Nasal septum displacement surgery

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Displacement and curvature of the nasal septum.

For those suffering from a deviated nasal septum, the phraseology “breathe deeply” has not only a figurative meaning, but also a literal one, because their illness sharply reduces the quality of life.

Table of contents:

It is known that the quality and “completeness” of inhalation depend 80 percent on nasal breathing, which is a complex process that has its own aerodynamics, ensuring the functional viability of all structures of the nasal cavity. Passing through the nasal cavity, the air is purified, moistened, warmed and resonated, which gives the voice a sound tint, so impaired nasal breathing leads to a number of pathological conditions.

The degree and types of curvature of the nasal septum.

In different patients, the curvature of the nasal septum has its own degree: from minor to severe pronounced deformities. Sometimes the curvature of the nasal septum is so severe that the openings of the nasal passages are completely closed, making breathing through the nose impossible. In this case, patients’ quality of life decreases so much that they are forced to subordinate life to their nose and give up work, entertainment and sports.

A deviated nasal septum can be:

  • S-shaped;
  • S-shaped (antero-posterior);
  • C-shaped;
  • curvature of the nasal septum and bone crest of the upper jaw;
  • curvature of the nasal septum in relation to the bony crest of the upper jaw.

The cause of non-traumatic curvature of the nasal septum is an anatomical and physiological feature of the structure of the nasal cavity. Due to the fact that the cartilage and bone parts of the nose grow and develop differently, there comes a time when the denser bone tissue presses and deforms the cartilaginous tissue.

Traumatic curvature can include displacement of the nasal septum due to injury and untimely treatment. This deviated nasal septum presents significant difficulties in treatment, so it is extremely important to consult an ENT doctor immediately after the nasal septum has been displaced.

The reason for the difficulty of the disease is a violation of the aerodynamics of breathing through the nose, which leads to the loss of the main functions of the mucous membrane: cleansing and warming the inhaled air. Subsequently, non-physiological proliferation of blood vessels (vasomotor rhinitis) is formed, which leads to more severe consequences of impaired nasal breathing. It is worth noting that the patient is often bothered by spontaneous nosebleeds, profuse discharge, dry nose or, conversely, discomfort in the nasopharynx. Susceptibility to viral diseases of the upper respiratory tract increases, which subsequently leads to sinusitis, pharyngitis, sinusitis, middle ear diseases, and also contributes to sleep apnea syndrome.

As a result of the above disorders, an insufficient amount of oxygen enters the body, as a result of which the brain suffers, and the patient is bothered by headaches, fatigue, high susceptibility to stress, decreased attention and memory, and a tendency to depression.

Diagnosis of a deviated nasal septum is not difficult with simple direct rhinoscopy - an instrumental examination of the nasal cavity. To clarify the diagnosis, video endoscopic technology is used, as well as skull radiography, computed tomography (CT) and magnetic resonance imaging (MRI) of the head.

The next stage after diagnosing a deviated nasal septum is surgery.

Indications for surgical treatment.

Treatment of a deviated nasal septum.

Currently, traditional methods (septoplasty) and laser treatment (laser septoplasty) are used, which has a number of contraindications and is used only for minor curvatures. The traditional technique is performed under local or general anesthesia, the operation lasts 1-2 hours. Note that in case of severe curvature of the nasal septum, the operation is performed using the traditional method.

After the operation, the patient is given a plaster bandage-mask, which is removed after 2 weeks.

There is no special prevention, but there are precautions that will help avoid curvature. Damage and injury should be avoided, and do not use vasoconstrictor drugs without the advice of a doctor, because after several months of use, they become addictive, after which the mucous membrane is in a state of swelling and does not respond to the medicine. As a result, breathing becomes more difficult due to a deviated nasal septum.

Complications after surgery.

Complications can be divided into early and late. Early complications include hematomas and bleeding, to eliminate which tampons are placed in the nasal passages.

Also, one of the rare complications is perforation, which occurs due to injury to the deviated nasal septum during surgery with a sharp instrument. Therefore, to avoid perforation of the mucosa, the surgeon must perform all manipulations with extreme caution.

An abscess occurs due to the presence of purulent crusts in the vestibule of the nose, blood clots and purulent sinusitis. To prevent an abscess, thorough disinfection of the surgical field before surgery and the administration of antibiotics afterward are necessary.

