain, the doctor may recommend applying cold or taking analgesics: Nurofen, Nise. Unpleasant sensations practically disappear after 3-5 days. Pain when touched can last up to 3 months.
    • A sore throat develops due to dryness of the mucous membrane if the patient breathes through the mouth or through tubes used during anesthesia. Strepsils or Faringosept can alleviate the condition.
    • An elevated temperature of up to 37.5 °C can last 3-5 days. Doctors consider this to be the norm and explain it as the body’s reaction to surgery. Chills and fever above 37.5°C may indicate an additional infection. Tell your doctor immediately.
    • After the operation, special tampons are inserted into the nose. They press the mucous membranes against the cartilage. This is necessary to speed up healing and prevent the development of hematomas. Modern tampons have air vent tubes that allow you to breathe through your nose. If they are clogged with blood clots, the tubes are washed with saline using a syringe without a needle. In ENT departments of hospitals, bandages are traditionally used for nasal packing. They perform the same function as tampons, but do not allow the patient to breathe through the mouth. Bandages are changed once a day - this procedure can be quite unpleasant due to the fact that the bandage dries to the nasal mucosa. Regardless of the tamponing technique, patients experience a feeling of pressure and fullness in the nose.
    • A sling-shaped bandage is applied at the entrance to the nose. Its task is to absorb ichor - a clear liquid that is released from the wound surface. When the bandage gets wet, it is changed to a dry one.
    • Bruises under the eyes are the result of injury and often occur after deep manipulation of the bony part of the nose.
    • Numbness of the nose is the result of damage to small nerve endings.
    • For the first 2-3 days, the outer part of the nose is enlarged due to tissue swelling. But gradually it passes. After 7-10 days, there are no external signs of the operation.
    • Breathing returns to normal after 2-3 weeks, when the mucous membrane is restored. Full recovery may take up to 3 months. During this period, the mucous membrane grows to the cartilage, the ciliated epithelium and chemoreceptors responsible for the sense of smell are restored. During this period, it is not recommended to blow your nose. Wash it with Salin or other saline solutions 3-5 times a day.
    • For a month, you should avoid physical activity, saunas, swimming pools, and solariums. Otherwise, bleeding may occur and hematomas may form under the mucous membrane.

    When to see a doctor:

    • repeated bleeding;
    • severe pain in the nose 5-7 days after surgery;
    • temperature increase ;
    • purulent nasal discharge.

    Inform your doctor about any health problems - this will help you take timely measures and prevent possible complications.

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    Source: http://www.polismed.com/articles-iskrivlenie-nosovojj-peregorodki-simptomy.html

    Deviated nasal septum: treatment without surgery

    The human body is symmetrical; its right and left halves (if we do not take into account the internal structure) can be reflected in a mirror passing in the sagittal plane. Therefore, all structures found along the midline experience “increased responsibility.”

    This is clearly visible in the example of the nasal septum. It can experience deformation during intrauterine development, as well as be influenced by injuries and various diseases.

    Therefore, a disease such as a deformed nasal septum is quite common among people of different races, nationalities and ages.

    It, in turn, can cause various problems not only with nasal breathing, but also many other disorders.

    What causes deformation of the nasal septum? What to do if the “nose is crooked”, so to speak? Is it possible to cure this bony defect of the nasal septum without surgery, or is surgery always necessary to correct it?

    What is a nasal septum?

    First, a little information from anatomy. The nasal septum, as is easy to imagine, divides the nasal cavity in the vertical plane into right and left symmetrical halves. The air enters them from the left and right nostrils, respectively, so inside the nasal cavity the inhaled air is divided into two isolated streams and sent further. What is a nasal septum? - This is simply the inner, middle (or medial) wall of the nasal cavity.

    It consists of the following durable and elastic formations:

    • The upper jaw, which on its palatine process has the crest of the nasal septum;
    • Ethmoid bone plates;
    • The vomer is an unpaired bone that forms the basis of the septum.

