Deviation of the nasal septum is its displacement away from the midline of this organ. Its ideal form is very rare. Therefore, the condition in question in many cases does not represent a pathology. However, this does not exclude the presence of the latter in certain situations. Therefore, you need to know the symptoms, causes and treatment of this ailment.
The concept of the nasal septum
This is a natural formation located in the middle of the nasal cavity and dividing it into two equal parts. In turn, it also includes 2 lobes, one of which is located in front and the other in the back. The anterior part is cartilaginous, the elasticity and compliance of which is easily determined by probing. It is she who is most often damaged due to various injuries.
The structure of the nose
The main departments of this body include the following:
- nostrils - inlets,designed to ensure the passage of oxygen into the nasal cavity;
- initial section - this is where the vertically located nasal septum is located;
- nasal passages - located further than the initial section, subdivided into lower, middle and upper, limited to similar nasal conchas;
- choanas - two openings that provide communication between the nasopharynx and the nasal cavity.
The nasal cavity also includes several walls:
- septum formed in front by cartilage and in back by vomer;
- lateral walls formed mainly by the ethmoid bone;
- lower - is formed due to the hard palate located in the area of the upper jaw and soft palate;
- anterior-upper wall - is formed due to the process in the above area and the nasal bones.
Inside the nasal surface is lined with mucous, due to which the secret is secreted. It also has a significant blood supply. Olfactory is the upper part of the nasal passage. Nerve receptors are located here.
The turbinates are located in the back of the corresponding cavity, which subdivide it into nasal passages. The lower of them is an independent small bone, and the middle and upper are processes extending from the ethmoid bone.
Nasal passages communicate with paranasal and maxillary sinuses located in departments.
The ethmoid bone has many small cavities in the form of sinuses. The sphenoid bone is located at the base of the skull and is almost invisible on the outside.visible. In her body there is an air cavity in the form of a sphenoid sinus.
Functions of the nose
These include:
- perception of various aromas using the olfactory cavity;
- detention by nasal mucus of various pathogenic microorganisms with their subsequent removal or destruction due to the bactericidal properties inherent in it;
- protection from mechanical irritants due to mucus and hairs, ensuring their retention and subsequent withdrawal;
- heating the air flow due to the venous plexus located under the mucosa;
- moisturizing the air entering the nasal cavity due to the secretion of the glands located in the mucosa;
- air flow to the larynx and nasopharynx.
Determination of the correct distribution of air flows for the two halves of the cavity is provided by the nasal septum. The curvature is a potential cause of these functions being impaired.
The ideal state of the nasal septum is noted in newborns. Here, almost the entire shell has the appearance of cartilage, which is subsequently partially converted into bones that are fused with each other. Due to various violations in these processes, there is a curvature of the nasal septum. It can be quite difficult to identify the initial causes of this phenomenon.
Most of the curvature occur at the age of 13-18 years. This deformity is 3 times more common in men than in women.
Curvature of the nasal septum according to ICD
The International Classification of Diseases (ICD) isa regulatory document created to take into account morbidity, reasons for citizens to go to medical institutions and causes of death. He is one. Currently, the classification is valid in revision 10 of the revision. ICD-11 is planned to be released this year.
Deviated septum in ICD-10 has code J34.2. It is indicated in the disability certificates.
Causes of deformity of the nasal septum
The main one is injuries to this organ. Deviated septum in a child is mainly formed during the eruption of molars, which causes expansion of the jaws and changes in the nasal cavity.
Sometimes the deformity is due to an overdeveloped rudiment of Jacobson's organ, which is located below in front of the nasal septum.
Their combination, causing curvature, can be combined into three groups:
- traumatic - nosebleed occurs and breathing through this organ is disturbed, as a rule, it is preceded by a nose fracture;
- compensatory - occurs due to prolonged irritation of the nasal septum due to thickening of the nasal concha, polyp, foreign body, etc.;
- physiological - mainly found in children and adolescents, due to a mismatch between the bone and cartilage tissue of the septum.