A late complication and an extremely unlikely complication is a change in the shape of the external nose, which is associated with high resection of the quadrangular cartilage.

Source: http://www.septoplastika.ru/iskrivlenie-nosovoy-peregorodki/

Deviated nasal septum - causes, types, symptoms, consequences, treatment methods

What is the nasal septum?

Causes of a deviated nasal septum

Physiological causes are associated with impaired growth of the skull bones or congenital anomalies. Among them are:

  • uneven growth of the bones of the cerebral and facial parts of the skull - active growth of the cerebral part of the skull leads to a decrease in the size of the nasal cavity and bending of the nasal septum;
  • uneven growth of foci of bone and cartilage tissue of the nasal septum - more active growth of bone tissue leads to deformation of areas of the nasal septum consisting of cartilage tissue;
  • excessive growth of the rudimentary Jacobson's organ, located in the olfactory region of the nose and consisting of an accumulation of nervous tissue - the active growth of this rudiment leads to a limitation of space for the normal development of the nasal septum and its curvature.

Compensatory reasons are due to the presence of various pathological formations in the nasal cavity:

  • hypertrophy of one of the nasal conchas - an enlarged nasal concha puts pressure on the nasal septum and causes its deformation and displacement;
  • tumors and polyps of the nasal mucosa - when they are large, nasal breathing is disrupted, and the nasal septum compensates for this condition and becomes bent.

Traumatic causes are caused by various injuries that contribute to the displacement of the nasal bones and the curvature of the nasal septum. The most pronounced deformations are observed when the nasal bones do not heal properly after a fracture.

Types and types of deviated nasal septum

According to the type of deformation, pathological curvature can be:

  • S-shaped anterior-posterior;
  • S-shaped;
  • C-shaped;
  • curvature in relation to the bone crest of the upper jaw;
  • curvature of the bone crest of the upper jaw and nasal septum.

Minor deformations of the nasal septum are not considered by otolaryngologists as a pathology.

Symptoms of a deviated nasal septum

  • chronic inflammation of the sinuses (sinusitis);
  • increased susceptibility to viral respiratory tract infections;
  • nosebleeds;
  • constant discomfort in the nose;
  • vasomotor rhinitis (due to excessive proliferation of blood vessels);
  • pain in the nose and face;
  • noisy breathing through the nose during sleep (especially in children);
  • snore;
  • swelling of the mucous membrane on the affected side;
  • headache;
  • fast fatiguability;
  • tendency to depression;
  • decreased concentration and memory.

In patients with a deviated nasal septum, respiratory infections last longer and are often accompanied by complications, and inflammation of the nasal mucosa leads to even greater deformation. Constantly impaired breathing through the nose leads to the progression or development of allergic rhinitis, which can subsequently become the cause of bronchial asthma.

Deviated nasal septum in a child

  • headaches;
  • fatigue;
  • poor memorization of new information;
  • decreased attentiveness;
  • frequent whims.

Consequences of a deviated nasal septum

  • tendency to frequent colds;
  • rhinitis (vasomotor, hypertrophic, atrophic, allergic);
  • frontal sinusitis;
  • sinusitis;
  • sinusitis;
  • tubootitis;
  • otitis media;
  • spasms of the larynx;
  • bronchial asthma;
  • convulsive epileptiform seizures;
  • astheno-vegetative syndrome;
  • disorders of the heart, eyes and other organs;
  • dysmenorrhea;
  • decreased immunity.

Treatment

Septoplasty

  • often exacerbating chronic sinusitis;
  • chronic swelling of the nasal mucosa;
  • frequent colds;
  • persistent itching or dryness in the nose;
  • frequent headaches or facial pain;
  • snore.

Surgery is performed under local or general anesthesia. Typically, the operation lasts about 1-2 hours. The surgeon makes an incision and peels away the mucous membrane. Next, the deformed areas of cartilage are excised. After this, the mucous membrane is returned to its place, absorbable sutures are placed on the mucous membrane or skin, and gauze swabs are inserted into the lumens of the nasal passages, which help stop bleeding and protect the wound surface from infection. A special plaster bandage is applied to the nose. As a rule, after the operation is completed, there is no bruising or swelling left on the face.

