Symptoms of Nasal Septum Deviation

Septal Deviation Symptoms

When the thin wall (nasal septum) between the two air passages in the nose is deviated or bent to one side (deviation of the nasal septum), it causes difficulty in air passage through an air passage (increased airway resistance).

When the deviation of the nasal septum is severe, it may block one side of our nose and reduce air flow, causing difficulty breathing. The most common symptom of nasal septum deviation is "nasal obstruction." In addition, many different signs and symptoms may occur. About 80 percent of people in the United States (USA) have more or less septum deviation. Generally, severe septum deviations or septum deviations causing respiratory distress (a small amount of septum deviation in the nasal valve area may cause obstruction of the nose) require treatment.

The most common symptoms of nasal septum deviation

The most common symptoms of deviation of the nasal septum are nasal obstruction and persistent sinusitis and symptoms of influenza infection lasting longer than normal.

Symptoms are often confused with respiratory infections, common colds or allergies.

Workers with non-severe deviation of the septum may only notice symptoms at this time.

Signs and symptoms associated with deviation of the nasal septum include:
• nasal congestion (usually more intense in one nostril)
• frequent sinus infections
• Drug-resistant sinus infections
• frequent nosebleeds (epistaxis)
• Frequent crusting or nasal dryness
• Noisy breathing while sleeping
• having facial pain
• postnasal discharge
• having a headache
• Having snoring
• whistling
• tendency to sleep to one side, often lying on the blocked nasal canal (in fact, what you know as habit may be an attempt to reach the largest airway during sleep, depending on the curvature of the nasal septum).
• sleep apnea in severe cases
• gum diseases

The symptoms of septum deviation may be more severe in infants due to nasal breathing.

Factors affecting severity of symptoms due to septum deviation

The inside of our nose is not like a fixed-shaped pipe; it consists of two separate spaces with narrow and wide areas. When the deviation of the nasal septum is in the nasal valve region, which is the narrowest part of our nose, even a small amount of septum deviation can be expected to cause a large amount of complaints. In addition, the presence of a disease such as allergic rhinitis, which may increase mucosal edema, may cause the symptoms of septum deviation to be felt more. The lower part of the nasal septum, ie, the portion of the "columella" in the middle of the nostrils, located behind the nasal septum, is called the "caudal septum" deviation. In addition, a curvature in this section may also show a nasal distortion in which the nostrils appear asymmetrically from the front and the tip of the nose more obliquely.

Caudal Septum Deviation

In the curvatures (caudal septum deviation or anterior septal dislocation) in the caudal part of the nasal septum, this part of the septum, the important supporting tissue of the nasal tip, is displaced into the nostrils. As seen in the photo below, it is also a visual problem in the nostrils and nose tip. In patients with caudal septum deviation, instead of a simple deviation surgery; Caudal septoplasty or open technique septoplasty is performed to reconstruct the caudal septum and restore the nasal tip support to normal. If the curvature of the caudal septum is simply surgically removed and cartilage graft reinforcement is not reintroduced into this region, it may result in nasal tip fall and nasal distortion.

In 1929, Metzenbaum was one of the first to describe a procedure addressing the problem of caudal septum deviation. Recognizing the difficulty in the treatment of anterior septal deviation and the posterior septum resection pointed out the minimal effect on the correction of anterior deviation. It also demonstrated the importance of maintaining the caudal septum for nasal tip support. He described the "swinging door technique" in which the caudal septum was removed from a vertical wedge on the outward-facing side and emphasized the need to reposition the caudal septum in the midline after the procedure. Subsequently, several variations of this technique, including the technique of fixing the caudal septum to the nasal support tissues by suture, have been reported.

Dr. Pastorek and dr. Becker shared his experience with a modified swing door technique, and in the modified technique, the septal cartilage is detached from the maxillary crest and is rotated over the base of the nose, which acts as a "door stopper" and secures the caudal septum to a more midline position. To secure the caudal septum part, suture is placed in the lower part. The authors emphasize that a swinging door technique may be used to avoid losing the support of the nasal tip in order not to weaken the caudal septum excessively.

There are many different surgical techniques that have been described to correct the deviation of the caudal septum without weakening the nasal tip support.

Open Technique Septoplasty Operation For Treatment of Caudal Septum Deviation

Normally, in conventional septoplasty surgery, the procedure is performed through the nose and there is no incision or deformation visible from the outside. Above are the pre-procedure nasal photographs of the caudal septum deviation and posterior deviation of the septum in contact with the nasal flesh after open technique septoplasty. Since no procedure is performed on the nasal bone, only the silicone nasal tampon is inserted into the nose and the process is terminated.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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