Curvature of the nasal septum. Symptoms, causes and consequences. Septoplasty operation: indications, contraindications, types and features

Curvature of the nasal septum is a common pathology that can lead to serious complications in the absence of effective therapy. Correction of a defect is carried out by conducting an operation. Modern methods of septoplasty are able in a short time to return the tissues of the nasal septum to the correct shape.

The structure and functions of the nasal septum

The nasal passages are separated by a plate. In front, the septum has a quadrangular shape and consists of cartilage tissue. Below there is a hard palate, behind the ethmoid and sphenoid bones, and in the upper part – the frontal bone.

The nose performs a number of important functions:

• filtration of inhaled air;
• maintaining the optimum level of its humidity;
• warming;
• odor recognition.

Violation of the structure of the plate can lead to partial or complete loss of some of them.

Causes of curvature of the nasal septum

The complex structure of the partition makes it vulnerable and easily deformable.

The main reasons for the violation of the shape of the plate may be:

1. Injury Half of the cases are associated with damage to the facial part of the skull or nose. Most often, injuries occur at a young age. Deformation in a newborn can be the result of illiterate manipulations of the midwife, too rapid progress along the birth canal.
   
2. Inconsistency in bone growth of the facial part of the skull. Such a pathology is present in 30% of patients. The uneven development of the parts of the nose violates its symmetry.
3. Diseases – tumors, polyps, proliferation of the nasal concha. The cause may be chronic rhinitis – a person inhales air only in one of the nasal passages, which leads to deformation.
4. Hereditary predisposition.
5. Hypertrophy of the opener-nasal organ in which the cells of smell are located. Normally, it is atrophied, but in some cases it can increase, provoking curvature.

Types and types of curvature of the nasal septum

Curvature of the nasal septum (the operation depends on the type of injury) can have a different degree:

• Group 1 – a slight deviation from the center;
• 2 group – the ledge of the partition is located in the middle between the side wall and the center line;
• 3 group – a curved plate touches the side wall.

There is also a more detailed classification that takes into account morphological, pathogenetic and clinical features:

1. Unilateral crest vertically located in the depths of the nasal cavity.
2. Two protrusions located in a vertical plane on different sides of the septum (S-shaped bend).
3. The crest is small in front of the nose and does not interfere with free breathing.
4. A crumpled plate with many fracture lines.
5. A pronounced protrusion in the anterior part of the septum, the lower edge of the cartilaginous quadrangle is shifted back. Breathing is disturbed.
6. An ascending crest, shaped like a saber, located on one side almost horizontally.
7. Two almost horizontal protrusions located opposite each other on the front of the nose and in the middle section. On one side there is a characteristic groove.

In addition to the listed species, one can distinguish multi-fragmented deformations of the nose, when the fragments of the septum overlap one another at different angles.

Symptoms of a nasal septum curvature

Curvature of the nasal septum (the operation is important due to the strong narrowing of the nasal passage) makes it difficult to pass air, the number of cilia on the ciliated epithelium decreases, which negatively affects the natural defense and cleansing of the mucous membrane. Lack of oxygen affects the activity of the whole organism.

Most often, patients note the following signs of deformation:

1. Respiratory failure, manifested in nasal congestion, the appearance of mucous secretions, sometimes with an admixture of pus, a feeling of dryness. Symptom may affect only one side.
2. Chronic inflammatory diseases of the sinuses (sinusitis).
   
3. Tendency to respiratory infections.
4. Nosebleeds.
5. Vasomotor rhinitis associated with proliferation of the vascular network.
6. Soreness in the face.
7. Noisy breathing, snoring.
8. Discomfort in the nose, itching, swelling of the mucous membrane.
9. A curved nasal septum often affects the trigeminal nerve, irritating it. This provokes regular migraines, cramps of the respiratory tract, chronic cough, sneezing.
10. Fatigue, depression, decreased ability to concentrate and remember due to oxygen starvation. Children may experience developmental delays, both physical and mental.
11. Forced inhalation through the mouth leads to chronic pharyngitis, halitosis, and drying out of the oral cavity. The air does not undergo purification and does not warm up, which is also dangerous for the lower respiratory tract. The likelihood of developing bronchitis, pneumonia increases.

Indications for surgery

The reason for contacting a surgeon may be:

• Frequent discharge of blood from the nose.
• Discomforting breathing noise and snoring.
• Tendency to colds.
• Headaches.
  
• Mucosal edema.
• Sinusitis, allergic rhinitis.

Preparatory stage

To clarify the diagnosis, you need to contact the otolaryngologist.

Inspection may include:

1. Assessment of the appearance of the nose. This stage allows you to identify serious deformations.
2. Checking the strength of inspiration and expiration through each of the nostrils and the ability to smell.
3. Rhinoscopy – examination of the nasal cavity using special equipment. To do this, an expander is inserted into the nostrils, and the mucous membrane is probed with a thin probe to assess the presence of tumors, ulcers, polyps. When penetrating through the oral cavity, it is possible to detect hypertrophy of the posterior side of the nasal concha.
   
