In the nose there is an anatomical formation in the form of a vertical plate dividing the cavity into two halves. It is called the nasal septum and consists of two parts. The largest part is the back. It is motionless and formed by thin bone tissue. There are moving parts in the middle and in the front. They are formed by cartilage and membranous tissue, respectively. The front is the smallest. If the lamina is twisted and interferes with breathing, nasal septum surgery may be needed.
Septal curvature symptoms
Deviations of the septum from the midline are dangerous as they can make it difficult to breathe through one or both nasal passages. This is because air, which normally should pass through the nose in an arcuate manner (first up to the middle nasal chamber, then down to the internal nasal openings), is forcibly directed along the lower nasal passage when it is bent. A strong deviation of the plate from the midline in general can lead to the fact that the wing of the nose will stick to it due to negative pressure, and one of the nose parts will turn off from the process.breathing.
This disrupts the outflow of fluid from the paranasal sinuses. Because of this, the tendency to sinusitis, tonsillitis, various types of rhinitis and other inflammatory and allergic diseases can increase.
You can notice the problem in time by paying attention to symptoms such as respiratory failure, persistent runny nose or sinusitis, dryness in the nasal cavity, bleeding from it, decreased sense of smell, pain in the head and ears, snoring. Deviation caused by trauma is also characterized by a change in the shape of the nose.
Severity of symptoms depends on the degree of curvature. If it is small, there may be no symptoms and no treatment is needed.
Types and degrees of curvature
The septum can be twisted for various reasons. Depending on this, types of deviations are distinguished. So, the physiological one arises due to the incorrect development of the facial skeleton, when the growth rates of cartilage and bone tissues do not correspond to each other. It may be hereditary and is usually diagnosed during adolescence.
The curvature that occurs after the growth of the mucous membrane, exposure to the cartilaginous part of a foreign body or some other irritating factor, is called compensatory, and as a result of a dislocation or fracture of the bones of the nose, it is called traumatic. The latter is 3 times more likely to be diagnosed in men than in women.
Depending on direction of deflectionsepta from the midline allocate an S-shaped, C-shaped or anterior-posterior curvature. It may be due to the formation of spikes, ridges, thickenings, dislocations of the quadrangular cartilage. In children, it can occur during childbirth (congenital) or after them (acquired).
According to the severity of the curvature, three degrees are distinguished, where I means minor deviations, II - protrusion of the area halfway between the midline and the lateral surface of the nose, III - practical touching of the side surface with part of the septum.
Conservative and surgical treatment and diagnosis
Slight curvature, difficulty in breathing due to swelling of the mucous membranes, is treated conservatively. For this, nasal lavage, the introduction of vasoconstrictor drops, antibiotics, sprays and other drugs into its mucosa, and laser therapy are used.
But if nasal breathing is difficult due to bone and cartilage structures, sinusitis, runny nose, otitis media and eustachitis constantly occur, blood often comes from the nose, a person snores heavily, and the curvature looks like a significant cosmetic defect, an alignment operation is performed nasal septum.
In preparation for surgery, assess the degree of difficulty in nasal breathing. Such a study is called rhinomanometry and is carried out using a special device (rhinoscope) placed in the nose of the patient and measuring air resistance.
Additionally, computed or magnetic resonance imaging of the paranasal sinuses is performed. This study is mandatory for concomitant diseases of the nasal mucosa. An x-ray of the skull is sometimes recommended, but it does not always reflect a reliable picture of the curvature.
Studies to assess the degree of curvature are performed at least twice. First, the immediate condition of the nasal cavity is examined, then vasoconstrictor drops or ointments with adrenaline are applied, and the results of instrumental analyzes are compared.
If, after the examination, the doctor considers the operation appropriate, the patient should begin to prepare for surgery. To do this, he takes a standard set of tests and finds out the date of the proposed hospitalization. It is better for women to coordinate the time of the operation with the menstrual cycle and schedule it 2 weeks after menstruation. This is due to the abundant blood supply to the lining of the nose and the possible loss of large amounts of blood during surgery.
10-14 days before hospitalization, it is advisable to give up bad habits and eliminate foci of inflammation in the body, in particular, cure bad teeth. Before the operation, hypothermia and the occurrence of infectious diseases should not be allowed. If the doctor insists on an additional examination before the procedure, it must be done.
Depending on how the nasal septum surgery is performed (under general or local anesthesia), the patient is prepared on the day of the procedure. With general anesthesia in the morning you can not eat or drink. An hour before the intervention, drugs are administered to prepare the body forpain relief.
Types of transactions
In general, surgical interventions to correct deformed elements of the nose are called rhinoplasty. But in this section of plastic surgery, there are several types of surgery. These are closed, open, revision and non-surgical rhinoplasty. All of them differ in technology, but have one goal, namely, the restoration of the correct shape of the nose. Separately, septoplasty stands out - nasal septum surgery used to improve nasal breathing.
