Septal deviation

Septal deviation is a curvature of the nasal septum that can hinder breathing.
Anatomically, the nasal septum separates the two nasal cavities and consists of a bone and a square cartilage.

Normally, the nasal septum is located in the center and divides the nasal cavities in a symmetrical way. In septal deviation, on the other hand, the upper part of the cartilage is abnormally offset to the left or right.
An S-shaped deviation may occur, that is, the upper part of the septum is displaced to one side, and the lower part to the opposite side.

Most people have mild septal deviation.
It is estimated that 80% of people have a malposition of the nasal septum.
Only pronounced curvatures cause respiratory problems and require therapy.

Causes of nasal septal deviation

The following are the main causes of curvature of the nasal septum:

• Congenital, i.e. congenital.
• Consequence of a nose injury: Contact sports, fights or traffic accidents can cause a fracture.
• Some people think that snorting cocaine leads to deviation of the nasal septum, but in fact this can lead to perforation.

How does nasal septal deviation manifest itself? The symptoms

Most septal deformations are asymptomatic, only rarely is the patient aware of the curvature of his nasal septum. However, some septal deviations can cause the following signs and symptoms:

• Congestion of one or both nostrils – difficulty breathing through the closed nostrils: this is most evident in a cold, upper respiratory tract infection or allergy. The patient always has the feeling of a closed or stuffy nose.
• Nosebleeds (or epistaxis) – The surface of the curved nasal septum can dry out, increasing the risk of nosebleeds.
• Facial pain – Despite numerous discussions about nasal causes of headaches, a serious deviation of the nasal septum pressing against the inner nasal wall may be responsible for pain in the same half of the face.
• Noisy breathing during sleep – Among the possible disorders, nasal sounds occur in infants and young children with septal deviation or swelling of the internal nasal tissue.
• Knowledge of the nasal cycle – The nasal cycle is a phenomenon in which only the closure of one side of the nose occurs, then the same happens on the other side. This phenomenon is physiological, but may indicate the presence of an important nasal narrowing.
• Always sleep on the same side – Some people prefer to sleep on a certain side to improve nasal breathing during the night: this is the effect of nasal septal deviation narrowing one nostril.
• Sleep apnea – Septal deviation is a risk factor for sleep apnea (respiratory arrest during sleep), and the patient often snores.
• Dry mouth – The dryness is especially evident in the morning after awakening.
• Respiratory infections – The patient may be prone to pharyngitis, laryngitis, sore throat (with mucus formation), sinusitis and bronchitis.
• Dark circles or bags under the eyes.
• Some people believe that septal deviation causes dizziness, tinnitus, or hearing loss, but in reality it is not directly related to these symptoms.

Diagnosis of nasal septal deviation

To diagnose nasal septal deviation, the doctor first examines the nostrils with a nasal speculum: he checks the position of the septum and the size of the nostrils.
In addition to this objective examination, the doctor must also ask some questions about the anamnesis. He asks the patient, for example, how he sleeps, whether he snores, whether he suffers from inflammation of the paranasal sinuses or has difficulty breathing.
The doctor may order a CT scan or magnetic resonance imaging with contrast medium before surgical intervention is performed.

What should you do? Therapy of septal deviation

A curved nasal septum is quite common, but if there are no breathing problems, no therapy is required.

When to operate?
If the doctor determines that nasal septal deviation leads to symptoms such as chronic sinusitis, narrowing of the airways or frequent nosebleeds, therapy is required.
Before surgical treatment is carried out, the doctor administers drugs that help the patient with breathing difficulties:

• nasal spray with cortisone – causes fewer side effects than tablets;
• decongestant drugs.

There are some natural remedies that improve breathing, but they do not correct the nasal septum.
If these drugs are not able to reduce the symptoms, a so-called septoplasty should be performed to correct the septal deviation.
For this surgical procedure, the patient undergoes local anesthesia or general anesthesia.

In septoplasty, the surgeon incises the septum and straightens it. For this purpose, the removal of excessive cartilage or bone is required, which leads to the decentralization of the septum. In other cases, the septum is removed, straightened and reinserted into the nose. After the septum is straightened, the doctor uses splints, sutures, or small tubes to fix it in its correct position until it is completely healed.

