Deviated Nasal Septum
Nasal Septum Deviation Definition
The nasal septum separates the nasal cavity into the two nostrils and it contain the bone and cartilage. The cartilage is called the quadrangular cartilage and the bones comprising the septum include the maxillary crest, vomer and the perpendicular plate of the ethmoid.
Nasal septum deviation (or deviated nasal septum) is defined as displacement of the nasal septum. It is an abnormal condition in which the top of the cartilaginous ridge leans to the left or the right, causing obstruction of the affected nasal passage. It, can lead to contraction of the air passages of the nose. Although at different levels of septum daviations are seen in many people (about %70-80).
Types of Nasal Septum Deviations
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The nasal septum can be divided into subclasses according to the area of its curvature or the shape of the deviation.
- C-shaped nasal septum deviation: It is the situation where the nasal septum is curved to the left or right in a C-shaped shape on the vertical axis.
- S-shaped nasal septum deviation: It is the situation where the nasal septum is curved in the vertical axis in an S shape.
- Dislocation of caudal septum or anterior septal dislocation: Displaced from the maxillary crest of the caudal part of the nasal septum. In this case, asymmetry between the nostrils, nasal tip deformity may occur (caudal septum deviation).
- Septal spur formation: A spinous bony prominence on the most posterior aspect of the nasal septum, extending laterally from the nasal septum, associated with previous trauma. In this case, headaches similar to the tension type emitted from the contact points can sometimes occur.
-Nasal septum thickening: Traumatic causes, various infections or cartilage diseases can be caused or can be seen without any reason.
Nasal septum deviation can become a health problem that can seriously affect quality of life by causing an increase in airway resistance in the nose. In patients with advanced septum deviation, many different symptoms such as decreased sleep quality and exercise capacity, increased frequency of throat infections, long-term lying on one's side in the sleeping position, neck pain, and headaches may occur.
Deviated Septum Causes
Septum deviation is most frequently caused by trauma, such as by a blow to the face that causes the nasal septum to be moved out of position. It can also be a congenital disorder, caused by compression of the nose during childbirth. Deviated septum is associated with genetic connective tissue disorders such as Marfan syndrome, Homocystinurias and Ehlers–Danlos syndrome.
In some cases, a deviated septum occurs during fetal development and is apparent at birth. Nasal septum deviation can become a health problem that can seriously affect quality of life by causing an increase in airway resistance in the nose. In patients with advanced septum deviation, many different symptoms such as decreased sleep quality and exercise capacity, increased frequency of throat infections, long-term lying on one's side in the sleeping position, neck pain, and headaches may occur.
Symptoms of Deviated Septum
Signs and Symptoms of Nasal Septum Deviation
Most septal deviations result in no symptoms. Some septal deformities, however, may cause the following signs and symptoms:
- infections of the sinus
- sleep apnea, snoring
- repetitive sneezing
- facial pain
- nosebleeds
- difficulty with breathing
- mild to severe loss of the ability to smell
Each patient may have different severity of symptoms
Caudal septum dislocations can cause both aesthetic and functional problems: In patients with caudal septum deviation, asymmetry between the nostrils and drooping of the nasal tip, nasal tip deformity can also be seen. In patients, both nasal congestion and nasal tip deformity may occur.
Headaches may be prominent in patients with nasal septal spur formation: In patients with nasal septal spur formation, contact pains that may spread to the head area may occur due to the contact of the spiny protuberance extending outward from the septum to the lateral wall. In these patients, pain resembling tension-type headaches may occur, which can be confused with neurological headaches.
In patients with nasal septum deviation, neck pain and decrease in sleep quality may occur due to the need to sleep sideways during sleep.
Patients With Nasal Setum Deviation Do Not Have Nose Deformity!
Patients with nasal septum deviation may have a deviated nasal septum without any externally visible deformity of the nose, when the deviation area in the septum is not close to the nasal tip or upper side.
Diagnosis of Septum Deviation With Turbinate Hypertrophy
A simple majority is sufficient for diagnosis of ear, nose and throat examination. Endoscopic examination and computed tomography allows for a more detailed assessment.
The animation above shows a deviated septum and turbinate hypertrophy on tomography scan.
