|Curvature of the nasal septum|
Computed tomography image showing congenital abnormality of the nasal septum
|ICD-10||J 34.2 34.2|
Curvature of nasal septum - the deviation of the septum in both or one side from the middle line. It is manifested by difficulty or absence of nasal breathing through one or both nasal passages. Difficult outflow of secretions from the paranasal sinuses, increases the propensity to the occurrence of inflammatory and allergic diseases of the respiratory system, including rhinitis, allergic rhinitis, vasomotor rhinitis, sinusitis, sinusitis, tonsillitis.
Types of Curvature
- Obstruction of nasal breathing, up to its complete absence.
- Chronic rhinitis.
- Dry nose.
- Frequent diseases of the nose and paranasal sinuses (sinusitis).
- Decreased sense of smell.
- Pain in the ear.
- If the septum was curved as a result of injury, a change in the shape of the nose is also possible.
Symptoms vary according to the degree of curvature. A slight curvature of the septum, which does not cause any symptoms, occurs in many people. In such cases, treatment is usually not required.
Types of Curvature What is the curvature of the nasal septum
The central flat thin plate dividing the air flow into equal parts, due to which it is processed and supplied harmoniously - this is the nasal septum consisting of cartilage and bone tissue. If the air begins to pass unevenly, the doctor may say that there is a displacement of the nasal septum (its cartilage sections), or its deformation in the form of a spike or crest in the bone section. Curvature occurs in 95% of people, but with varying degrees of severity, so you may not know about it until the end of life.
Curved nasal septum may be felt both externally and through internal changes in the body. If there is a deformation of cartilaginous tissues close to the anterior part, or at the top of the nose bridge (bone section), it will be visible due to the loss of symmetry of the nose. The internal curvature is mainly expressed in:
- frequent nosebleeds, triggered by the thinning of mucous membranes in the constricted nostril,
- difficulties with nasal breathing (feeling that the air does not flow at all),
- snoring if a person sleeps on his back
- frequent fatigue (due to hypoxia due to difficulty in nasal breathing),
- decrease in immunity, which entails an acute respiratory infection, influenza and other diseases that are difficult to endure,
- chronic diseases of the upper respiratory tract (mainly doctors focus on the appearance of chronic rhinitis in patients with curvature of the septum).
What is dangerous curvature of the nasal septum
If timely and complete air purification does not occur, a sufficient amount of oxygen does not get into the blood and the brain, immunity and brain activity gradually decrease, and vessels suffer. Following the curvature of the septum entails inflammation of the mucous membranes and chronic hypoxia, which can give rise to constant headaches, and can cause male impotence.
Symptoms of the disease gradually develop into chronic disorders, and the result is:
Types of curvature
There are 2 classifications of the deformation of the nasal septum - according to the prerequisites for its appearance and by the form that the plate takes. Mainly the curvature of the front coulter is observed, and even if there is a back defect, its edge remains even. The most widely used classification of partition curvature is as follows:
- Spike - the appearance of bone growth, can be one-sided or two-sided. Depending on the length and direction, it can provoke irritation of the mucous membrane of the opposite wall, injure it.
- Crest - local thickening of the nasal septum at the bend, coupled with its deformation, can also injure the membrane of the nasal cavity, going into it.
- The classic curvature of the nasal plate - C-shaped deformation, in which there is a slight deflection mainly in the central part. Such minor curvatures are very common, but not always a person knows about their existence, since they may not appear in any way.
- Combination of all 3 types - the most difficult variant of the curvature, since it is already guilty not only of breathing difficulties, but often its complete absence (if the deformation is bilateral, there is a shift of the front and middle sections).
Causes of nasal septum deviation
Doctors subdivide the entire list of prerequisites for deformation of the nasal septum into 3 categories:
- Traumatic. Caused by blows to the facial area of the skull, mainly this cause is found in males. Even with minor injuries, curvature of the nose is not excluded if the accretion of broken bones and cartilage tissue has happened incorrectly.
- Compensatory. They are the result of pathologies of the nasal cavities, including polyps, tumors and even permanent rhinitis, in view of which a person imperceptibly due to the congestion of one of the nasal passages, learns to breathe only free and provokes this curvature of the septum. Separately, compensatory hypertrophy is isolated, in which, due to its increased size, one of the concha is pressing on the septum and can displace it. In compensatory distortions, the cause and effect often change: even a doctor cannot always say that something has arisen before - plate deformation or breathing problems due to an increase in bone formations that divide the nasal cavity into zones.
