Nasal septum is a thin, 2-3 mm wide, plate which separates nasal cavity into two approximately equal halves. Septum is typically located in the midline, however, when deviated; the septum may project into the nasal airway of one or both sides of the nose. The anterior part consists of cartilage and the posterior of a thin bone covered by mucous lining on both sides.
Septal deformities like lateral deviation, spines, crests can create various degrees of nasal airway obstruction including complete blockage. This condition can seriously decrease the quality of life and lead to the higher risk of nasal inflammatory and allergic diseases. Congested nose and breathing problems has negative effect upon cardiovascular and urogenital system, induce neurosis, simple snoring and night breath interruptions.
Nasal deviations relate to different reasons and are subdivided into - natural (congenital) and
- posttraumatic.
1. Natural nasal septum deviation.
This type represents thickened areas (spines and crests) appear at the junctions of osseous and cartilaginous septal parts as a result of their abnormal development. Sometimes they become quite large so they can “run into” nasal side wall ( see the photo) thus blocking airway and interrupting normal process of breathing.
Besides, they induce neuro-reflector stimulating effect that a person may not be even aware of. Such a spine or crest can be the reason of constant sniffing, stuffiness and clear mucous secretions as well as sneezing attacks, headaches and neuroticism.
2. Septal deviation as a result of injury.
In case of direct blow, most tension falls on the front end of septal cartilage. This is the most protruding part of septum. Due to the cartilage fragile nature it may be fractured or get deviated. The complicated factor of the traumatic septal deviation is a very small size of the airway passage in the front part of the nose (nasal valve area). Any airway obstruction at the narrow passage site may lead to severe breathing problems.
The picture shows posttraumatic septal deviation in case of a 45 year old man. The front portion of the septum protrudes from the right nostril. The left nasal airway is almost completely blocked.
Patients quite often excessively use such vasoconstricting medications like Naftisin, Nasol, Nock-Sprey etc in order to ease the existing conditions. It may become habit forming and result in the drug-induced vasomotor rhinitis. To diagnose the problem and determine the best therapeutic planning, our clinic provides both traditional ENT exam as well as diagnostic endoscopy that allow more detailed view of the smallest anatomical nasal structures that can not be evaluated during the standard exam. Besides, we use rhinomanometry – the only objective testing (evaluation) of nasal breathing. This testing can assess the nasal resistance degree by calculating in cubic centimeters the amount of airflow per time unit. Such evaluation is very important for comparing treatment outcome at the postoperative period or after the conservative treatment is completed.
Treatment:
Deviated nasal septum is associated with the deformation of normal nasal cavity anatomy that is why all conservative methods (vasoconstrictive nasal drops, medications, breathing exercises) have temporary and often not very pronounced effect.
In cases of clinical manifestations of nasal deviation we recommend surgical invasion called endoscopic septoplasty. The surgery does not imply any facial incisions. As a result, external shape of the nose will not change. The average surgery time varies from 30 min to 1 hour and is done under local or general anesthesia. Nasal surgery technique for congenital and posttraumatic deviations is different. The posttraumatic surgery correction is more complicated due to the requirement to restore the septal front portion which is responsible for the support and look of nasal tip. The surgery is concluded by placement of special silicone plates into the nasal cavity that is splints and special MEROCELL sponges that are removed in 24 hours. Therefore the patients stay at the hospital just one day and night.
In the course of 5-7 days after the surgery a patient comes to change the special dressing that help fast healing and prevent potential commissural formation.
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