    These are bones, but the septum also contains an elastic element - nasal cartilage in the form of an irregular quadrangle, which continues the septum in the anterior sections and takes part in the formation of the movable part of the dorsum of the nose, below the bridge of the nose.

    This is the supporting structure of the nasal septum. It must be remembered that there is a mucous membrane on the outside, richly supplied with blood vessels to warm the incoming cold air. On the surface of the mucous membrane there are glands that produce secretions. The mucous membrane and deeper layers of the septum are innervated by various sensory and secretory parasympathetic branches of the cranial nerves.

    The main function of the partition is to work with air flows and their proper distribution, cleaning, humidification and warming.

    Types of deviated nasal septum

    Since the hardness of the nasal septum increases from the surface of the cartilage into the depths of the skull, curvatures are much more common in the front, and in the posterior parts of the septum there is almost always no deformation.

    The curvature can be different: in the vertical plane it can be convex (one-sided), or S-shaped. Structurally, the curvature can be a significant deformation, like a spike or ridge. Sometimes a bony spike in the nose or ridge “cuts” into the side wall of the corresponding turbinate.

    There are frequent cases of complex curvatures, when the wall is not just changed, but “twisted” in several planes. In the case when the deformation involves the anterior sections and elastic cartilage, its dislocations and even partial or complete separation from the bones are possible. Of course, this happens in the depths, and on the outside the mucous membrane “masks” internal disorders.

    The degree and type of curvature “give the key” to complications, symptoms and type of treatment tactics.

    How to determine the type of curvature? For this, collecting complaints is not enough; you need rhinoscopy (anterior and posterior), which is performed by an ENT doctor at an outpatient appointment in a clinic. Magnetic resonance imaging can provide comprehensive information by constructing a three-dimensional image of the entire nasal cavity.

    What are the different nose shapes?

    Everyone knows that different people have different structures of the external nose. But not everyone knows that its internal structure varies significantly, and the shape depends not only on the bones, but also on the configuration of the elastic cartilage.

    Since the nose is a “solid anatomical structure,” its appearance consists of the shape of the bridge of the nose, wings, tip of the nose, cut of the nostrils and the back of the nose. It is these details that make it possible to distinguish the proud Roman profile from the “potato nose.”

    The simplest classification of nose shapes includes the following main types:

    • straight nose (the back is also straight);
    • snub-nosed (concave back);
    • aquiline nose (back with a hump).

    A separate, rather rare type of nose is the “Greek” one. A special feature of this form is the absence of a notch on the bridge of the nose, that is, the bridge of the nose is an extension of the forehead.

    Children's noses are low and wide, like a button. Then, by the age of 10, the shape of the nose takes on a genetically determined shape with the growth of the skull.

    The medial wall of the nasal cavity also has a shaping function: removal of the nasal septum, especially in the anterior, cartilaginous part, can affect the overall configuration of the nose.

    Why does the nasal septum shift?

    The variety of causes of a deviated nasal septum can be divided into several groups:

    • physiological reasons - that is, related to the development of the bones of the head, due to heredity;
    • injuries of the skull and nasal structures;
    • compensation.

    Deformation of the nose due to physiological reasons occurs due to the uneven growth of its various parts. This is similar to the curvature of the trunk of an apple tree, changes occur slowly over many years, and such “surprises” end in adulthood.

    Trauma is a common cause of sudden curvature, especially in males due to known causes. After an impact, which usually occurs to the side, not only the cartilage is displaced, but, with great force, the central structures of the nasal cavity are also displaced.

    In addition, after an injury, a hemorrhage may form, which may not “resolve”, but become organized. Such a post-traumatic hematoma of the nasal septum can lead to significant deformation of the medial wall of the nose over a large area.