Classification
The main types of curvatures under consideration are the following:
- Comb.
- Spike.
- Direct curvature.
- Combination of the first two options,called mixed.
The third kind has the following variations:
- deformation involving a certain area of the septum, vomer or vertical plate of the ethmoid bone;
- curvature located at the front or back of the septum;
- one- or two-sided deformation;
- curvature in a horizontal or vertical plane.
Basically, they diagnose curvature in the front. The ridges and spikes are mainly located on one of the edges of the coulter. Their base is bone tissue.
Symptoms
They appear in most people, without bringing them any discomfort. The following are the ones that worry patients:
- changing the shape of the nose due to injury;
- epilepsy attacks can contribute to severe forms of deviated septum;
- itchy, sore and dry throat;
- cough;
- violation of distraction, thinking and memory due to lack of oxygen in the blood, which can lead to problems with the functioning of the brain and central nervous system;
- signs consistent with inflammation in the middle ear;
- infectious diseases;
- as a result of curvature, low resistance to physical exertion, increased fatigue, decreased performance;
- dry nasal cavity;
- allergic rhinitis, which is pre-asthma - nasal congestion occurs due to contact with a certain substance;
- snoring;
- rhinitis, resulting inthere are constant mucous secretions;
- difficulty in nasal breathing is the main sign of deformity, but it may be absent.
Deviated septum in children can be congenital or acquired. Snoring, bleeding, rhinitis, breathing through the mouth they may indicate adenoids.
Collateral violations
What are the consequences of a deviated septum (treatment will be discussed later)? With difficulty in nasal breathing, the following changes occur:
- attachment of the nasal wing to the septum - occurs due to the curvature of its front part, leads to a significant difficulty in the passage of oxygen;
- development of a reaction from nerve endings in the mucosa - with curvatures, air turbulences are formed, which irritates the receptors, as a result of which the vessels of the mucosa expand, mucus appears in large quantities, swelling develops;
- narrowing of the territory of the nasal passage, impaired breathing in the direction where the concavity formed;
- change in air circulation inside the nasal cavity - during normal breathing, the air rises, then it passes through the middle nasal passage and partially along the upper one, when exhaling it goes to the lower one, but when it is bent, the air flow is disturbed, which leads to that in relation to breathing;
- change in air circulation in the area in which the septum is convex - up to a complete blockage of the nostril on this side.
Changesmucosa with curvature occurs as follows:
- vortex flow begins to hit the mucosa, which leads to its thickening in these places and to the loss of cilia by epithelial cells, which causes a decrease in protective functions;
- when secreted, the mucus dries up with the formation of crusts;
- rhinitis appears.
Sufficient supply of oxygen to the lungs and blood depends on the processes of nasal breathing. As a result of the curvature, gas exchange in the alveoli is disturbed, which leads to oxygen starvation.
When breathing through the nose is disturbed, a person is forced to perform this function through the mouth. This process is characterized by the following negative consequences:
- an adenoid develops, accompanied by inflammation of the pharyngeal tonsils;
- for this method, the protective functions of the nasal cavity are not typical, which leads to an increase in the risk of respiratory diseases;
- the air does not warm up and is not moistened, which does not ensure the proper efficiency of gas exchange in the alveoli, the blood is not sufficiently saturated with oxygen, which negatively affects the entire body.
Due to the curvature of the nasal septum, nerve disorders may appear:
- visual;
- affecting the work of internal organs;
- dysmenorrhea in women;
- seizures in epileptics;
- bronchial asthma;
- laryngeal spasms;
- reflex sneezing and coughing;
- headaches.
In addition, the considered defects cause changes in neighboring organs:
- eyes - with pathological deformity, the nasolacrimal canal can act as a source of infection;
- nose - an inflammatory disease called "sinusitis" develops, sinusitis and frontal sinusitis also develop;
- ears - there are disturbances in the Eustachian tube and middle ear.
In chronic inflammation, mucus and infectious agents that are not removed from the nasal cavity may end up in the eardrum or auditory tube.
