Deviated nasal septum - what to do? Deviated nasal septum: treatment without surgery is possible

A deviated nasal septum is a fairly common phenomenon that can often be observed in adults and children. Often crooked nasal septum causes difficulty breathing, sinusitis, runny nose and other complications.

Treatment for a deviated nasal septum can only be surgical. Surgery on a deviated nasal septum is called septoplasty.

Causes of a deviated nasal septum

The most common cause of a deviated nasal septum is a discrepancy between the growth rates of the bone and cartilaginous parts of the nasal septum, i.e. anatomical defect. Other common causes include trauma to the nose, as well as the presence of nasal diseases such as polyps, thickening of the nasal turbinates, etc.

The nasal septum is an anatomical formation located in the nasal cavity and dividing it into two equal parts. In turn, the nasal septum also consists of two parts: the anterior cartilaginous part and the posterior bone part, located deep in the nasal cavity. The cartilaginous part of the septum can be easily felt if you run your finger along the back of the nose. It feels pliable and elastic to the touch, making it more susceptible to damage due to injury.

Types of deviated nasal septum

Depending on the causes, there are three main types of deviated nasal septum:

• Physiological, which is caused by a discrepancy between the growth rates of the cartilaginous and bone parts of the septum. Such curvature begins as early as childhood.
• Compensatory, which develops during constant irritation of the cartilaginous part of the nasal septum by a polyp, an overly thickened nasal septum or a foreign object;
• Traumatic curvature resulting from injury. It is the traumatic curvature of the nasal septum that is the most common cause of difficulty breathing and nosebleeds.

Symptoms of a deviated nasal septum

To one degree or another, every person has a deviated nasal septum. However, mostly this does not cause discomfort, so treatment of a deviated nasal septum in in this case not required. However, a significantly deviated nasal septum requires surgery. Surgery is necessary when the following symptoms appear:

• snoring during sleep;
• visible change in the shape of the nose caused by a crooked nasal septum;
• difficulty in nasal breathing, sometimes so severe that the patient is forced to breathe through the mouth;
• frequent nosebleeds;
• frequent respiratory infections, runny nose, sinusitis, rhinitis, chronic pharyngitis and etc.;
• allergic vasomotor rhinitis, which manifests itself in constant runny nose, sneezing, nasal congestion, itching, clear discharge from the nose.

The most common symptoms of a deviated nasal septum in children are snoring during sleep, a constantly open mouth, nosebleeds, and rhinitis.

Treatment of deviated nasal septum

According to reviews, surgery on a deviated nasal septum (septoplasty) is the most effective method treatment.

Currently, traditional and laser septoplasty are used. You should know that laser septoplasty has a number of contraindications and is used only in cases of minor curvature.

Traditional septoplasty is performed under local anesthesia. The surgeon performs all manipulations directly in the nasal cavity, so no scars or traces remain after the operation. The duration of surgery on a deviated nasal septum, according to reviews, may vary. In most cases, it ranges from half an hour to two hours and depends on the degree of curvature.

The effectiveness of the treatment can only be judged after completion recovery period which is about two weeks.

The operation is performed on children after they reach 14 years of age. However, if the symptoms of the curvature are too pronounced, the child has difficulties with nasal breathing, rhinitis and other complications constantly arise, surgery is allowed from the age of six.

Possible complications after septoplasty

Complications after surgery can be divided into early and late. Early complications are bleeding and hematomas. To eliminate them, it is necessary to insert tampons into the nasal passages. A fairly rare complication is perforation, which occurs as a result of injury to the nasal septum during surgery with a sharp object. To avoid this complication, the surgeon must perform all manipulations with extreme caution and thoroughness.

An abscess may occur due to the presence of purulent sinusitis and a blood clot in the vestibule of the nose. To avoid an abscess, the surgical field must be thoroughly disinfected. The patient is recommended to take a course of antibiotics before the operation and for some time after it.

A late complication is a change in the shape of the nose associated with high resection of the quadrangular cartilage. It should be noted that such a complication is extremely rare.

Prevention of deviated nasal septum

To prevent a deviated nasal septum, any trauma or damage to the nose should be avoided. You should not take any medicine without a doctor's recommendation. vasoconstrictors, since with prolonged use they provoke swelling of the mucous membrane, which aggravates nasal breathing with a deviated nasal septum.

