Deviated Nasal Septum

The nasal septum is the part of the nose that separates the two airways and the nostrils.

A deviated septum is when there is a shift from the midline or center position.

Description of Deviated Nasal Septum

Deviations of the nasal septum may develop during growth or by trauma due to a fall, a blow to the nose or surgery that further exaggerates the deviation.

Symptoms of Deviated Nasal Septum

These deviations are common, and for the most part, cause no symptoms and require no treatment. However, the septal deviation may be severe enough to obstruct the passage of air through the nostrils. This obstruction may predispose the patient to sinusitis, infection and epistaxis (nose bleeds).

Treatment of Deviated Nasal Septum

Treatment of a deviated septum is based on the patient’s symptoms. It may include analgesics (pain medications) to relieve headaches, decongestants to reduce secretions, antibiotics to eliminate a suspected infection, and corrective surgery for the more persistent, troublesome symptoms.

Corrective surgery may consist of reconstruction of the nasal septum by repositioning the nasal septal cartilage, thus relieving the nasal obstruction. Other surgical procedures include rhinoplasty to correct nasal structure deformity and septoplasty to relieve nasal obstruction and enhance cosmetic appearance.

Surgical complications are relatively rare, however, there is the possibility of hemorrhage (bleeding), infection, and further deformity. While most patients achieve relief of nasal obstruction, some may have persistent and recurrent nasal obstruction.

Is the operation for correction necessary -

The importance of ‘effective’ nasal breathing cannot be over emphasized. By the time inspired air passes through the nose and reaches the lungs, the air has been properly warmed, humidified and also cleaned. The physiologic cleaning and filtering function which is important for proper pulmonary and overall health is emphasised simply because the continual or episodic absence of ‘healthy’ nasal breathing often is a reason to a host rise of medical problems and conditions.

Nasal airway obstruction is a very common problem throughout the world. There are multiple causes, both temporary and acute, for as well as chronic and persistent nasal obstruction. It can persist for weeks and months and sometimes even throughout ones lifetime.

The following is a list of some of the more important causes of chronic nasal airway obstruction: of the adenoid tonsil enlargement, chronic adenoiditis, chronic allergic rhinitis, chronic sinusitis, congenital choanal atresia (congenitally obstructed nasal passage), chronic vasomotor rhinitis, nasal polyps, nasal valve collapse, nasoseptal deviation, refractory turbinate (nasal mucosa) enlargement, and outer nasal deformity due to trauma or surgery.

What Causes a Deviated Septum?

Two common reasons for internal nasal obstruction due to nasoseptal deviation are nasal trauma and cartilaginous growth abnormalities. Nasal trauma is probably the most common cause for septal deviation. In the past several decades, there has been an increase of young adult participation in contact sports and road traffic accidents. This has given rise to an increase in trauma to the nose, increase in nasal fracture, and subsequently an increase in nasoseptal deviation and crookedness. Essentially this results in nasal obstruction and turbulent nasal airflow that is of a chronic nature. Simple trauma from birth delivery can also cause internal nasoseptal airway obstruction persistent in adulthood. Since the outer portion of the nose is intimately connected with the nasal septum, simple nasal trauma and nasal fractures can cause nasoseptal deflection and nasal airway obstruction.

Secondly, a very common cause of septal deviation is unusual nasoseptal growth pattern. Sometimes the septum grows crooked due to the confined space. This overgrowth can lead toward buckling and bending of the cartilaginous and bony septum.

Manifestations of Nasoseptal Deviation

A significantly crooked nasal septum induces turbulent airflow. Sometimes, airflow is completely absent and there is no nasal airway patency. Decreased nasal breathing compromises ones sense of smell. The ability to perform the normal physiologic functions of the nose is significantly impeded, as the air flowing into the nose is “processed” so that air delivered to the lungs is humidified, warmed, and filtered and cleaned. Diminished nasal breathing compromises this process and compromises ones health.

Epistaxis (bloody nose) is a common manifestation of nasal airway compromise. The increase in air turbulence and nasal dryness lends itself more towards nasal bleeding. Correction of the septal deviation tends to decrease the epistaxis tendency. Additionally, alterations in nasal airflow currents can cause crusting, irritation, and metabolic changes to the normal mucosa, as well as normal mucosal functioning.

Nasoseptal deviation can also impinge on the sinus drainage (doorways), which can sometimes lead to sinus obstruction and/or recurrent or chronic sinusitis. By straightening the septum, improvement of nasal sinus drainage and ventilation can be achieved, which often times improves chronic sinusitis. Nonetheless, septoplasty can play an important role in the battle against chronic sinusitis.

Nasal obstruction and a deviated septum contribute to snoring and obstructive sleep apnea, as well as related sleep disordered breathing problems. With the alleviation of upper airway nasal obstruction via nasal septoplasty, snoring and sleep apnea can be significantly improved in many individuals.

The Nasal Septoplasty Procedure

Septoplasty is generally performed on an outpatient basis with IV sedation or general anesthesia. The procedure takes approximately 30 minutes. A small incision is created inside the nose and cartilage and bone is inspected and specifically treated appropriately. Bony spurs are trimmed or removed if present. The cartilage is morselized and straightened back to its original position. Bone is also manipulated to the center to achieve reasonable straightening and better nasal airflow.

Sometimes small splints are placed internally to support the septum. These are removed simply in a few days time. Packing is not required.

Concurrent Surgery

Nasal septoplasty is commonly performed with other procedures. The most common procedures include turbinate reductive surgery for additional improvement in nasal breathing; also endoscopic sinus surgery is quite common to achieve improvement for chronic sinusitis. Reconstructive or cosmetic rhinoplasty is often performed at the same time as septoplasty depending on each individual’s needs.

