Introduction:
The most prevalent surgical condition in the field of rhinology is a deviated nasal septum. Most people have some nasal septum deviation. The important clinical question is which one has a complicated deviated nasal septum? The human body is not a building but a complicated biological creation. Anatomically, the nasal septum runs identically with the midline of the body, and because of the normal anatomical variation, everyone has some degree of nasal deviation.
What Is Nasal Deviation?
The nasal septum is a thin wall of cartilage and bone between the two cavities of the nose dividing it into two parts. In some cases, the septum may be a little off-center or deviated to one side of the nasal cavity and is called the deviated nasal septum. In severe cases of a deviated septum, it can cause blockage on one side of the nose, causing difficulty in breathing.
What Are the Causes of Nasal Deviation?
The nasal septum, the flimsy wall that divides the right and left nasal passages, can get moved to one side, which is known as a deviated septum. A deviated septum may result from:
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A Birth Defect. Sometimes a fetus develops in the womb with a deviated septum, which is visible at birth.
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A Nasal Injury. Injuries that cause the nasal septum to shift out of place can also result in a deviated septum. During labor, such an injury can happen to infants. A nose injury and deviated septum can occur in both children and adults as a result of many different incidents. The most frequent causes of nasal trauma include contact sports, physical play like wrestling, and auto accidents.
Age-related changes to nasal anatomy may exacerbate a deviated septum over time. An infection-related swelling and inflammation of the sinus cavities or nasal cavities can further constrict the nasal channel and produce nasal obstruction.
What Are the Signs and Symptoms of Deviated Nasal Septum That Indicate the Need for Surgery?
A deviated nasal septum that needs surgical correction results in some of the following problems -
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A deviated nasal septum can compress nasal turbinates, causing a contact headache; unilateral nasal congestion accompanies the contact headache. The compression of the middle turbinate may lead to blockage of the maxillary sinus opening, leading to a recurrent sinus infection and thinning of the bony sinus wall. This causes negative sinus pressure, which is called silent sinus syndrome.
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A deviated nasal septum may cause repeated epistaxis (bleeding from the nose) because of extreme tension on the nasal blood vessels that pass over the nasal septum's deviated part. This type of epistaxis may not respond to medical treatment.
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A deviated nasal septum may not be presented only by subjective criteria but also can be presented by objective cosmetic signs. Here, surgery is more critical because minimal changes in the nose shape strongly affect the general look of the face.
What Are the Types of Nasal Septum Deviation?
Nasal septum deviation can be classified anatomically according to the deviated part and functionally according to the direction of deviation.
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Anatomically the nasal septum is formed of an anterior cartilaginous part and a posterior bony part. The union of different skull bones forms the bony part. In some cases, the nasal deviation affects just the anterior cartilaginous part, and in other cases, the deviation extends to the bony part too.
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Functionally nasal septum deviation can be directed to one side of the nasal cavity; the deviation here is called the C-shaped deviation. The deviation can be directed to both sides of the nasal cavities; the deviation here is called the S-shaped deviation. In the case of S-shaped deviation, symptoms and signs are more exaggerated.
Can Surgery Help in Treating Complicated Nasal Septum Deviation?
In case of persistent bilateral or unilateral nasal obstruction, a successful deviated nasal septum surgery can end the problem completely. Still, in case of persistent contact headache, the outcome of the surgery may not satisfy one’s need, even in case of complete correction of the nasal septum deviation. Until now, the cause is unknown.
In the case of cosmetic surgeries, the outcome is based not only on the surgeon's skills but also on the patient's expectations. Many cosmetic nasal surgeries worldwide are medically successful, but these do not match the patient's expectations, especially in female patients.
Nasal Septum Surgery in Children: In the past, nasal septum surgeries were not welcomed before the age of 16 years because, before this age, the ossification centers in the nasal septum grew active. So any trauma to these centers can affect the growth of the nasal septum, which in turn affects the whole development of the face. Now, after using endoscopes and special pediatric surgery instruments, the rule of 16 years is broken. There is a big medical branch now called pediatric otolaryngology, which cares about otolaryngology, pediatric diseases, and surgeries.
What Are the Complications of Nasal Septum Deviation Surgeries?
Complications of nasal septum surgeries are less frequent now due to the use of endoscopes, but complications still persist.
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The most common complication is nasal septum perforation, which happens because of vigorous manipulation during surgery, affecting the septum's anterior cartilaginous part. The annoying problem with this perforation is the persistent whistling sound with each breath, plus continuous crust formation along the perforation boundaries. This perforation can be easily closed by the use of a silicon button.
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Bleeding is one of the most common complications of nasal septum surgeries. Although the hypotensive anesthesia technique now decreases the incidence of intraoperative bleeding, bleeding still persists in some cases because the nose is a highly vascularized space. Intraoperative bleeding is mainly a problem for surgeons while bleeding after surgery is a complication for surgeons and patients. Although bleeding after the surgery is mostly minimal, the patients and their relatives can see it as a horrible disaster. Nasal packs and medications that promote blood coagulation can stop bleeding.
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One of the annoying complications is the adhesion between the covering mucosa of the nasal septum and the covering mucosa of the lateral nasal wall. These adhesions can be easily avoided during surgery by avoiding vigorous manipulation and by the use of silicone sheets after surgery, which prevents contact between the mucosa of the nasal septum and the mucosa of the lateral nasal wall. If adhesions are noticed after surgery, they are treated surgically by cutting.
All the above-mentioned complications are less commonly seen now due to the use of computerized tomography (CT) scanning, which acts as a navigation system that helps the surgeon to detect his way through surgery, allowing him to respect the dangerous areas during nasal septum surgeries.
Conclusion:
A deviated nasal septum is a normal variation among people unless it is complicated with persistent nasal blockage, persistent headache, epistaxis, or any other complication. Complicated nasal septum deviation is a surgical problem, which needs surgical intervention, and not a medical problem that medications can solve. Nasal septum surgeries can be performed at any age now due to the recent surgical facilities. Nasal septum surgery has its specific complications, which are less commonly seen now due to the use of nasal endoscopes. The success of a nasal septum surgery varies not just depending on the surgical facility but also on the demands of an individual.
