Nasal Septum Deviation - Symptoms, Diagnosis and Treatment

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


Types of Nasal Septum Deviation - S shaped - C shaped deviation - Caudal septal dislocation - septal thickening

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 definition - Nasal septum deviation causes - Symptoms of deviated septum - Diagnosis of septum deviation with turbinate hypertrophy - Treatment of nasal septum deviation - Septoplasty in Istanbul - Septoplasty in Turkey

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

 
Nasal septum deviation definition - Nasal septum deviation causes - Symptoms of deviated septum - Diagnosis of septum deviation with turbinate hypertrophy - Treatment of nasal septum deviation - Septoplasty in Istanbul - Septoplasty in Turkey

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.

S-Shaped Nasal Septum Deviation

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

 
Nasal septum deviation definition - Nasal septum deviation causes - Symptoms of deviated septum - Diagnosis of septum deviation with turbinate hypertrophy - Treatment of nasal septum deviation - Septoplasty in Istanbul - Septoplasty in Turkey

 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


Nasal septum deviations near the nasal valve area may cause more symptoms: The amount of air passage in the nose may vary depending on the area where the nasal septum deviation is located and the amount of curvature. For example, a significant amount of nasal obstruction and an increase in airway resistance can be seen in the nasal septum deviations near the nasal valve area.

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

 
Nasal septum deviation definition - Nasal septum deviation causes - Symptoms of deviated septum - Diagnosis of septum deviation with turbinate hypertrophy - Treatment of nasal septum deviation - Septoplasty in Istanbul - Septoplasty in Turkey

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

 
Nasal septum deviation definition - Nasal septum deviation causes - Symptoms of deviated septum - Diagnosis of septum deviation with turbinate hypertrophy - Treatment of nasal septum deviation - Septoplasty in Istanbul - Septoplasty in Turkey

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).
More detailed information about septoplasty operation available at >>
 
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
E-Mail: muratenoz@gmail.com
Mobile phone: +90 533 6550199
Fax: +90 212 542 74 47


 
 

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