- Physiological. Associated with congenital features of the structure of the skull - mostly uneven development of its bones. In rare cases, there is such a physiological curvature of the septum, as the development of a rudiment beyond the olfactory zone, pressing on the nasal separation plate. This deviation is rare.
The nasal septum in children under the age of 10 years is predominantly a cartilaginous plate: more flexible than bone, and more vulnerable. Doctors mention fractures of cartilage in children more often than in adults, and this is often the reason for the deformation of the septum. If time does not give importance to the violation of proper breathing after an injury, the plate over time (when the child becomes older) ossifies, and the curvature will not be as easy to straighten as in childhood.
However, there are several other prerequisites for this problem in babies:
- birth injuries
- uneven growth of the bones of the skull (minor curvatures, are eliminated independently),
- inflammation of cartilage tissue.
Attempting to confirm or refute the diagnosis of septal curvature begins with examining the patient by an otolaryngologist, who first assesses the appearance of the front of the nose. With severe deformities of the nasal septum, they will be visible already at this stage. After checking the breathing of each nostril separately, the results are correlated: if the curvature of the nasal septum is absent, the force of inhalation and exhalation is the same for the left and right side. The last is the test of smell.
If the suspicion that the nasal septum is crooked is stronger, the doctor may prescribe:
- Rhinoscopy - is to examine the nasal cavity (left and right) with a special tool that expands the nostrils. A thin probe is introduced into the lumen to probe the mucous membrane, evaluate the neoplasms (if any): these are polyps, tumors, ulcers. Additionally, hypertrophy of the posterior ends of the nasal conchae may be detected when examining the curvature through the oral cavity.
- Endoscopy - more informative examination, which should be performed with local anesthesia of the nasal mucosa. Assessment of its condition is carried out through a probe with a "video camera". Thanks to the endoscopic method, the lower shell is well visible, where mucus accumulates.
- X-ray skull - A snapshot is needed to say if there are no formations in the paranasal sinuses, to confirm or deny the presence of a traumatic deformity, congenital bone anomalies of the skull, which could provoke a curvature.
- Computed tomography - helps to inspect in detail the back of the nasal cavity, to determine the presence or absence of spines and ridges on the septum.
Curved nasal septum is an anatomical problem, therefore it is not medically possible to align the plate. If during its deformities, respiratory and hearing impairments are observed, an olfactory disorder develops, the average shell is additionally increased, or lower hypertrophy is observed, it will necessarily concern surgical interventions, mainly traditional ones, such as septoplasty or endoscopic surgery. In rare cases, curvature of the septum is eliminated by a laser.
Treatment without surgery
Conservative therapy can be aimed at eliminating the chronic inflammatory process, polyps, adenoids (a consequence of curvature of the septum), help in alleviating allergic diseases, restoring breathing and strengthening the immune system. However, the correction of the septum curve is not possible, therefore, the effectiveness of such treatment by doctors is questioned. Mostly experts can advise:
- removal of adenoids, polyps,
- osteopathy (manual therapy),
- a long course of drugs to eliminate puffiness.
The doctor may recommend surgical correction of the curvature in case of serious deviations in the development of the cranial bones, which provoke a large number of complications: among them, hypertrophy of the shells, permanent sinusitis, inability to breathe narrowed nostrils. Surgical intervention is carried out only in persons older than 16 years (exceptions are possible). Nasal concha resection can be performed with an endoscope, which is less painful. For severe injuries, rhinoplasty is performed simultaneously with classical surgery.
Classical septoplasty is performed only in the case of severe forms of curvature, and for minor deformities the doctor may offer laser treatment. This method is used only if it is necessary to level the cartilage tissue - the laser will not perform resection of the spines and correct the bending of the bone tissue, nor will it help with traumatic curvature. According to reviews, the procedure is painless, but children and the elderly are not recommended to do it.
Rehabilitation after surgery
If you had to perform surgical correction of a curved nasal plate, after it, the patient is inserted into the nostrils swabs, be sure to install the clips from silicone. The next day they are removed, if there is no abundant bleeding, the patient returns home, but it is possible that he will be in the hospital for 4 days. However, completely normal breathing is restored only 3 weeks after straightening the septum. During rehabilitation you need:
- during the first week, daily clean the nasal passages from the ENT specialist to remove the crusts, to prevent the appearance of pathogenic microorganisms,
- do breathing exercises that will not allow spikes to form,
- use topical wound healing agents (they must be prescribed by a doctor).