  • bleeding disorders;
  • diabetes;
  • infectious diseases;
  • oncological diseases;
  • severe diseases of internal organs.

Septoplasty, like any other surgical procedure, can be complicated by infection or bleeding. Specific and rarer complications of this operation include the formation of fibrin clots in the nasal cavity and perforation of the nasal septum.

Laser treatment

  • bloodlessness;
  • minimal trauma to soft tissues and cartilage;
  • antiseptic effect on the soft tissues of the nose;
  • stimulation of the patient's immune system;
  • extremely rare postoperative complications;
  • reduction of the rehabilitation period.

Laser septoplasty is performed under local anesthesia and lasts about 15 minutes. This operation can be performed in both inpatient and outpatient settings.

Rehabilitation after surgery

Operation price

  • degree of curvature of the nasal septum;
  • type of operation;
  • type of anesthesia (local or general anesthesia);
  • volume of rehabilitation measures.

For example, correcting a minor congenital deformity will cost approximately thousands of rubles, and restoring the nasal septum after injury can cost 2-3 times more.

Reviews about surgical treatment

  • the ability to breathe fully through the nose;
  • eliminating the need to use nasal drops to restore nasal breathing;
  • absence of snoring and snoring;
  • disappearance of pain in the nose;
  • no nasal discharge;
  • lower incidence of respiratory infections, sinusitis, sinusitis, etc.;
  • no scars;
  • improving the appearance of the nose (especially after injuries).

Most of the above positive aspects are observed within 10 days after surgery.

Deviated nasal septum: causes, symptoms, treatment - video

Deviated nasal septum: laser septoplasty - video

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Deviated nasal septum: types, causes, symptoms in adults and children

A deviated nasal septum is the result of deformation of the osteochondral tissue, leading to obstruction of the airway. This provokes the development of snoring, prolonged runny nose and other unpleasant symptoms that reduce a person’s quality of life.

The nasal septum is an osteochondral structure that normally divides the nasal cavity into two symmetrical halves. The division of the outer and inner nose ensures uniform redirection of air flow when breathing through the nose. The nasal septum provides a harmonious relationship between humidifying, purifying and warming the inhaled air.

With pathology of the cartilaginous or bone part of the nasal septum, deformation of the lumen of the airways occurs, displacement of the nasal cavities as a result of deviation. This leads to a redistribution of the load, disruption of the nasal passages and an increase in pathological changes in the mucous membrane.

Types of deviated nasal septum are classified depending on the cause and degree of deformation.

  • deviation of the upper part to the right or left side;
  • full displacement;
  • complete displacement with deformation;
  • ridge formation;
  • thorn formation.

According to the degree and direction of the actual displacement and curvature of the nasal septum, they are distinguished:

  • vertical or horizontal displacement;
  • deformation of the front or back;
  • bilateral or unilateral curvature;
  • defect of cartilage tissue (dislocation, tear);
  • deformity involving the vertical plate of the ethmoid bone;
  • S-strain;
  • C-deformation.

The doctor creates a treatment plan based on the degree of deformation and disruption of the breathing process. The disease is combined in severe cases with chronic rhinitis or nasal polyposis, accompanied by a constant runny nose. Before surgery, symptomatic therapy is necessary for rapid tissue healing.

Causes of a deviated nasal septum:

  • physiological (uneven growth and maturation of the bones of the facial skull);
  • traumatic (impact, bruise, fall, fractures);
  • compensatory (hypertrophy of the turbinates, growth of polyps, cysts or neoplasms).

Symptoms of a deviated nasal septum depend on the degree of disruption of the anatomical structure of the airways. The first signs of narrowing of the lumen are the appearance of loud snoring during night sleep and constant congestion of one or two halves of the nose.