4. Endoscopy, which involves a more detailed study of the mucosa, is performed using local anesthesia. Through the probe with a video camera, you can clearly see the lower sink.
5. Computed tomography showing the presence of spikes and ridges on the septum.

Before surgery, you must:

• men to shave;
• stop drinking alcohol and smoking;
• Do not take medications that affect blood coagulation rate.

Two weeks before surgery, a number of tests should be taken:

• blood for syphilis, human immunodeficiency virus, viral hepatitis;
• determination of the Rhesus factor and blood group;
• fibrinogen concentration, platelets, coagulation level;
• analysis of urine for the presence of protein, sediment composition;
• blood test – leukocyte formula, hemoglobin, white blood cells, red blood cells and platelets.

Anesthesia

Depending on the location of the deformed area, local or general anesthesia is used:

1. Local anesthesia is acceptable if the curvature does not affect the bone tissue. The mucous membrane is wetted with a solution-eliminating solution using a nebulizer or tampons.
2. General anesthesia. In children and patients with deformation of bone structures, the operation is performed in a state of anesthetic sleep.

Surgical treatment methods

Septoplasty is performed using several methods. The choice of this or that method depends on the type of deformation, as well as on the policy of the clinic in which the patient is observed.

Operation Killian

It does not require cuts on the skin, therefore, eliminates the formation of scars. Using a small scalpel, incisions of the perichondrium and mucous membrane are made on both sides in turn. An anesthetic is injected under the perichondrium, and through the incisions made, the membrane moves to the desired position.

If there are spikes or ridges, detachment is done only around them, so as not to disturb the structure of the mucous membrane above the protrusions. After this, the partition wall is straightened mechanically, elevations are cut off and deformed sections are excised.

The aligned nasal septum is fixed with tampons, pressing the mucosa to the bones and cartilage. The application of a sling bandage is often recommended.

Septal redress

The mucous membrane and perichondrium are cut with a scalpel in one of the nasal passages. Separation is done only from the side of the cut. From the same edge, the cartilage is dissected in 4 places so that its deformed part is connected only with the perichondrium, the mucous membrane, and also with the periosteum of the second nasal passage.

After this, the partition is cut in the place of curvature of its base. After this, the nasal septum becomes mobile and occupies its natural position, in which it is fixed with tampons.

Mobilization of the septum

The nasal septum is cracked in several places with the help of special surgical instruments. After that, the fragments stabilize and the plate straightens.

Mucosal dissection in most cases is not required. If there is a need to make incisions, they are stitched with a self-absorbable suture material – catgut.

Circular resection

If, after mobilization, the quadrangular cartilage does not acquire sufficient mobility and the septum is not straightened, a circular incision is made and a thin layer of cartilage is cut off around the quadrangle. After this, the bone base of the septum is redressed.

Partial resection

One nasal passage is operated on. The mucous membrane is dissected to the cartilage along the entire length of the septum. With a special tool, the shell is separated from the perichondrium. Cartilage is dissected through the incision so that it becomes possible to separate it from the mucosa from the opposite side.

After this, the deformed part of the septum is removed with scissors, and the mucous membrane is put in place and fixed with tampons. If the bleeding is heavy, tampons are impregnated with a hemostatic composition.

Resection-reimplantation

Recognized as the most advanced method of septoplasty. A deformed cartilage plate is cut with a metal knife.

After that, the pieces are flattened with a special device, giving them the correct shape, returned to their original place and fixed.

Laser Septoplasty

The curvature of the nasal septum (an operation that is performed using a laser) is eliminated by the surgeon using equipment that allows you to adjust the depth of radiation penetration into the tissue.

Blood in the process practically does not stand out, since the laser “seals” the damaged vessels. The cartilage tissue that breaks the shape of the septum is evaporated, after which the plate is fixed with a plaster cast and gauze swabs.

The advantages of this technique:

• antiseptic effect;
• stimulation of tissue regeneration and immunity;
• bloodlessness;
• minimal invasiveness;
• short recovery period.

Endoscopic Septoplasty

Belongs to less traumatic, gentle methods. Resection is performed inside the nose on the mucosa, which helps prevent scarring on the skin of the face. The duration of the operation is 30-40 minutes.

During the detachment of the mucous membrane, its integrity is preserved, with the exception of injuries in which damaged areas must be removed to give the septum a vertical position.

Rehabilitation

After the operation, tampons with antibacterial and hemostatic compounds are placed in the nose for a day. If the operated area continues to bleed, the used swabs are replaced with new ones and left for another 1 day. If necessary, the nose is additionally fixed with a gel dressing. During this period, you have to breathe through your mouth.