Treatment of Nasal Septum Deviation
Medical treatment (such as such as decongestants, antihistamines, and nasal spray) relieves symptoms, but does not correct the underlying condition. Non-medical relief can also be obtained using nasal strips. A cure to symptoms related to septal deviations is available in the form of a minor surgical procedure known as a septoplasty or submucous resection (SMR). The septoplasty operation is performed quickly (lasts roughly 1 hour) and does not result in any cosmetic alteration or external scars. Recovery from the procedure may take anywhere from 2 days to 4 weeks to heal completely.
Pictured above, the patient underwent septoplasty and radiofrequency turbinate reduction operation. Endoscopic nasal examination photos before and after one week from nasal surgery is showing.
Sometimes nasal septum deviations may accompany severe nasal deformities and septorhinoplasty operation may be required for treatment.
Septoplasty Operation Technique
Classical septoplasty operation technique:
The operation can be performed under both general and local anesthesia. Generally, general anesthesia is more suitable for the comfort of the patient. Again, anesthesia is more comfortable, especially in posterior septum deviations, since local anesthetic injection is difficult and the patient can hear cartilage sounds. Before the operation, local anesthetic is injected into the nasal septum. Before the classical septoplasty operation, a Killian incision is often made on the left side. Both cartilage perchondrum are dissected. Submucoperichondrial dissection is advanced to the deviated cartilage areas. Nasal septum areas with deviation and narrowing of the air passage are resected (submucosal resection). The operation was terminated after it was observed that the intranasal air passage was normalized and the nasal septum became smooth in the vertical axis. The incision site is usually sutured with a self-soluble suture material. In order to avoid a third dead space in the nasal septum, the nasal septum is sutured in full thickness with a self-melting suture material. Internal silicone splints are placed in both nasal cavities, and the operation is terminated. During the septoplasty operation, turbinate reduction with radiofrequency is also performed, usually for the treatment of turbinate hypertrophy.
Open technique septoplasty technique:
This technique is especially suitable for patients with caudal septum dislocation or patients with sagging nasal tip due to severe loss of support tissue at the tip of the nose. Unlike the closed technique septoplasty operation, alar cartilages are exposed by making a midcolumellar incision into the columella. In the form of nasal tip aesthetic operation, curved areas in the caudal region of the septum can also be resected and the cartilage support of the nasal tip area can be increased by using various grafts. Link where you can find detailed information about open technical septoplasty >> Open Technique Septoplasty
Nasal Septum Deviation Animation
In the Treatment of Nasal Septum Deviation, Closed Technique Septoplasty Operation is Usually Performed and There is No Shape Change on The Nose After The Operation!
In patients with nasal septum deviation, closed technique septoplasty is usually performed. During this operation, only the curved parts of the nasal septum in the nose are excised and removed. It is a procedure that involves the removal of a limited amount of tissue and leaves the cartilage or bone structure responsible for the shape of the nose intact. After the septoplasty operation, internal silicone splints are placed in the nose and kept in the nose for 1 week. During this time, the nose may appear wider from the front, but after the silicone splints are removed, the shape of the nose is restored.
Animation of Septoplasty Operation For Treatment of Nasal Septum Deviation
Does Smell Decrease After Septoplasty Operation?
Normally, immediately after the septoplasty operation is completed, there is a positive effect on the sense of smell and taste after the septoplasty operation, since there is an increase in the intranasal airways and more odor particles can go to the olfactory area. However, after the septoplasty operation, since the silicone splint is placed in the nose for the first 7-10 days and the patients breathe air through the hole of the silicone splint only in this process, a decrease in smell and changes in the sense of taste (when taste is an odor-dependent sense) can be seen in the patients.
Numbness in the Upper Teeth May Be Observed for a Few Months After Septoplasty Operation!
During the septoplasty operation, the nasopalatine nerve, which passes over the nasal septum, may be affected, and since this nerve is responsible for the sensation perception of the forehead and upper teeth, numbness in the upper teeth that may last for a few weeks may occur temporarily (usually it disappears within a few months and may rarely become permanent).
Lung functions are also nose dependent!
