Introduction
The nasal septum is the dividing half of the left and right nasal passageways, that is, the observable wall between both our nostrils. Ideally, the nasal passages should be equal in size, that is, equally proportionate, but as per research, an estimated 80 % of the population worldwide tend to have an “off-center” or slightly deviated nasal septum, which is common and does not pose any risk for nasal obstruction or disease.
Does a Deviated Nasal Septum Pose Any Health Risk?
Though a mildly deviated or off-center nasal septum may not be a clinical issue, a deviated nasal septum can be a source of nasal congestion, snoring, facial pain, and sinus infections.
The nose, consisting of bone and cartilage, is also covered inside by mucous membranes with turbinates (fingerlike structures that moisten the air while breathing) and has a rich blood supply. However, in severe cases of the crooked or deviated nasal septum that would be either genetic or because of lack of broadening of the palatal arches, clinical symptoms such as difficulty breathing and noisy breathing (especially in young adults and children) are not an uncommon finding. Even due to injuries either to the facial bones or specifically the nasal bones only or in the case of fractures, a deviated nasal septum can cause obstructed breathing or nasal bleeding. It would be a source of sinus infections also. Deviations of the nasal septum hence though commonly found are often responsible for various anatomical, physiological, and pathological changes.
What Theories Are Put Forward for Nasal Septum Deviation?
Various theories and factors that have been put forward to explain septal deflections are;
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Racial - The deflections are more common in Europeans than in Asian or African races.
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Age - Deflections are uncommon in children.
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Sex - They are found more commonly in males.
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Hereditary - Heredity may be a factor in its causation as even as the fetus is in utero, it may be possible or during the birthing process.
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High Arched Palate - It is a common finding in many individuals globally that is a very common effect of septal deviation.
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Trauma - Trauma is the most important factor. Injury ruptures the chondro-osseous joint capsule of the septum and causes dislocations and fractures of the premaxillary wings.
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Birth Molding Theory - Prolonged and forceful stress during the birth process affects the nose and causes dislocations and deformations. As per evidential studies, 20 % of neonates or newborn infants may present with an S, or C-shaped deviated nasal septum. The deviation thus tends to change more as the individual ages naturally. This theory links the causative trauma faced during complicated deliveries, large birth weight infants, and other birthing challenges to be associated with a deviated septum.
Certain conditions like inferior turbinate hypertrophy and air bubbles in the middle turbinate also cause a deviated septum.
What Are the Clinical Features?
Many of us have varying degrees of septal deviations, but only a few are symptomatic. The common symptoms produced are the following -
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Nasal obstruction, which may be unilateral or bilateral and can be continuous or intermittent.
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Dryness of the mouth and pharynx.
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Recurrent attacks of cold.
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Headache and facial pains.
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Epistaxis or nose bleeding.
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Post-nasal drip.
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Snoring (may be mild, moderate, or severe).
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In severe cases of a deviated septum, sleep apnea is possible.
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Frequent recurrence of sinus infections.
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Cosmetic deformity - The dislocated anterior end may project into the nasal vestibule to cause deformity of the tip.
How Is Nasal Septal Deformity Treated?
A thorough physical examination by the physician or otolaryngologist will help in the proper assessment of any existing asymmetric or unstable cartilage of the nasal passageways. The hand instrument commonly used for examination is the speculum to visualize the bone structure and inner tissues of the nose and the nasal septum. Diagnostic methods such as CT (computed tomography) scan or fiberoptic nasal endoscopy may be used to determine structural abnormalities and in detailed evaluation of the nasal passages.
A deviated nasal septum that does not cause any clinical symptoms can simply be treated by decongestants, antihistamines, and vasodilators by the physician. However, surgical correction is done to relieve the patient of symptoms. The conventional operation is called submucous resection (SMR) of the septum. SMR has also been deemed a traditional septoplasty procedure for long-term improvement in relieving the patients' airway discomfiture or congestion and sleep-related disturbances.
Endoscopic Sinuplasty: Recently, over the last two decades, another widely preferred surgical method by otolaryngologists or physicians have been endoscopic sinuplasty which is minimally invasive and can potentially limit the trauma and post-operative swelling. This is because only the area of deviation is the extent of the incision involved. For treating lateral wall injuries or abnormalities of the nose, this is indeed preferred over the traditional septoplasty technique.
Septoplasty (Deviated Nasal Septum Surgery or Submucous Resection):
Septoplasty is the traditional technique that still remains the most used and accepted surgical step-to-step guide for improving aeration of the paranasal sinuses and for epistaxis caused by the deviated nasal septum. A curved incision is made at the mucocutaneous junction with a deflection on the convex part. With an elevator, the mucoperichondrial flap elevation is done and the cartilage exposed. With an elevator, the cartilage is separated from the mucoperichondrium of the other side without tearing the flap. A long-bladed nasal speculum is used to retract two mucoperichondrium flaps from the central cartilage. With scissors, a cut is then made in the cartilage along the dorsal front. Deflected cartilage is then removed with Ballenger’s knife or alternatively Luc’s forceps. The mucoperiosteum needs to be further elevated from the perpendicular plate of the ethmoid, vomer, and maxillary crests. Cartilaginous and bony spurs are removed. The flaps are approximated and maybe then sutured.
Conclusion:
The nasal septal deviation is not just a source of misalignment leading to other clinical symptoms but also potentially causes an increased rate of infections, post-nasal drip, reduced airflow, and nasal blockages or obstructions. Whether in early childhood, adolescence, or later in life, a deviated nasal septum should be addressed by the healthcare provider, physician, dental surgeon, or ENT (ear, nose, throat) specialist to solve the relevant issue.