Possible complications after surgery
According to the doctors, it is relatively safe to do septoplasty (even from an aesthetic position - a photo of people who transferred it, prove that there are no scars): blood loss is minimal, traumatization too. However, any operation is accompanied by a risk, so after septoplasty can:
- to form ulcers, hematomas,
- appear prolonged nasal bleeding in the rehabilitation period,
- there is adhesion of cavities, narrowing of the lower stroke,
- develop purulent sinusitis, perichondritis.
If the nasal septum is not so crooked that the doctor insists on surgery (no resection of the ridges, removal of the spines, correction of the fracture effects) is required, but causes problems, you can do breathing procedures that expel the mucus, but this will only relieve the symptoms. Home therapy may include:
- Preparations of silver.
- Compositions for washing the nasal passages (struggle with the frequent symptom of the curve of the septum - rhinitis).
It is possible to avoid deformation of the central nasal plate only in the case when it is initially even, or the curvature is insignificant. For this recommended:
- avoid activities that are accompanied by cranial fractures (injury-free sports, etc.),
- prevent developing ENT diseases before polyps and adenoids,
- strengthen the immune system.
- Smell - the ability to perceive smells,
- purification of inhaled air - large dust particles are retained with the help of hairs in the nostrils, and small particles are deposited due to electrodynamic attraction to the mucous membrane. All foreign particles with mucus enter the stomach and, like a conveyor belt, are removed from the body,
- warming and moistening of inhaled air - the air is warmed to body temperature, its humidity rises to 100%. Also, when you exhale in the nasal cavity, moisture and heat are retained from the exhaled air, thus preventing the development of dehydration and hypothermia.
Consequences of injury
- In 50% of patients with a deviation of the septum, various injuries of the nose and facial skull are detected during life. Especially dangerous are traumatic situations in childhood and adolescence.
- Curvature of the septum of post-traumatic origin is characterized by peculiar deformations, sharp fractures.
- Birth injuries also fall into this category: cases are described where, due to rapid delivery or incorrect tactics of an obstetrician-gynecologist, pathology was detected even in newborns.
Jacobson's organ hypertrophy
It also has the name of the coulomus-nasal organ. It contains olfactory cells. In nature, it occurs in animals for mating, as it perceives pheromones (specific odorous substances secreted by the male and female). In humans, Jacobson’s organ is atrophied. In rare cases, the vomer-nasal organ may increase (hypertrophy), causing deformation of the nasal structures.
What type can take a deformed septum (according to Lopatin)
- C-shaped curvature
- S-visible deviation,
- dislocation of 4-coal cartilage and their combination.
Almost every adult has a slight curvature of the nasal septum, which does not interfere with the normal flow of air. But with a more significant defect, complications appear that depend on the type and severity of the deformity.
- Often there are deformities in the front, with even a slight curvature can create air turbulence, significantly violating nasal breathing.
- Combs and spikes, as a rule, are located along the lower or lower edge of the vomer and consist of bone tissue (tops of cartilage), have different lengths, can be directed in different directions or go into the mucous membrane on the opposite side.
Rhinitis and sinusitis
With this pathology, sinusitis (sinusitis, ethmoiditis, antritis, sphenoiditis) occurs much more frequently in a patient when an infection penetrates into the sinuses of the nose than in a person without such a defect. And also in 3% of cases allergic rhinosinusopathy develops, in 15% of vasomotor rhinitis.
According to some authors, the majority of patients (with deformity of the nasal septum requiring surgery) have a concomitant pathology, namely chronic sinusitis (in 47% of cases), which is accompanied by:
- nasal congestion
- secretions of mucous or mucopurulent character,
- tearing and sneezing
- nasal voices.
Snoring, sleep apnea
- Often, patients with this pathology complain of snoring (according to statistics, men are 2 times more likely than women).
- However, snoring is not only a hindrance to the sleep of others. Such patients have short-term episodes of respiratory arrest during sleep — apnea (see the causes of snoring and treatment).
- Patients often complain of daytime drowsiness, headache, school failure and at work, increased blood pressure (due to circulatory disorders of the heart and brain).