Rhinoplasty
In most cases, closed rhinoplasty is performed, in which there are either no external incisions, or they are located on the columella pedicle in an inconspicuous place. The patient needs general anesthesia. Nasal septum surgery, through closed rhinoplasty, lasts about an hour.
Open type of intervention is used when a large amount of impact on the nose is required. In this case, incisions are made in its cavity or in the region of the columella.
Another name for revision rhinoplasty is secondary. As the name implies, it is performed to correct both minor and difficult problems left over from previous operations. According to the technology of conducting, it can be open and closed.
Non-surgical rhinoplasty deserves special attention. Its implementation is possible only with minimal defects, which are diagnosed in no more than 5-7% of patients in need of treatment. In this case, fillers, absorbable preparations orspecial threads.
Fillers in most cases give a temporary effect from several months to a year and a half. The duration of action depends on their quality, but in any case, after a certain time, they dissolve, and repeated injections can lead to changes in the structure of tissues. The exception is when fibrous tissue forms at the injection site. However, there is a possibility of migration of fillers. Therefore, they are resorted to only because of the relatively low cost of the operation, as well as due to the short and easy recovery period.
Hormonal absorbable preparations in precisely calculated dosages are pointwise injected into the convex parts of the nasal elements. Irregularities are eliminated in 2-3 weeks. If necessary, the procedure can be carried out in several stages, since an overdose of the drug can lead to irreversible changes, and an insufficient amount will not be able to correct the problem.
Specialized Aptos threads tighten the necessary parts of the elements through punctures made in the nose. But in practice, they are rarely used, since rough scarring can form at the insertion site of the thread, and the thread itself, due to the mobility of the nose, can break.
Septoplasty
The complexity and duration of the operation to straighten the nasal septum, called septoplasty, depends on the individual structure and condition of the plate separating the cavity. On average, it is successfully completed in 30-60 minutes. Sometimes rhinoseptoplasty is performed - a complex operation of the nasal septum, combined withnose reshaping.
Septoplasty is performed in a hospital under general or local anesthesia. The first type of anesthesia is usually used for children, and the second - for adults. The doctor does not make incisions from the outside, the intervention is endonasal (through the nostrils), the mucosa is dissected and moved aside. During surgery on the nasal septum, most of the plate is not affected, only its curved sections are removed or rebuilt. They can be either bony or cartilaginous. After successful cutting of parts of the septum, the mucosa is sewn into place. The plate remaining in the nose is fixed with a bandage, special silicone inserts and gauze swabs soaked in hemostatic medicinal solutions, which should be in the nasal passages for 2-3 days after the operation. During this time, the patient must breathe through the mouth. To reduce the discomfort of dry mouth and lips, regularly drink water and juice through a straw and use lip balm.
The result of the operation of the nasal septum will depend not only on the professionalism of the surgeon, but also on the correctness of the cleaning and processing of the nasal cavity. The first sanitation is carried out by the doctor, the subsequent ones are carried out by the patient himself. For better tissue healing, the procedure is carried out 2-3 times a week for a month.
Reviews about the operation to correct the nasal septum using septoplasty are in most cases positive. Patients note high performance for easier breathing and quickrehabilitation after the intervention.
Impact of the laser beam
Sufficiently innovative method is laser surgery. In this case, the curvature of the nasal septum is eliminated by heating the deformed sections of the cartilaginous part and their subsequent fixation in the correct position with special tampons. The duration of the manipulation itself does not exceed 15 minutes, the fixation time is a day. The entire procedure is performed under local anesthesia on an outpatient basis. At the same time, the patient practically does not feel any discomfort.
The advantages of this method are minimal tissue trauma and virtually no blood loss. In addition, the laser has antiseptic properties. After surgery to correct the nasal septum, made using a laser, rehabilitation measures are practically not required. Due to this, the method is applied quite successfully, but still it has a number of limitations. Its use is not possible for bone deformities and broken septal cartilage, and these pathologies are observed in 90% of adults with operable curvature.
Reviews after laser nasal septum surgery are only good. In the absence of contraindications, it is ideal for children and adults, does not require hospitalization and allows you to quickly return to your usual way of life.
Post-op care
A patient who wakes up from anesthesia after surgery on the nasal septum should not eat and drink cold and hot food and drinks, as well as soda during the day. Afterremoving tampons from the nose, you can blow your nose, but this must be done very carefully to avoid bleeding. The care of the nasal mucosa is carried out by removing dry crusts, lubricating it with therapeutic ointments, washing with saline and products containing sea water. Seams do not need to be removed. In rare cases, after nasal septum surgery, the nose hurts, in which case analgesics are prescribed. Antibiotics may also be prescribed to help prevent infectious complications.
