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Nasal Septum Deviation

Published on Sep 17, 2020 and last reviewed on Sep 18, 2020   -  3 min read

Abstract

Abstract

When the nasal septum is significantly displaced to one side, it is called nasal septum deviation. Do all deviated septum need surgery? This article will answer this and many more such questions.

Nasal Septum Deviation
Contents

Introduction:

A deviated nasal septum is one of the most common surgical diseases in rhinology society. Mostly, every one of us has a degree of nasal septum deviation. The important clinical question is which one of us has a complicating 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, each one of us has his degree of nasal deviation.

Signs and Symptoms That Indicate the Need for Surgery:

A deviated nasal septum that needs surgical correction is the one that results in some of the following problems:

1) A deviated nasal septum can compress nasal turbinates, causing what we call 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 a silent sinus syndrome.

2) A deviated nasal septum may cause repeated epistaxis 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.

3) 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 of the nose shape strongly affect the general look of the face.

Types:

Nasal septum deviation can be classified anatomically according to the deviated part and functionally according to the direction of deviation.

Anatomically the nasal septum is formed of an anterior cartilaginous part and a posterior bony part. The bony part is formed by the union of different skull bones. In some cases, the nasal deviation affects just the anterior cartilaginous part, and in other cases, the deviation extends to the bony part too.

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.

If I Have a Complicated Nasal Septum Deviation, Would Surgery End My Problem?

In case of persistent bilateral or unilateral nasal obstruction, a successful deviated nasal septum surgery can end the problem completely, but in case of persistent contact headache, the outcome of the surgery may not satisfy your 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.

Complications:

Complications of nasal septum surgeries are less frequent now due to the use of endoscopes, but complications still persist.

1) The most common complication is a 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.

2) 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, but the patients and their relatives can see it as a horrible disaster. Simply bleeding can be stopped by nasal packs and drugs that increase the blood coagulation ability.

3) 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 silicon 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, it would be 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.

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 grow actively. 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 the use of endoscopes and the special pediatric surgery instruments, the role of 16 years is broken. There is a big medical branch now called pediatric otolaryngology, which cares about otolaryngology pediatric diseases and 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 can be solved by medications. 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 outcome of a nasal septum surgery varies not only according to surgical facilities but also according to your expectation as a patient.

 

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Last reviewed at:
18 Sep 2020  -  3 min read

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Dr. Mohammed Osama Aboborda

Dr. Mohammed Osama Aboborda

diploma in otorhinolaryngology diseses, bacelore of medicine and surgery

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