Obstructed nasal breathing
This sign can be expressed in varying degrees, from a slight violation of nasal breathing to its complete absence, when a person is forced to breathe through his mouth. There are frequent cases when nasal breathing is difficult, not because of the curvature of the nasal septum, but in the presence of hypertrophy of the concha. When this occurs, the growth of the tissues of the lower turbinates, and as a result, the lumen is narrowed, there is a weak nasal breathing. The person turns to the ENT, and he diagnoses the curve of the nasal septum (since it is crooked in most cases). After surgery, the nose still does not breathe. In such cases, excess tissue should be removed with a laser.
- Decreased sense of smell - the ability to perceive smells is disturbed, up to the complete absence of smell.
- Bleeding from the nose - the deformation causes thinning of the mucous membrane, especially in the lower part, where the vascular plexus is concentrated. As a result, any injuries, even a banal nose-picking can cause excessive bleeding.
- Frequent sore throats and bronchopulmonary diseases - when breathing with your mouth, the air is not cleared of dust and microbes, which allows them to enter the lungs and provoke frequent acute respiratory viral infections, as well as bronchial asthma.
- Dryness of the nasal mucosa - the cause of dryness in the nose is as follows: with a strong curvature of the nasal septum, the mucous membranes can come into contact with each other, disrupting the function of the cilia and cells secreting mucus.
- Periodic headaches - are reflex in nature, associated with irritation of the mucous membrane.
- Congestion and tinnitus, hearing loss - due to the spread of the inflammatory process in the middle ear through the Eustachian tube. In advanced conditions, hearing loss may develop.
- Dry mouth - if a person is forced to breathe through his mouth (with severe deformation), while the moisture from the mucous membrane evaporates, and dry mouth appears.
- Cosmetic defects - in children, due to pathology, the adenoid type of face develops - the mouth is ajar, the wrong bite, the nasal voice. Cosmetic nasal defects are also possible after injuries and bruises.
How to identify pathology
|X-ray of the nose|
|Magnetic resonance imaging||The examination is prescribed if a tumor or polyp is suspected in the nasal cavity or in the middle ear.|
|Rinoendoscopy||The technique is shown for a better inspection of the posterior nasal sinuses. Necessarily performed using anesthesia fibroelastic endoscope.|
|Rhinoscopy||The study allows to examine the anterior vesicle and deeper parts of the septum. To detail the picture, vasoconstrictive drops (0.1% Xylometazoline solution) are instilled before rhinoscopy.|
|Rhinometry||Acoustic rhinometry allows you to identify the degree and localization of obstacles to the flow of inhaled air, that is, the degree of nasal congestion. Based on measuring airflow in the nose.|
When an operation is necessary in the curvature of the nasal septum
It is not difficult to guess that the treatment of the curvature of the nasal septum is possible only by surgery. The indication for surgical intervention is not the fact of the curvature of the nasal septum, but surgery is necessary if the curvature is pronounced and leads to the patient having difficulty in nasal breathing, discomfort, and concomitant diseases. To change the nasal septum should be approached very strictly:
- breathing or not breathing nose - that is, whether the function of the nose is preserved
- weigh the risk or benefit ratio in each case
- take into account the age of the patient.
In recent years, doctors have concluded that it is inappropriate to carry out an operation on children up to 4-5 years old. A child older than 5 years old surgery is performed only if there are complaints. The operation to reconstruct the nasal septum is called rhinoseptoplasty.
The modern operation of the correction of the curved nasal septum is much more benign than a similar operation 20-30 years ago. Today only the small ridge on the partition, which interferes with the partition, is to be removed, and no one removes the entire partition, as it was done before.
How to prepare for rhinoseptoplasty?
Rhinoseptoplasty does not require special preparation. 2 weeks before the surgery, you should give up bad habits, minimize the risk of infection and hypothermia. It is also advisable to visit the dentist and cure bad teeth, eliminate possible other foci of inflammation in the body. Before surgery, the patient is recommended to conduct standard studies:
- clinical blood test,
- study of the hemostatic system (coagulogram),
- research on HIV and syphilis,
- Consultation of the therapist and anesthesiologist.
Since a significant blood loss is possible during surgery, it is more expedient for women to perform it in the middle of the cycle (2 weeks after the menstrual period). The patient is usually prescribed a cleansing enema for the night, asking him not to eat after 6 pm on the eve of the operation. An hour before the intervention, the patient is given premedication - the administration of drugs that help prepare the body for anesthesia.
Are there any contraindications to rhinoseptoplasty?