If the patient feels well, he is discharged 2 days after the operation, but then within a month he must come to the ENT doctor several times to check the condition of the nasal cavity. After 1-2 weeks after surgery, the swelling should go down, after which nasal breathing will be fully restored without the use of drops.
If any problems occur during rehabilitation (bleeding, severe pain a week after surgery, fever, purulent discharge), you should consult a doctor.
Consequences of the violation of aerodynamics in the nose
Sometimes after surgery, large hematomas and ulcers form under the mucous membrane, nosebleeds begin, defects in the form of holes form in the septum, sinusitis and nose deformity occur. The latter happens due to retraction of the back when the septum is resected too high. These complications are extremely rare and can be corrected. However, fearing them, somepatients avoid nasal septum surgery despite the indications for it.
This is wrong, because the refusal of the necessary surgical intervention can lead to serious complications and greatly impair the quality of life. The fact is that shortness of breath leads to the drying of the nasal mucosa, as well as the accumulation of fluid in the cavity of the paranasal sinuses. Because of this, susceptibility to respiratory viral infections increases, immunity decreases. The brain receives less than 10-15% of oxygen, which negatively affects the working capacity of adults and the mental development of children.
Breathing through the mouth, the only possible with the curvature, is defective. Because of it, inflammation of the pharyngeal tonsil can occur, and it also prevents the protective properties of nasal mucus from manifesting itself. Not enough air enters the lungs, moreover, it is not moistened and not warmed. As a result, the efficiency of gas exchange decreases, and oxygen deficiency is formed in the blood.
Another problem in patients with a deviated septum can be respiratory arrest during sleep, in which pulmonary ventilation stops for 10-30 seconds. In advanced cases, stops can reach a duration of 2-3 minutes, as a result of which a person will not breathe for more than half of the total sleep time. The consequences of such a process will not keep you waiting: angina pectoris, hypertension, headache, fatigue, decreased concentration, or even depression will appear. Reflex disorders may also occur: asthma, short attacks of suffocation, epileptic seizures, problems with the menstrual cycle. The organs adjacent to the nose are also affected: the Eustachian tube and middle ear, the lacrimal ducts and the lacrimal sac.
Restrictions and contraindications to surgery
An operation on the nasal septum can be postponed if the patient is under the age of 16-18 years, since the facial skeleton is finally formed only by this time. However, with severe negative consequences of respiratory failure, surgical intervention can be performed at the age of 14. Sometimes it is performed for children 6 years of age or even younger, but for this, in the process of a thorough examination, it must be reliably proved that severe symptoms are precisely the result of a curvature.
Also, the indications for the operation are narrowed for people over 48 years old, and in old age it is almost never performed. This is due to the fact that over the years, respiratory failure is partially compensated. Symptoms are relieved even without nasal septum alignment surgery, especially since surgical intervention is difficult due to atrophy of the mucous membranes, and the risk of complications is increased.
Other contraindications include serious pathologies of internal organs, general serious condition, bleeding disorders (in particular, hemophilia), cancer, infectious, cardiovascular, mental diseases, diabetes mellitus and other diseases in the acute stage.
Cost of different types of operation
In some cases, the shape of the partition can be corrected for free. To do this, in the clinic you need to get a referral to the hospital and get up inwaiting list for the operation. In this case, additional funds may be needed only for anesthesia and medicines. But this method has a significant drawback - the practical absence of the possibility of choosing a surgeon. Thus, both a specialist with extensive experience and high qualifications, and a novice doctor can be assigned to the operation.
When you go to a private clinic, you can be more confident in the professionalism of the surgeon, but you will have to pay for his work. The price of the procedure will largely depend on the status of the clinic and its location. So, in Moscow, the operation of the nasal septum is usually a little more expensive than in other regions.
On average, rhinoplasty in the country costs from 35 to 250 thousand rubles, septoplasty - 20-45 thousand, laser surgery - 30-130 thousand. The final price depends on the qualifications of the doctor and the amount of work. The price also includes a preliminary examination, anesthesia and stay in a 1-2-bed ward.
Conclusion
No more than 5% of people can boast of an ideally straight partition. However, this does not mean that the vast majority of the population requires treatment for a deviated septum and surgery. In fact, only 26% of people with this problem are indicated for surgical intervention, since for them it really leads to difficulty in breathing, and for the rest it is enough to monitor the hygiene of the nose, rinse it, try to be less likely to be in dusty and smoky rooms.
In addition, it will be useful for everyone to avoid hypothermia and cure colds in a timely and complete manner. For preventiontraumatic curvature should be careful when practicing extreme sports. However, if a doctor talks about the need for surgery to straighten the nasal septum, his recommendations should be followed in order to prevent he alth complications and maintain the aesthetic appearance of the nose.