    Compensatory causes are a diverse group of different diseases that lead to deformation:

    • catarrhal inflammation of the nasal septum (chronic rhinitis, vasomotor rhinitis);
    • sinus polyposis, tumors. In case of pronounced growth, they can disrupt the air flow. In order to restore it, a slight curvature of the nasal septum occurs first, and then a more pronounced one;
    • constant congestion on one side;
    • purulent diseases of the nasal cavity, such as abscess of the nasal septum.

    Understanding in a timely manner why the nasal septum is displaced is very important for choosing treatment.

    Symptoms caused by curvature

    Signs of septal deformation vary. But the most typical symptoms are:

    • difficulty breathing through the nose: more often than one nostril;
    • constant runny nose, nasal congestion;
    • allergic rhinitis. It is associated with the constant mechanical impact of the partition on the adjacent side wall;
    • symptoms associated with dry nasal mucosa: pain, redness, swelling;
    • frequent nosebleeds;
    • possible night snoring and periods of sleep apnea (temporary stops in breathing);
    • more frequent incidence of ARVI and other respiratory infections;
    • signs of chronic inflammation in the middle ear, larynx and pharynx (otitis, laryngitis).

    to the content?

    Left-sided deviated nasal septum

    Does nature have preferences when choosing the side of the nasal cavity? Is the lesion more common on the left or right side? According to existing statistics, there is no specific trend. There is some interesting detail that may make it clear why most queries on the Internet concern the left-sided curvature.

    Yes, simply because most doctors - otolaryngologists - are right-handed, and during anterior rhinoscopy it is simply more convenient for them to examine the patient’s left nostril, which will be to their right, since the patient is sitting facing them. After all, it is in the right hand that the doctor holds the nasal speculum, and at the same time the wings of the nose are on the left and do not block the picture. This is why the doctor may see smaller and more insignificant changes.

    Submucosal resection of the nasal septum

    How is the nasal septum straightened? Most often, surgical treatment is used for this pathology. One of the most common operations is resection of the nasal septum.

    This name is given because this operation is organ-saving: the mucous membrane is preserved, and after the operation it is “put in place”; as a result, the septum simply becomes thinner.

    • constant difficulty breathing through the nose: complete congestion on one side;
    • snoring during sleep;
    • “silent” nasal passage, with lack of ventilation (even if the patient is used to it and has no complaints);
    • Deviation of the nose (cosmetic defect);
    • In some cases, resection is not the goal, but only the first stage of an operation to access deeper structures of the skull, for example, the ethmoidal labyrinth. In some cases, a crooked nasal septum makes it difficult to access the nasal sinuses during purulent inflammation (empyema).

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    Deviated nasal septum - consequences

    • Deterioration of gas exchange in the lungs, as the air in the nasal cavity is moistened, purified and warmed. Not fully warmed air can cause spasm of the small bronchi, and in the presence of accompanying factors, cause bronchial asthma;
    • Decreased mucus production leads to a decrease in the amount of immunoglobulins in the nasal cavity, making the body susceptible to infections;
    • Impaired nasal breathing can cause a reflex cough (if you breathe through your mouth all the time, dryness of the larynx and ligaments develops);
    • Headaches, symptoms of migraines and other manifestations of insufficient oxygenation may appear. If the patient, before problems with the nasal septum, had, for example, a lung resection for tuberculosis, or suffered from emphysema, then due to a deformation of the septum, he may experience shortness of breath.

    If a deviated septum prevents an obese person with hypertension and atherosclerosis from sleeping, then spontaneous stoppages of breathing during sleep can lead to stroke and sudden death, so this disease should not be underestimated and one should assume that the consequences are only local.

    Treatment without surgery

    Of course, the largest number of patients with this pathology do not immediately consult a doctor, but only when complaints accumulate and the process is far advanced. Then surgery is inevitable.

    Only if the deformation has occurred to an insignificant extent and does not cause significant ventilation disturbances, you can “not go under the knife.” It is in such cases that there is a chance to straighten the nose without surgery.

    How to straighten the nasal septum using conservative methods?

    If a curvature of the nose occurs after an injury, then within a few hours or even a day you can “put” the septum in place using special elevators. This is done without any cuts.