Clinical symptoms of a deviated nasal septum:

  • impaired breathing through the nose (caused by neuromotor changes, swelling of the mucous membrane and maceration of the epidermis due to uneven loads);
  • a prolonged runny nose develops against the background of a decrease in local immunity, as a result of frequent exacerbations of rhinitis, which is difficult to treat;
  • allergies in the form of hay fever, bronchospasm or the onset of bronchial asthma occur due to neuropsychic imbalance and compensation of oxygen starvation of the body by mouth breathing;
  • pain syndrome due to the constant irritating effect of pathological formations of the nasal septum (spikes, corners) from the mucous membrane of the nasal passages;
  • nosebleeds develop as the mucous tissue thins, vascular permeability increases and the tone of the vascular wall decreases;
  • snoring occurs when mouth breathing during sleep due to vibration of the soft tissues of the oropharynx and prolapse of the uvula into the lumen of the airways;
  • decreased performance and other somatic symptoms are associated with chronic oxygen starvation, which has a depressing effect on the central nervous system.

During the initial examination, the doctor conducts a full examination of the patient, makes a diagnosis according to ICD-10 and prescribes medication. After eliminating symptoms at home and restoring the function of the ENT organs, a plan for surgical intervention is drawn up for serious septal deformities.

In children, a deviated nasal septum is accompanied by frequent infectious diseases of the respiratory tract, increased fatigue and impaired memory function. Septoplasty surgery, according to reviews from doctors and patients on forums, is the most effective treatment method.

Prices for laser correction of the nasal septum depend on the age of the child, the degree of deformation and the presence of concomitant diseases. The total cost is determined after laboratory and instrumental examination of the patient.

Deviated nasal septum: surgery, indications for it and technique for performing it

If during an examination the doctor diagnoses a deviated nasal septum, surgery is performed if there are absolute indications. Surgical intervention is aimed at gentle correction or total correction and restoration of the nasal septum or its parts.

Diagnosis of a deviated nasal septum begins with an external examination of the patient. With traumatic deformities, displacement of the wings and back of the nose occurs due to complete displacement of the septum in the vertical plane. Examination of the nostrils reveals asymmetry in the lumen of the airways and impaired patency.

Rhinoscopy is performed using a special instrument and allows the doctor to carefully examine the nasal cavity for pathological formations and damage to the mucous membrane. The anterior rhinoscopy method is used to detect the formation of spines and growths on the nasal septum, polyps and cysts in the soft tissues and mucous membrane.

An X-ray of the facial bones visualizes the bony part of the nasal septum, located deep in the nasal cavity. The doctor evaluates the condition of the paranasal sinuses, which is important if complete resection of the posterior part of the septum is required.

Endoscopic examination is carried out using a probe in cases where complete visualization of all parts of the nasal septum is required. The procedure is performed by the surgeon directly during the operation if indicated.

When is surgery necessary? A deviated nasal septum requires surgical intervention to completely eliminate unpleasant symptoms.

  • recurrent chronic rhinitis, nasopharyngitis;
  • bilateral nasal breathing disorder;
  • frequent inflammation of the outer ear and Eustachian tube;
  • chronic sinusitis with purulent contents;
  • constant headaches;
  • heavy snoring;
  • violation of aesthetic appearance.

Surgeries for deviated nasal septum

Preparation for rhinoseptoplasty is carried out together with a general practitioner by collecting laboratory tests to exclude the acute phase of inflammation. Instrumental research methods (X-rays, computed tomography and endoscopic examination) are carried out several days before surgery to obtain control results.

During the examination, the doctor collects detailed information about the patient’s allergies and intolerance to medications, including drugs used for anesthesia. Before the operation, a course of symptomatic therapy is prescribed to eliminate the runny nose and restore the mucous membrane.

  • severe cardiovascular failure;
  • progressive diabetes mellitus;
  • malignant neoplasms;
  • psychical deviations;
  • bleeding disorders;
  • severe infections, sepsis.

The technique involves gentle submucosal resection of the deformed area of ​​the nasal septum to restore the normal diameter of the airways. The operation is performed under general anesthesia, takes from 1 to 2 hours, and has a short rehabilitation period.

Complications after septoplasty surgery include bacterial infection at the suture site and the development of bleeding in the postoperative period. Taking antibacterial drugs and following the regimen during postoperative rehabilitation reduces the risk of developing such phenomena.

Deviated nasal septum: treatment without surgery, laser therapy

To restore airway patency when diagnosing a disease with a deviated nasal septum, treatment without surgery is impossible; this is due to deformation of the osteochondral structures that are not amenable to conservative therapy methods. Constant congestion of the airways irreversibly disrupts the process of nasal breathing, depressing the condition of the entire organism.