Nasal Septoplasty Recovery

After septoplasty individuals will go home the same day. There is mild discomfort to the nasal area for 24 to 36 hours afterward. Oral pain medications are generally effective in reducing postoperative discomfort. Ice packs are placed around the nose and cheek area for alleviation of the mild discomfort. Individuals are able to resume reasonable activities after three to four days and can go back to work after five to seven days. Nasal irrigations and nasal supplemental steroid sprays are used continuously until the healing process is complete.

Septum deviation – Septum deviation is not often a problem, but sometimes the cartilage is too deformed that it bends and blocks one air passage, and nasal septum can depart from the centreline of the nose. Septum deviation may be caused by trauma, like an injury to the septum from a punch to the nose, excessive nose-picking or cocaine usage. However, there are two common causes for internal nasal obstruction due to nasoseptal deviation. People, suffering from some sort of injury or some other familiar nasal trauma have probably the most common cause for septal deviation. In the past several decades there has been an injury increase in nose trauma, nasal fracture and consequently a rise in nasoseptal deviation and crookedness. Reason for that is the rise of young adult participants in sports such as skiing, snowboarding, skateboarding, bicycling and other contact sports.

Nose fractures, which are very common among this group may occur due to the trauma of each or a combination of the following three structures of nasal septum: ethmoid bone, vomer bone and septal cartilage. And since the bony parts of the nose the perpendicular plate of the ethmoid bone and the vomer are too thin, fractures are very common. The outer portion of the nose is connected with the nasal septum, so simple nasal trauma or nasal fractures can cause septum deviation.

Second most common group suffers from septum deviation because of cartilaginous growth abnormalities or unusual nasoseptal growth patterns. However, most often the deviation is caused by postnatal trauma (it can during a fist fight or even during delivery).

Symptoms

Nasal Blocked

Sinus Blockage

Nosebleeds

Neadaches

Sleep Apnea

Colds

Chronic Sinusitis

Surgery for deviated nasal septum – Surgery is necessary as there are no other way to correct them

There is no other medicine or cure for a deformed nasal cartilage, septoplasty is the only effective treatment Septoplasty is a surgical procedure in which a deviate nasal septum is straightened. This results in both improved examination and breathing. Namely, when you have septum deviation, it is difficult to examine your sinuses and the your nose for polyps, tumors, epistaxis, thus in order to improve health problems, it is essential to undergo septoplasty.

The procedure takes about 30 minutes to be performed, but swelling and irritation may delay final improvement for about four to six weeks.

Septoplasty is generally performed on an outpatient basis with local or general anesthesia. The surgeon works through the nostrils, making an incision in the lining of the septum to reach the cartilage targeted in the operation. Bony spurs are trimmed or removed if they are present. The cartilage is morselized and straightened back to its original position. Bone is also manipulated to the center to achieve reasonable straightening and better nasal airflow.

Sometimes small splints are placed internally to support the septum, but they are removed in a few days time.

Nasal septoplasty is commonly performed with other procedures, such as reductive surgery for additional improvement in nasal breathing; endoscopic sinus surgery and reconstructive or cosmetic rhinoplasty.

After the procedure individual will go home the same day. There will be mild discomfort to the nasal area for one or two days afterward. In reducing postoperative discomfort oral pain medications are generally effective. Ice packs are also placed around the nose and cheek area for alleviation of the mild discomfort. Patient typically regain about 80% of their energy in one week after the surgery” patient is able to resume reasonable activities after three to four days and can go back to work after five to seven days. However, full recovery from the procedure is achieved after one month. During postoperative care frequent saline irrigations of the nasal cavities are continuously used until the healing process is complete.

After Surgery

Nasal bleeding

Right after surgery, you will have drainage from your nose. There may be a small amount of bright red bleeding, but do not be alarmed. A small amount is normal and may continue through the week. A gauze dressing will be placed on your upper lip to absorb this drainage. On the day of surgery it may be necessary to change the dressing.. If bleeding does occur, place an ice pack over the nose. At the same time place an ice cube in your mouth; let it melt. Any bright red bleeding that lasts more than ten minutes, or id heavy, should be reported to your doctor immediately. Old blood, which accumulated during surgery, is dark reddish-brown. It will drain for a week or more. It is of no concern.

Nasal Congestion

For the first week after surgery, your head will feel stuffy. This is due to swelling of the mucous membranes in your nose. This is normal and expected. The stuffiness will gradually decrease over the next few weeks , so please be patient. After this, you should notice an improvement in your nasal breathing.

Nasal Packing

Packing may be removed the day of surgery before you are discharged. If nasal packing is left in your nose, it will be removed in 1-4 days. This packing keeps the nasal septum straight and prevents bleeding. Do not remove this packing.

Discomfort After Surgery

There is some discomfort after surgery. If a pain medication is prescribed, take as ordered. If none was ordered, take acetaminophen (Tylenol) according to package directions. DO NOT TAKE ASPIRIN OR MEDICATIONS WHICH CONTAINS ASPIRIN. These products may cause bleeding. For additional pain relief place an ice mask or cool washcloth over your eyes and forehead for the first 24-36 hours after surgery.

Post-Operative Visits

You will have 2 to 3 post-operative visits. The purpose of these visits is to clean and examine the operative site. This helps the healing and improves nasal breathing. If packing is left in your nose, it will be removed at your first post-operative visit with minimal discomfort. If packing is not left in your nose, your first visit will be 5 to 7 days after surgery. If everything is healing well, your last visit will be 10 to 14 days later.