    The second way to correct a crooked nose without surgery is laser septochondrocorrection. It is currently applicable only in the case of anterior deformities, or in the case when a significant part of them is cartilage.

    This is possible because the laser is capable of bloodlessly vaporizing cartilage defects, but it is not powerful enough to do the same with bone tissue. In a sense, this type of treatment can be called a “bloodless” and “non-contact” operation. For most patients this is quite acceptable.

    The second name for this operation is laser thermoplasty. It is used if the elastic cartilage can be returned to its normal position. For example, simply by pressing on it with your finger. If you release the finger, the elastic cartilage will return back.

    To fix it and give it rigidity, it is heated with a laser.

    The operation itself on the nasal septum is carried out within a matter of minutes, and for anesthesia it is enough to drip lidocaine spray so that it does not hurt. After the operation, a tampon is inserted into the patient’s nose to fix the cartilage and sent home. The next day the tampon is removed. That's all.

    Therefore, everyone can choose treatment methods. The main thing is that it is carried out if there are indications for it.

    Deviated nasal septum photo

    Deviated nasal septum: video

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    Specialty: Otorhinolaryngologist Work experience: 12 years

    Specialty: Otorhinolaryngologist Work experience: 8 years

    Source: http://nasmorkam.net/iskrivlenie-nosovoj-peregorodki-lechenie-bez-operacii/

    Consequences of a crooked nasal septum and methods of treating pathology

    Sometimes a person feels severe discomfort, thinking that he has some kind of viral disease, accompanied by a runny nose and breathing problems. However, the real cause may be a deviated nasal septum.

    What is the nasal septum

    Nasal septum: structure and functions

    This element belongs to the osteochondral tissue of the facial part of the skull and is located in a vertical position in the nasal opening, dividing it into two halves. It is almost never strictly vertical and even - for various reasons it can deviate from its natural position, have slopes, curvatures, growths and other types of deformations.

    Nasal cartilage is essentially an extension of the bony structure of the septum. The size and shape of the nose, as well as the attractiveness of facial features, largely depend on the structure of this part of the skull. Violation of the vertical structure can cause not only a cosmetic defect.

    Pathologies of the nasal septum can lead to numerous diseases, some of which can be quite painful and unpleasant.

    If there is a crooked nasal septum, the health consequences may be completely invisible or manifest themselves in clearly identifiable signs.

    Causes and types of curvature

    Congenital and acquired causes of deviated nasal septum

    A deviated nasal septum can be congenital or acquired.

    There are several main reasons for this defect:

    • Curvature that occurs during the period of active tissue growth. Since this part of the nose is made up of bone and cartilage, in some cases dissimilar tissues can grow at different rates. As a result, deformation or change in the shape of the septum occurs, and the formation of internal defects.
    • Since the bridge is very thin, fragile and pliable, various neoplasms in the nose, for example, polyps or foreign bodies in the cavity, can cause it to deviate from the vertical and become crooked.
    • Deformation can also occur as a result of the development of a strong inflammatory process that affects this part of the bone, or accompany some diseases associated with the destruction of bone tissue of the facial part of the skull (syphilis in the last stage, leprosy, and so on).
    • Trauma is one of the most common causes of curvature. It can be caused by an accident or a bad fall, but most often it happens when a blow to the face causes injury or a broken nose. Men suffer from nasal injuries more often than women; athletes receive blows to the face with a crooked nose more often than people who do not engage in sports, tourism, or simply do not lead an active lifestyle.

    It is not always possible to determine the curvature of the nasal septum by external signs, since what we see is a cartilaginous structure, and the septum itself is located deep in the nose. Therefore, a crooked nose does not always mean the presence of septal defects, and the curvature may well accompany a perfectly straight nose.

    Symptoms

    Symptoms of a deviated nasal septum

    It should be noted right away that in most people this part of the skull is curved to one degree or another. It is very rarely completely smooth, but small defects do not manifest themselves as pathological phenomena. For its curvature to become noticeable, it must be quite intense.