Diagnosis
Treatment of the curvature of the nasal septum should be preceded by a procedure for diagnosing this pathology. First of all, an external examination is necessary, which reveals a displacement of the tip or scoliosis of the nose.
The main research method is rhinoscopy, during which asymmetry is detected during the comparison of the nasal cavities. In case of violations, on the one hand, the turbinates are clearly visible, and on the other, they may not be visible at all.
To determine the features of the configuration of the side walls, the results of which make a decision on the need for nasal surgery with a deviated nasal septum, lubrication of the shell and septum with a 5% solution of cocaine and adrenaline is used.
X-ray examination is uninformative. But it may be necessary to determine the condition and location of the paranasal sinuses.
Treatment of deviated septum
Most conservative treatments provide very short-term relief. SoThe main method of treatment is to perform surgery for the curvature of the nasal septum. The main method of its implementation is endoscopic septoplasty.
The impact is carried out through the nostril with a dissection of the mucous membrane and its separation from the septum in question, after which plastic surgery is performed with suturing. The operation takes about half an hour. It can be performed under local or general anesthesia.
According to reviews, surgery for deviated septum is better tolerated under general anesthesia. Finally, splints and gauze pads are placed in the nasal cavity, which are removed the next day. After their removal, the patient is prescribed a saline solution in the form of nasal drops or lubrication with oil solutions of vitamins, which contributes to faster healing of the mucosa. Bloody crusts from the nose can stand out within a month, swelling subsides after about two weeks, which will help restore nasal breathing.
Thus, the stay in the hospital after the operation is one day. After the operation, the curvature of the nasal septum is eliminated. Within a week after this, the medical office is visited for dressings, which speed up healing and act as a means of preventing the formation of adhesions.
Currently used for the treatment of deviated septum laser. The advantages of this method are as follows:
- rehabilitation activities are kept to a minimum;
- antiseptic effect of laser;
- minimalinjury rate;
- least blood loss.
But it also has a drawback - it can be used to eliminate not all types of deformities, especially those associated with damage to the bone part of the septum.
Treatment without surgery for deviated septum involves the use of laser chondrosentoplasty. In this case, the cartilage is heated, which makes it elastic. With the help of a special tool, the cartilage is given the necessary shape, which is fixed for one day with a swab. After that, the septum takes a central position, and the cartilage straightens.
Operation cost
In public hospitals, it is performed free of charge with a medical policy. But you have to wait your turn. In private clinics, the price of surgery for a curvature of the nasal septum starts from 35,000 rubles. It is determined by the level of the institution, the complexity of the intervention, the type of anesthesia, the qualifications of the staff, the length of the patient's stay within its walls.
Laser septoplasty has a minimum price: for deviated nasal septum - 30,000 rubles. In Moscow clinics, its average cost reaches 54,000 rubles.
Complications after surgery
The consequences of a deviated nasal septum as a result of the operation may be as follows:
- perforation or perforation of the septum;
- scarring;
- hematoma;
- purulent sinusitis;
- abscess formation under the mucosa;
- inflammation and infection of the wound, which was formed during the operation;
- adhesion formation;
- deformation of the nose - there is a sinking of its back due to a resection carried out too high;
- bleeding.
The following measures must be taken to eliminate them:
- hematoma puncture with pressure bandage applied;
- taking antibiotics for infection;
- dissection of adhesions with a scalpel;
- hemostatic agents for bleeding.
The likelihood of their occurrence can be significantly reduced if you follow the doctor's instructions for postoperative care and follow the necessary regimen.
In closing
Deviated septum is observed in most people. For most of them, it does not cause any discomfort. In case of difficulty breathing through the nose, you should contact the ENT, who may prescribe an operation or the use of laser therapy. It continues for a short time, and its outcome is favorable. Usually the septum is fully aligned.
The operation can be carried out in public and private clinics, which is determined by the funds available to the client. It can be performed under general or local anesthesia. According to most reviews, the first option is preferable.