If nasal septal deviation is the only cause of chronic sinusitis, septoplasty eliminates this problem. In other cases, chronic sinusitis persists and surgery of the paranasal sinuses is required to open them and clean the sinuses directly.

Usually, a septoplasty takes about 60-90 minutes, the entire operation is done through the nostrils. Most people return home on the same day of the procedure and take about a week to recover from septoplasty, while a month is required for full recovery.
Septoplasty does not change the external aspect of the nose and does not eliminate any existing “hump”.

In some cases, a so-called rhinoplasty is performed instead of a septoplasty to model the nose. Rhinoplasty involves a change in the bone and nasal cartilage to change nose size or shape, or both.

The cost of the operation depends on the complexity of the technique used, usually ranging from € 2,200 to € 8,000.
Often patients want to know if a nasal voice returns to normal after surgery, but in reality it does not change.

Side effects of septoplasty

The side effects of septoplasty are usually transient and include:

• Nasal pain or discomfort, especially at the tip of the nose
• A nasal congestion that can last up to six weeks
• Leakage of watery and bloody colored fluid from the nose
• Formation of crusts in the nose.

Complications of septoplasty

These complications occur during or after surgery and are often related to local or general anesthesia.
Main complications of septoplasty are:

• Severe bleeding from the nose – This only occurs in the first few hours after surgery or in the five to ten days that follow. In this case, the surgeon inserts nasal tampons or another operation is required.
• Infection of the nose, even severe – If the patient has pain and a closed nose after the surgical procedure , the family doctor should be consulted as soon as possible.
• Perforation of the nasal septum – Usually this does not cause any problems, but you can hear the air passage inwards and a whistling outside in the nose. To correct this defect, a new operation is required.
• Change in nose shape – Is unusual and will be corrected with additional surgery.
• Numbness of the upper row of teeth – The nerve responsible for the sensation in the upper row of teeth is located near the nasal septum: during surgery, it can be partially or completely damaged.

Postoperative healing for nasal septal deviation and prognosis

After local anesthesia, a few hours are required before the feeling of the nose returns.

If the septoplasty is performed under local anesthesia, the patient can usually go home as soon as he feels able to do so. If the procedure is performed under general anesthesia or sedation, an accompanying person must accompany the patient home.
Sedation and general anesthesia temporarily reduce coordination and thinking. The patient is therefore not allowed to drive, drink alcohol, operate a machine or sign legally valid documents until 24 hours after the operation.

Rest should be observed as long as the effect of anesthesia has not passed. In case of possible discomfort or pain, the patient takes painkillers if necessary after consulting his doctor.
The patient is unable to breathe through the nose as long as there is bandage inside or the nose is swollen. So he breathes for a few days until the removal of the bandage and until the swelling of the nose through the mouth.

The suture material commonly used in the surgical treatment of nasal septal deviation is absorbed after about six weeks.
The nose is bandaged for the night after surgery, the nurse or surgeon removes the bandage before the patient is discharged home.
In the first few days after surgery, fever may occur.
The plastic splints must remain in the nose for about a week after surgery, then the patient must come back to the clinic to have them removed.

Surgical shell resection
The nasal concha (Concha nasalis) is a bony structure that protrudes into the nasal cavity.
The mussel serves to heat and humidify the breathing air.

A nasal obstruction caused by an enlarged mussel is treated surgically: in this type of operation, the excessively grown part of the mussel is removed. In any case, the complete removal is avoided, which would lead to a dry and irritable nose.
This operation is performed in different ways, the type of operation, which entails partial resection of the bone, gives the best result.
The period of convalescence is about 2-3 days.
In a mild nasal septal deviation, parts of the mucosa can be contaminated with the CO₂lasers can be incised and removed, which involves fewer contraindications than traditional surgery.

Complications or consequences that may be caused by this surgical procedure include:

• excessive resection of the nasal turbinates, which causes a so-called “dry nose”,
• the bleeding caused by the procedure extends over several weeks,
• if the resection of the nasal turbinates is not performed correctly, an obstacle remains in the nasal cavity and re-surgery is required.

• Inflammation of the prostate or prostatitis
• Acute and chronic pancreatitis
• Acute and chronic otitis media