The ability of our nose to perform the air heating, treatment, moisturizing and pressurizing allows the normal absorption of oxygen in the lung end airways. In cases such as nasal septal deviation, Turbinate hypertrophy, nasal polyp or intra -nasal masses, which may cause a decrease in nasal functions and oral respiration, in -nasal air resistance increases and nasal congestion occurs. Oral respiration causes blood oxygen levels during sleep and during exercise, as well as an increase in the risk of upper respiratory tract infection in the mouth. Imagine, you are in the epidemic of the coronavirus and you are making air travel, if you have severe nasal septum deviation in the nose and breathing orally, the Coronavirus may be the easiest in your lungs in the cabin. No face mask, such as the nose can not filtrate and cleans.
Simple Septum Deviation Correction Surgery's Risks!
In the treatment of nasal septum deviation, septoplasty operation is performed (closed technique) which is usually not exceeding half an hour and does not exceed half an hour. Sometimes names can be used as "submucosal resection - SMR" or "deviation operation" in the sense of cartilage resection under the mucosa. The technique is simply the clay in the nose "after the" pericondrium on both sides, the pericondrium) is elevated, the giant cartilage areas and the base cret are seiser. In cases found (the folded septum cartilage, the dyslocated sharp curvature), the cartilage tissue between them is excreted, the nasal septum perforation may occur when the cartilage membranes are drilled on both sides at the same time.
Nasal septum perforation can be repaired as an intraoperative. If it becomes mold, it can cause drying, bleeding and crusting in the nose. When the nasal septum cartilage is excessively removed, the collapse of the nose or the nose may occur in the nose and the nose may occur. The smallest surgical trauma in surgical procedures may prevent these risks from occurring.
In patients with nasal septum deviation, the nose is more easily clogged!
In patients with septal deviation that narrows the air passage in the nose, severe nasal congestion may occur in cases such as influenza infection and allergic rhinitis, since intra -nasal passage is already narrow compared to normal. Sometimes patients can only become dependent using nasal decongestant sprays that temporarily reduce tubinates and mucosal swelling. Nasal septum deviation does not improve with medical treatment, the only treatment is surgery! Nasal decongestants only allow the inflammation in the nose to be reduced and relieved intra -nasal airways. lthough it does not provide the treatment of nasal septum deviation directly; they temporarily benefit in reducing the nasal congestion caused by.
Symptoms that require you to suspect nasal septum deviation
In patients with nasal septum deviation, the following symptoms may occur directly and indirectly:
- One nostrils are constantly clogged than the other
- Mouth open sleep
- snoring
- headache
- Bad sleep quality
- Dry mouth
- headache
- Nasal bleeding (more pronounced in those with advanced septum deviation)
- Sleeping in a sleep constantly (in patients with septum deviation close to the nasal valv region, on the side of the deviation, they touch and pull their cheeks by lying on the side.
- Being constantly nasal decongestan medication
If you have one or more of the above symptoms, you should be examined by a otorhinolaryngology specialist.
Is septum deviation surgery painful?
Fixing of a deviated septum can normally be done under local and general anesthesia. Local anesthetic injection during the procedure may cause pain. During local anesthesia, it is more comfortable to perform the procedure under general anesthesia due to the hearing of cartilage and bone sounds by patients.
Childhood Deviation of septum can adversely affect the development of face and jaw bones!
Nasal septum deviations that are present in childhood may cause nasal congestion, causing chronic mouth open breathing and face-to-jaw development negatively. However, childhood septum dislocation caused by nasal trauma and children with severe septum deviation may occur in the form of nose -shaped (curvature and bending) over time.
What is the best nasal spray for nasal septum deviation?
Nasal septum deviation cannot be corrected with a spray and treatment is only surgery. However, a treatment is not necessary in patients with all nasal septum deviation. Nasal decongestant sprays can be used in patients with nasal congestion, providing temporary relief to reduce intra -nasal inflammation. It is generally recommended to use 3 times a day and up to 5 days. For a long time, the rhinitis condition caused by drugs, called "rhinitis medimentosa", may occur.
Patients with nasal septum deviation have a negative impact on the quality of life!