The following symptoms may occur:

• pain in the upper jaw;
• migraine;
• dry mouth and thirst;
• fever;
• dizziness, breakdown, drowsiness.

During the rehabilitation period, doctors recommend taking antibiotics, hemostatic medicines, pain-relieving medications.

For successful tissue healing, you must:

• drink not too hot drinks;
• Do not take a warm bath or hot shower;
• do not blow your nose with effort;
  
• after removing tampons, rinse the nasal passages with antiseptic and saline solutions every day;
• within a month after the operation, you should refrain from going to the bathhouse, heavy physical exertion, or drinking alcohol.

Usually, the patients spend the first 5-6 days after correction of the septum in the hospital, but discharge is possible already on the second day after removal of the hemostatic tampons, subject to a daily visit to the doctor.

Free breathing is not restored immediately, the first time in the nasal passages, swelling persists. For most patients, the ability to fully breathe and smell is returned after 7 days, but for some, recovery takes a month.

Video when you need to do an operation:

Complications

Curvature of the nasal septum (surgery to correct is quite simple) is rarely accompanied by complications.

Unpleasant symptoms during the rehabilitation period can occur in this way:

• spotting from the nose;
  
• poor sense of smell;
• hematoma – a cavity filled with blood between the mucosa and cartilage or bone tissue;
• inflamed abscesses;
• unnatural, sunken nose;
• adhesions in the nose;
• chronic sinusitis;
• the hole connecting the nasal passages.

Contraindications for surgical treatment

Septoplasty is prohibited in the following cases:

1. The presence of a concomitant inflammatory process in acute form or in exacerbated chronic.
2. Coagulopathy is a bleeding disorder.
3. Tuberculosis of the lungs and upper respiratory tract.
4. Menstrual bleeding and the first week after it.

   

5. Atrophic changes in the epithelium of the nasal septum.
6. Psychical deviations.
7. Decompensation of somatic pathologies.
8. The patient is older than 50 years or younger than 16-18 years.

Can nasal septum curvature be treated without surgery

There are no reliable methods to align the septum without resorting to surgery. Using alternative methods aimed at alleviating the symptoms of deformation, but it is important to contact experienced specialists so as not to aggravate the situation.

The following methods were most widely used among opponents of the operation:

The name of the method	Description
“Butterfly”	This is a plastic clip that snaps onto the back of the nose. The duration of treatment is several hours a day. The device is used to narrow and straighten the cartilaginous back of the nose. A side effect may occur – stagnation of mucus in the sinuses and the development of sinusitis.
Osteopathy	Manual effects on cartilage and facial bones. Some experts argue that this can achieve complete rectification of the septum. It is important to remember that this type of correction is not acceptable for all types of deformations, and in order to get a noticeable result, you will have to undergo a long course of treatment.
Conservative tactics	It helps if the cause of the curvature is polyps, severe maxillary sinus edema, and other nasopharyngeal pathologies. With the disappearance of provoking factors, the septum partially or completely shifts to its proper place. To control the result, 2-3 months after completion of treatment, an X-ray should be taken.

Is prophylaxis of the nasal septum possible

In order to prevent deformation of the central plate of the nose, it is necessary:

• timely treat ENT diseases;
• avoid traumatic activities;
• strengthen immunity.

What operations is combined with the alignment of the nasal septum

For parallel disposal of concomitant pathologies, it is possible to combine septoplasty with other operations:

• removal of foreign objects and polyps;
• lower conchotomy – correction of an overgrown nasal concha in the chronic course of rhinitis;
• sinusotomy – the elimination of congestion in the paranasal sinuses;
• external plastic nose.

Where can an operation be done and how much does it cost

The total cost of septoplasty is calculated depending on several factors:

• types of surgical intervention;
• type of anesthesia;
• degree of deformation of the nose;
• list aimed at restoring activities.

The curvature of the nasal septum can be corrected for free by contacting the clinic at the place of registration. The ENT will write a referral to aal hospital, where it will be necessary to stand in line and pass all the necessary tests. After a while, an operation invitation will follow.

The disadvantage of this path is the inability to choose a surgeon yourself. A specialist may be a beginner, although interns are usually supervised by more experienced doctors.

The cost of a standard operation, which also includes hospital stay, is about $ 272 – $ 1360. Often the price is increased, explaining this with the use of wave scalpels, but, considering the minimum size of the incisions, the use of expensive equipment may be unjustified.

Prices for laser septoplasty range from $ 408 – $ 544.

An operation that corrects the curvature of the nasal septum, as well as the rehabilitation period, under the supervision of a qualified specialist, goes without serious complications. If there is evidence, do not postpone surgery and endure unpleasant symptoms. After surgery, it is important to monitor the healing process in order to detect abnormalities in time.

Nasal septum curvature video

Comprehensive diagnosis and treatment: