Minor Septum Deviations in the Nasal Valve Region May Cause Serious Nasal Congestion!

Location of Nasal Septum Deviations May Affect Severity of Nasal Obstruction

Nasal septum deviation in the region of the internal nasal valve

Nasal septum deviation is a curvature of the nose septum and it can be due to congenital, traumatic, or iatrogenic causes.  The location and the amount of curvature change the airway resistance within the nose.

The nasal valve area is defined as most narrowest area in the nasal cavity that between the nasal wings and the upper part of the nasal septum. The nasal valve area can be divided into two as internal nasal valve (the area between the upper edge of the nasal septum and the upper lateral cartilage) and external nasal valve (the area between the outer legs of the cartilages and the outer and vestibular soft tissue areas). You can see the details about nasal valve and and its collapse at >> Nasal Valve Collapse and Treatment. Changes in the the internal nasal valve angle can be resulted in increase in airflow resistance thus nasal obstruction. Less amount nasal septum deviations in the region of the internal nasal valve can affect the severe increase the nasal resistance.

Why deviations in the nasal valve region cause more nasal obstruction?

Unlike other areas in the nasal cavity, the "nasal valve area" is already the most drastic region, and the rate of reduction in the available air cross-sectional area is greater in the deviation of the nasal septum. As shown in the photo above, in the patient with deviation of the nasal septum in the right nasal valve region, the intranasal airway was almost completely closed. In similar septum deviations, sometimes even symptoms cannot be seen; In minor septum deviations in the internal nasal valve region, symptoms such as alar collapse while breathing, nasal congestion and open mouth sleep may occur.

In this article, the deviation of the septum in the internal bnasal valve region is deviated from the upper and anterior region of the nasal septum close to the caudal septum. Surgical treatment can be planned according to the location and severity of nasal septum deviation in each patient and whether there is external nasal deformity. For the treatment of septum deviations in the area of the internal nasal valve, some open technique may be necessary (closed technique septoplasty may not be sufficient in some cases).

Cottle test can be used to determine  the nasal valve obstruction

Cottle test or The Cottle's maneuver

Cottle test or The Cottle's Maneuver is a test in which the cheek on the side to be evaluated is gently pulled laterally with one to two fingers to open the valve. This test is used to determine the nasal valve obstruction (source >> Effects of the Cottle's maneuver on the nasal valve as assessed by acoustic rhinometry). By doing this maneuver, you can see if there is a problem in your nasal valve region (collapse, septum deviation). If you have a septum deviation in the Zten nasal valve area, you are lying in that direction during sleep, pulling the cheek area up and out (like the Cotlle maneuver) with the pillow. Most patients think it is a sleeping position.

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

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