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Deviated Nasal Septum: Diagnosis and Treatment


The dividing wall between the inside of the nose is called the nasal septum. It is composed of cartilage and bone covered by a mucous membrane. It allows us to breathe through our nostrils so that air may enter our lungs. Without the nasal septum, air in our nose would get lost, causing turbulence which can interfere with the natural transit of air and cause a host of problems.

Having difficulty breathing through the nose may be a result of a host of reasons, one of which is a deviated nasal septum. The reality is that the majority of us are not born with a perfectly straight nasal septum and over time the shape of the nasal septum can change due to various things like trauma. Treatment can range from conservative to reparative which means surgery.

How do I know if I have a deviated nasal septum?

Most patients who complain of difficulty breathing through their nose at various times may have both a reason for the nasal obstruction such as a simple cold or upper respiratory infection or allergies and have a deviated nasal septum as well. A deviated nasal septum makes smaller matters such as a cold more difficult, particularly on one side where there is more obstruction.

One of the most common patient complaints is difficulty breathing through the nose. Many of these symptoms are temporary and solved with medications such as antihistamines, decongestants, steroid nasal sprays, and the like.

It is important to understand that other causes of nasal obstruction must be ruled out. These include nasal polyps or masses and sinus disease. The nasal septum gets blamed for a lot of problems, but it is essential to have an ENT specialist perform a thorough examination of the nasal cavity and nasopharynx to make sure that the nasal septum is the only problem.

A deviated nasal septum can cause bleeding, irritation, headaches, and changes in not only breathing, but in the sense of smell or taste. Most people who become frustrated with these issues opt for a surgical correction since medications and conservative measures are usually of limited benefit.

A deviated nasal septum is best diagnosed by direct examination. X Rays, CT scans, and MRIs are of little use in the diagnostic work-up except for confirmation.

In addition to the nasal septum being crooked, there are other potential problems that can occur such as developing a perforation, or a hole in the septal wall. This can occur with trauma or use of drugs, infection, or other reasons. This is often a more difficult problem to solve surgically and beyond the scope of this article.

When should I consider having my nasal septum repaired?

There are two main categories of patients who should consider undergoing a septoplasty. There are those who have to and those who want to have the surgery. There is some overlap between the two groups, but both are seeking a better quality of life.

Those who have to include those who have sustained some type of trauma to the nose. These can range from either a facial fracture such as in a sports-related injury or automobile accident or from drugs or even iatrogenic, meaning from prior surgery. There are also those patients who have to undergo a septoplasty because they just cannot breathe well, have persistent nosebleeds, or their sinus problems will not improve.

Those patients who want to have the surgery tend to be equally grateful. They want to be able to breathe better for many reasons. They claim to have improved sense of smell and taste, fewer sinus, or nasal problems and some even say they snore less.

Generally, patients are ecstatic with the results of a successful septoplasty. Some even claim to be “drunk with air.” However, it is important to emphasize that the correction of the nasal septal deviation does not guarantee all of these improvements mentioned. If the patient has chronic sinus disease or polyps, fixing the nasal septum does not solve that problem.

How is the septoplasty done and what can I expect?

A septoplasty refers to nasal septal repair. A rhinoplasty may or may not involve a septoplasty and that is what most people refer to as a “nose job” because it involves changing the outside out of the nose.

Rhinoplasty was first described in 3500 BC in Egypt. In 1757, Quelmatz was one of the first physicians to address the deformities of the nasal septum. Most of the procedures were less than satisfactory until Freer and Killian described the first submucous resection (SMR) operation around 1902. In the next 30 years, refinements were made by Metzenbaum, and Peer and the procedure done today is largely based on the submucous resection.

You can expect your doctor to have you undergo a general anesthesia or at least local anesthesia with heavy sedation for the septoplasty.

An incision will be made inside the nose near the tip on either side or both. All the work the doctor will do is done through a relatively small incision. The mucosa overlying the bone and cartilage is elevated.

The doctor will remove some of the bone which is posterior or back near your nasopharynx and possibly some of the cartilage anteriorly as well. It is important for much of the cartilage to be left intact since otherwise there can be undesired changes to the appearance of the nose afterwards.

There will be absorbable sutures used both to close the front incision and throughout the inside to keep the mucosa in place, so no fluid or blood develops between the layers.

Many doctors will use either no packing or light absorbable packing material for rapid healing. Rarely, a doctor will use packing that must be removed, depending on the circumstances.

A final word

Most patients who undergo a septoplasty are incredibly grateful. The procedure is relatively simple, and it is often accompanied by procedures to further reduce nasal obstruction such as a reduction of the lining on the sides of the inside nasal cavity or inferior turbinates. In other words, not only is the nasal septum fixed, but the side walls are improved as well, giving the patient a maximal result.

The septoplasty procedure is permanent. Only very rarely does it need to be revised.

Most patients go home the day of surgery and find the recovery time to be less than a week. Most patients also state that the post operative pain is tolerable enough that only a few need extended use of pain medicines.

References

Mayo Clinic https://www.mayoclinic.org/diseases-conditions/deviated-septum/symptoms-causes/syc-20351710#:~:text=A%20deviated%20septum%20occurs%20when,is%20displaced%20to%20one%20side

Cleveland Clinic https://my.clevelandclinic.org/health/diseases/16924-deviated-septum

Cedars Sinai https://www.cedars-sinai.org/health-library/diseases-and-conditions/d/deviated-septum.html

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