In case of severe inflammation and swelling of the nasal mucosa as a result of progression of the pathology, surgical intervention is indicated to prevent the development of complications. Chronic oxygen starvation triggers irreversible destructive organisms throughout the body, inhibits the cardiotonic reflex, and disrupts the functioning of the heart muscle.

How to prevent curvature? Compensatory curvature of the nasal septum due to the growth of polyps, cysts and neoplasms leads to a gradual displacement of the nasal turbinates. If you prevent the consequences of pathological growth and deformation of the lumen, this will allow early contact with a doctor and excision of formations.

Non-surgical treatment is aimed at eliminating the symptoms of a deviated nasal septum using vasoconstrictors and antihistamines. Medicines are aimed at reducing swelling of the mucous membrane, improving the outflow of mucus and preventing inflammation.

Antibacterial drugs are prescribed for the prevention of sinusitis, rhinitis and nasopharyngitis with prolonged congestion and cracks in the mucous membrane. Increasing the properties of local protection is carried out with the help of immunomodulatory drugs.

Laser treatment is aimed at gently removing the deformed area under continuous video control. The advantages of this method are instant coagulation of the excised mucous membrane, which leads to rapid healing and minimizes the risk of bacterial flora joining.

Treatment with a laser of such an ailment as a deviated nasal septum without surgery as such has a beneficial effect on restoring nasal breathing and prevents the formation of scars or polyps at the site of the incisions. When massively removing the spines or corners of the nasal septum, the laser device reduces the volume of blood loss by cauterizing the vessels.

Deviated nasal septum: consequences and prevention

If a patient is diagnosed with a chronic stage of the disease, a deviated nasal septum, the consequences affect not only the function of nasal breathing, but also the entire body as a whole. Mouth breathing is not physiological, since cold air that is not purified from dust particles enters the lungs.

When nasal congestion occurs, the mucous membrane of the entire respiratory tract is primarily affected. In response to constant irritation, bronchitis, tracheitis and alveolitis develop. Inflammation of the adenoids is the primary reactive phase of chronic inflammation of the ENT organs, leading to frequent exacerbations and the risk of bacterial infection.

Possible consequences of a deviated nasal septum from the respiratory system include an increase in symptoms of broncho-obstruction and laryngeal spasm, and the body’s protective reactions to constant overstimulation. Bronchoobstruction tends to enter the chronic phase into bronchial asthma or chronic obstructive pulmonary disease, which is determined by the age and allergic background of the patient.

Recurrent pneumonia develops due to the entry of dust microparticles and pathogenic microorganisms into the distal parts of the lungs. The disease does not respond well to specific treatment and requires long courses of broad-spectrum antibiotics.

Inflammation of the ENT organs in the form of chronic sinusitis, otitis and tubotitis leads to thinning of the bones of the facial skull and anatomical structures. Life-threatening complications (meningitis, encephalitis) develop with prolonged infection, purulent melting of bone structures and breakthrough of the abscess into the soft meninges.

Prolonged oxygen starvation reduces a person’s performance and endurance, leads to the accumulation of excitation in central neurons and provokes attacks of epilepsy with a prolonged runny nose. The condition is most dangerous in childhood due to the risk of epileptoid fixation of the pathological focus and the development of single attacks into a progressive disease of the central nervous system.

Prevention of symptoms due to a deviated nasal septum is primarily aimed at the use of vasoconstrictors and moisturizing drugs. This reduces swelling of the mucous membrane, reduces mucus production by goblet cells and normalizes airway patency.

Antihistamines prevent sensitization of the body, relieve allergic rhinitis and the first attacks of bronchospasm. Drugs are prescribed strictly after consulting a doctor to avoid the development of side effects.

Mucolytic and expectorant drugs are indicated for the physiological cleansing of the surface of the airways from dust particles, household allergens and bacteria through the production of endobronchial secretions. This prevents the development of inflammation and the entry of pathogenic agents into the distal parts of the lungs.

Specialty: Otorhinolaryngologist Work experience: 29 years

Specialty: Audiologist Work experience: 7 years

Source: http://gajmorit.com/iskrivlenie-nosovoj-peregorodki/

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

FAQ

The site provides reference information. 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