    A crooked nasal septum, the consequences of which may not appear immediately, may have “blurred” manifestations, or demonstrate obvious health problems.

    The main symptoms of the pathology:

    • Most often, there is a violation of breathing through the nose, and it can be bilateral or unilateral. The violation can be complete or partial, it depends on how severely the nasal passage is blocked. In most cases, this occurs after an injury when a piece of bone becomes dislodged or breaks off, completely or partially blocking breathing.
    • Due to the deformation of the septum, noisy breathing and snoring occur during sleep. At the same time, both men and women, even children, can snore.
    • A person suffering from curvature may have a chronic runny nose or its complicated forms - inflammation of the maxillary and frontal sinuses. This is due to the fact that the curvature of the nose does not allow the contents of the sinuses, especially purulent ones, to freely separate and come out. As a result, stagnation occurs, secondary infection occurs and serious chronic diseases develop.
    • The hearing organs can also be affected - due to chronic infection, inflammation of the middle ear occurs. If the infection “settles” close to the septum, this can cause even greater deformation.
    • Many patients note increased dryness of the mucous membranes, which is accompanied by irritation and frequent sneezing.
    • If the septum is curved for a long time, polyps may form on it due to injury to the mucous membrane. They can be single or multiple. Their presence and size significantly complicate the course of the disease.

    Curvature of the nose, noticeable to the naked eye. All of these symptoms may not necessarily be diagnosed all together. The most common reasons for visiting a doctor are frequent runny noses and breathing problems, especially under exertion.

    Diagnosis of the disease

    The patient's history can help identify a violation of the shape of the nasal septum. After carefully listening to the complaints, an experienced doctor can draw a conclusion about the possible presence of a disease and send the patient for further examination. If the patient's record contains data on injuries, accidents or fractures, bruises of the face and nose, the examination must be continued.

    The next step should be a visual inspection. Sometimes this is enough to identify the problem, since some external defects of the nose clearly indicate the presence of a deformed septum.

    If the defects are obvious and require surgical intervention, photographic images in different projections must be taken.

    Next, the doctor may palpate the nose to identify possible defects in the cartilage and nostrils. Then you can move on to instrumental research. This includes anterior rhinoscopy without the use of a nasal speculum, only with the help of a head reflector. For an experienced doctor, such an examination is usually sufficient, since he can immediately assess the degree of curvature of various elements of the nose structure.

    To examine the deep parts of the nose using anterior rhinoscopy, the mucous membranes are treated with an anesthetic to eliminate pain during the examination. In cases where it is not possible to understand the problem with the help of conventional examinations or in the presence of injuries to the facial bones, an X-ray of the skull and a tomogram are prescribed. They help to see all the violations as a whole.

    Consequences of a crooked nose

    The influence of a crooked nasal septum on human life

    Once a crooked nasal septum is diagnosed, the consequences can vary. If there are no significant health problems, no special treatment will be required, but if the deformation is visually noticeable, or there are chronic ailments that cause great inconvenience, treatment is simply necessary.

    The consequences of a deviated nasal septum may not immediately affect your health. For example, at rest a person does not feel that the nose is “working” incorrectly, but under load the body begins to suffer from a lack of oxygen. This may include shortness of breath, heavy breathing, cramps, headache, dizziness, and even loss of consciousness.

    A person with such a problem experiences difficulties in playing sports, dancing and other intense activities; he cannot run fast, it is difficult for him to read aloud for a long time, sing and even talk.

    Prolonged lack of air can negatively affect the condition of the cardiovascular system and even the lungs.

    Sometimes the consequences of having a crooked septum in the nose can only appear in old age.

    Curvature of the nose is especially dangerous for children:

    • It may not manifest itself in any particular way, but a chronic lack of oxygen has a detrimental effect on brain development, affects the child’s mental abilities and his learning ability.
    • If such a defect is congenital, the child may be permanently delayed in development.
    • In addition to the negative impact on the baby’s mental development, prolonged oxygen deprivation can negatively affect the child’s health. Due to the restriction of air intake, the baby tries to breathe through his mouth, he even develops a characteristic appearance - an “adenoid face”, puffy, pale, with a constantly slightly open mouth and hoarse breathing.
    • If nasal breathing is impaired and air is inhaled through the mouth, bacteria, viruses and fungi easily enter the child’s body. This causes a variety of diseases; such a baby is more susceptible to colds and ARVI, allergies, sinusitis and otitis media.
    • In turn, constant infection in the body “harms” the immune system, causing problems with the cardiovascular system and diseases of internal organs.
    • Such a child is usually lethargic and inactive, since it is difficult for him to run, and this entails muscle weakness and diseases of the musculoskeletal system. And the reason for everything may be a subtle defect in the nasal septum.

    Treatment methods

    A crooked nasal septum is treated by two main methods - surgical and laser.

    Surgical intervention can be:

    Surgery is prescribed when the curvature is very significant, is accompanied by other defects and causes serious problems for the patient. Endoscopic correction is performed using a special flexible instrument - an endoscope and is carried out with miniature instruments under the control of a video camera. No external incisions are made - all manipulations are performed through the nasal passages.

    After the operation, gauze turundas and special silicone pads are placed in the nose, which are removed one day after the intervention. The patient is discharged the next day. As soon as the swelling of the mucous membranes subsides, and this happens after about a week, nasal breathing is restored and the patient becomes much easier. This type of surgery is called septoplasty.

    More information about a crooked nasal septum can be found in the video.

    This type of surgery can be performed on children over 14 years of age. For young children, such an operation is performed only in exceptional cases, when possible risks are outweighed by health benefits. This procedure is performed under general anesthesia for children over 6 years of age after a very thorough examination.

    Laser surgery on the nose is only possible if we are talking about deformation of the cartilage and the absence of a fracture.

    It is performed under local anesthesia and lasts no more than a quarter of an hour. When performing rhinoplasty in cosmetic surgery, nasal septum defects are often corrected at the same time, especially if they are directly related to external manifestations and affect the patient’s appearance.

    Complete reconstruction of the nose with restoration of the septum and cartilage is performed under general anesthesia in cases of extensive facial trauma with bone fractures, lacerations and damage to the nose. This is a very complex operation that requires long-term rehabilitation and sometimes repeated surgery.

    Complications with a crooked nasal septum

    The most dangerous complications are fraught with a deviated nasal septum resulting from injury. A severe blow to the face or a traumatic brain injury that breaks the integrity of the nose usually results in very extensive nosebleeds.

    It can be very difficult to stop, especially if the victim's face is very damaged and it is not possible to find the source of the bleeding. In such a situation, before the ambulance arrives, you should try to secure the victim in such a way that blood does not enter the respiratory tract, try to stop the bleeding, if possible, by applying luda in sterile gauze or introducing pieces of a hemostatic sponge into the nostrils.

    The main danger of a deviated nasal septum as a result of trauma is that a piece of broken bone can enter the respiratory tract or bloodstream. If the victim is unconscious and no one provides first aid, he may simply choke on his own blood due to a nosebleed.

    A frequent complication of a deviated septum is the formation of polyps.

    They greatly complicate the patient’s life and make surgical intervention inevitable. During the operation, the patient can simultaneously have the adenoids removed and the nasal septum corrected.

    Since the curvature of the nose is accompanied by breathing problems, it can be dangerous for people suffering from respiratory diseases, for example, asthmatics. They already constantly lack air, and the presence of complicating defects significantly aggravates the problem. The same applies to hypotensive patients and heart patients. Lack of air can provoke headaches, irritability, sleep disturbances and lead to fainting, heart attacks, and decreased performance. No matter how insignificant the problem with a deviated nasal septum may seem, it requires careful attention, a thorough examination and timely correct treatment.

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