There are no absolute contraindications to the operation. To the relative include:
- elderly (over 65 years) age (patients are more difficult to suffer anesthesia),
- pregnancy, lactation,
- decreased blood clotting (as there is a high risk of bleeding),
- malignant neoplasms (cancer, sarcoma),
- high blood pressure (risk of heart attack and stroke),
- acute respiratory infections (surgery is possible not earlier than one month after recovery),
- during the flowering of herbs (during the exacerbation of allergic rhinitis).
When to consult a doctor?
Contact a specialist if the following symptoms occur:
- Persistent nasal congestion that does not go away after treatment with drops or inhalations.
- Periodic nasal (nasal) bleeding.
- Repeated infections of the sinuses (sinusitis, sinusitis, etc.).
Causes of nasal septum deviation:
- Physiological deformities. Structurally, the nasal septum consists of cartilaginous and bone plates. Curvature occurs during growth and development of the facial skeleton in the case when the cartilaginous area is ahead of the growth of bone areas or, on the contrary, on the lines of their contact, deformations are formed.
- Damage to the nose. The deviation of the septum can also be the result of injury, which leads to its displacement. In children, such an injury may occur during childbirth. Dull injuries of the external nose, with or without displacement of the back of the nose, contribute to the deformation of the nasal septum, increasing the existing physiological curvature. Injury to the nose mainly occurs during contact sports, fights or car accidents.
Age-related changes also affect the nasal structures, increasing over time the deviation of the nasal septum. In addition, changes in the size of the concha, in the form of tissue edema, hypertrophy due to developing rhinitis, rhinosinusitis, or allergic reactions can increase the narrowing of the nasal passage, which leads to nasal obstruction.
If you have a sufficiently curved septum that causes nasal congestion, this can lead to the following consequences:
- Hypoxia (decrease in oxygen in the blood) due to chronic lack of proper nasal breathing, the blood is poorly saturated with oxygen, this leads to chronic fatigue, weakness, drowsiness.
- Sleep disturbance (insomnia, snoring, apnea) inability to breathe through the nose at night makes the mouth breathe as a result of the mucous membrane of the mouth and throat "dries" and the tissues stick together, snoring occurs up to the cessation of breathing. Breathing in a dream of life is a threatening condition requiring immediate treatment.
- Headaches arise both because of the compression of the nasal walls that are crooked by the nasal septum, and because of hypoxia.
- Sinusitis (antritis, sinusitis, etc.) as a result of pronounced curvature of the nasal septum, air exchange in the sinuses is disturbed - this contributes to the development of sinusitis.
- Rhinitis arise due to irregularities in the mucous membrane of the curved septum of the nose.
Symptoms of curvature of the nasal septum
The curvature of the nasal septum is accompanied by typical symptoms. The first sign of the disease is difficulty in nasal breathing, it may be partial or complete. Moreover, with partial curvature, the human body quickly adapts to the changes that have occurred and the person may not notice the deformation.
Snoring is a symptom that often results from impaired nasal breathing. Dryness in the nasal cavity. The appearance of chronic inflammatory diseases of the paranasal sinuses: sinusitis, frontal sinusitis and other sinusitis.
Allergic diseases are also associated with curvature of the nasal septum.
Changes in the shape of the nose, its displacement to the right or left, appears most often as a result of injury. If not adequately treated, the septum cartilage can grow together incorrectly. Symptoms of curvature of the nasal septum are often accompanied by recurring nasal bleedingthat may occur when blowing your nose or trying to clean the nasal cavity. Violation of proper air circulation through the nasopharynx, can sometimes contribute to hearing impairment.
The operation is performed under general endotracheal anesthesia (insertion of an endotracheal tube into the trachea and supply of anesthetic gas) and with local anesthesia (injection injection of local anesthetics - novocaine, lidocaine). There are several types of rhinoseptoplasty:
The operation is bloodless and safe for the sick. Based on the fact that cartilage under the action of laser radiation can change its shape. The operation is performed on an outpatient basis, does not require hospitalization in the ENT department. Its advantages:
- minimal blood loss
- minimal tissue trauma
- rehabilitation and the postoperative period are much milder
- laser has antiseptic properties
The lack of laser - not all the deformation of the nasal septum, he is able to correct, especially the bone part.
Classical submucosal resection of Killian
The operation is rather outdated, its essence is to remove the curved bone-cartilage septum. This resection has many side effects:
- the partition becomes mobile and can vibrate when breathing,
- the nose can sink, taking the saddle shape,
- patients after surgery often do not disappear complaints (nasal congestion, mucous discharge),
- the partition can be perforated.