Many negative health effects may occur in patients with nasal septum deviation and consequently nasal obstruction, such as decreased blood oxygen level, decreased sleep quality, decreased exercise capacity, dry mouth, increased number of upper respiratory tract infections, and more ear-related problems. If you think very simply, if you think that you are in a crowded environment and you have to breathe with your mouth open due to the deviation of the septum in your nose, all the microorganisms in the environment can reach your lungs first. These symptoms may not occur in every person with nasal septum deviation, because these symptoms do not necessarily occur in deviations that do not obstruct the air passage in the nose and do not cause stenosis in the nose. Nasal septum deviation cannot be corrected by medical treatment and ultimately it causes a mechanical blockage. In the presence of an already narrow airway in the nose, a simple upper respiratory tract infection or a condition that can cause edema in the mucosa, such as allergic rhinitis, very serious nasal congestion may occur. Generally, decrease in performance is inevitable in patients with nasal septum deviation during a sportive activity related to running or lifting. In patients with septum deviation close to the nasal valve area, the effect may be more pronounced in the sleeping position. The reason for this is that when patients lie on the side of the nasal septum deviation, there is an opening in the air passage in the nasal valve area and they notice an increase in sleep quality when they stay in this position. In these patients, shoulder and neck pain, and even sagging on the cheek over time, may occur as a result of staying in a lying position for a long time during sleep. Since nasal septum deviation causes narrowing of the intranasal air passage, it may also adversely affect the operation of the ostachian tube, which is the main structure responsible for the aeration of the middle ear. Aeration problems can be seen more in the middle ear on the side with septum deviation. There are many relationships that can be discussed, and one of the organs in which nasal symptom deviation can affect the functioning of our health is our lungs. The work of our lungs is dependent on the nose, that is, when the nasal functions are healthy, the work of the lungs normalizes and improves. Mouth-open compliance may occur in patients with nasal obstruction due to nasal septal deviation, and in this case, cold, dry, polluted and low-pressure air is transmitted to the lower respiratory tract. In this case, a serious decrease in oxygen absorption in the lungs may occur and the end airways cannot be sufficiently widened to fill with air. An increase in the risk of lower respiratory tract infections may occur as a result of conveying the outside air to the lung without being filtration and heated and humidified. Another condition associated with nasal septum deviation is sleep apnea syndrome. Obstructive sleep apnea syndrome is a condition characterized by episodes of respiratory arrest during sleep that occur as a result of narrowing of the upper airways. Patients may have problems such as enlarged tonsils, sagging of the soft palate, prolapse of the uvula, large root of the tongue, narrow jaw structure, and deviation and turbinate hypertrophy, which can cause narrowing of both the nasal and throat passages. When there is nasal congestion during sleep, the work of dilator muscle activity of the airways is considerably reduced. In this case, collapse of the upper airways becomes easier and an increase in bed time may occur in the number of episodes of obstructive sleep apnea. In these patients, surgical treatment of nasal septum deviation and normalization of its passage helps to reduce complaints in patients. In the presence of nasal septum deviation in patients with obstructive sleep apnea syndrome, tolerance to the CPAP machine that increases the automatic oxygen pressure may decrease.
Does nasal septum deviation correct itself?
Nasal septum deviation is the condition in which the septum, which is composed of cartilage and bone that divides the nasal cavity, is curved to one side on the vertical axis. This condition, which can cause nasal congestion, can only be treated surgically and it is not possible to correct the cartilage curvature with a simple medical treatment or spontaneously. On social media, videos are published showing that the septum can be corrected by pressured massages outside the nose or by inserting a finger into the nose. Turbinates can be lateralized outwards (turbinate outfracture) by inserting fingers or hard objects into the nose. It is not easy to correct nasal septum deviation by simply breaking it in this way or pushing it to the opposite side with pressure. After surgically removing the mucosa on the septum, resection of the curved septum pieces, that is, septoplasty (or submucosal resection), is the only treatment method.
More detailed information about septoplasty operation available at >>
Link group where you can find detailed information about myringotomy on this website >> https://www.ent-istanbul.com/search?q=nasal+septum+deviation
Source Links:
Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul
Private Office:
Address: İncirli Cad. No:41, Kat:4 (Dilek Patisserie Building), Postal code: 34147, Bakırköy - İstanbul
Appointment Phone: +90 212 561 00 52
Appointment Phone: +90 212 561 00 52
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