Video from YouTube on the topic of the article:

– violation of the proportions or symmetry of the nose as a result of deformation of its back or septum. In addition to the fact that deformation of the nasal septum leads to a change in the shape of the external nose, its curvature may be accompanied by impaired free nasal breathing, nosebleeds, vasomotor rhinitis, headaches, and snoring. Diagnostics of anatomical and functional disorders includes rhinoscopy, x-ray of the nasal bones, consultation with an otolaryngologist. Correction of nasal deformity is carried out surgically using various types of rhinoseptoplasty.

Options for nasal deformity

Depending on the deformed tissue, bone and cartilaginous types of nasal curvature are distinguished. The symmetry of the nose is most often disrupted in the dorsum or nasal septum.

There are several types of deviated nasal septum that are important when performing plastic surgery crooked nose: C-shaped, S-shaped, curvature of the nasal septum relative to the bone crest upper jaw, as well as a combined curvature of the nasal septum and the bone crest of the upper jaw.

Indications for correction of nasal deformity

The need to correct a crooked nose can be dictated by two groups of reasons: aesthetic and therapeutic. For aesthetic reasons, not only public people (actors, politicians, etc.), but also ordinary patients who are dissatisfied with its shape are increasingly resorting to correcting a crooked nose.

By medical indications Correction of nasal curvature is carried out for people who have difficulty breathing through their nose, suffering from vasomotor rhinitis, nosebleeds, acute and chronic sinusitis, and snoring.

Operations to correct the shape of the nose (rhinoplasty) are often combined with septoplasty - correction of the curvature of the nasal septum and dictate the need for interaction between a plastic surgeon and an otolaryngologist. The result of correcting a crooked nose should be not only the formation of beautiful and correct outlines, shape and size of the nose, but also the restoration of normal nasal breathing.

Surgical treatment of a bent nose is carried out after the age of 18, i.e., after the formation and growth of the nasal bones are completed. In the presence of pronounced disorders and complications, it is possible to perform surgical correction of the curvature of the nose at an earlier date.

Since performing rhinoplasty is associated with large blood loss, women are advised to undergo surgery 10-14 days after the end of menstruation. In case of exacerbation of inflammatory processes in the nasal cavity (rhinitis, sinusitis, sinusitis), they are first treated, and rhinoplasty is performed 2 weeks after the final cure.

Surgical correction of nasal deformity

If it is necessary to correct the curvature of the nasal septum, septoplasty is performed. Usually the operation is performed under local (infiltration or application) anesthesia, sometimes under general anesthesia.

Through an incision in the skin of the nasal septum, the mucous membrane of both sides of the septum is detached. Then the curved parts of the cartilaginous and bone structures of the nasal septum are isolated and removed. Next, stitches are placed and nasal packing is performed for 24-48 hours to stop bleeding. The top of the nose is covered with a sling-shaped bandage.

After the operation, until the tampons are removed, the possibility of nasal breathing will be excluded. It is recommended to take liquid, non-hot food for several days. IN postoperative period Antibacterial and painkillers are prescribed. In the days following removal of the tamponade, the nasal cavity is cleaned of drying crusts and the nasal passages are lubricated with oils. Free nasal breathing is restored after a few weeks, after the swelling has subsided and the formation of crusts has stopped. After septoplasty, the patient can return to work after 1-2 weeks; physical activity is prohibited for a month.

For other forms of nasal deformity, operations can be performed to bring the lateral bones together (osteotomy), remove the hump (rhinoplasty), and straighten the contour of the nose.

Prevention of complications after surgical correction of nasal deformity

The number of complications when performing nose surgery is small. Quite rare early complications are nosebleeds and the formation of hematomas caused by the accumulation of blood between the sheets of the nasal mucosa. To prevent these complications, tamponade and drainage of the nasal cavity are performed.

It is extremely rare that perforation of the nasal septum occurs in the postoperative period as a result of trauma to the nasal mucosa with sharp instruments. Prevention of perforation dictates the need to perform the operation with great care, to control the position of the instruments when moving between the layers of the nasal mucosa.

Also, rhinoplasty is rarely complicated by an abscess of the nasal septum. Abscess formation can be promoted by the drying of purulent crusts in the vestibule of the nose, the presence of purulent sinusitis, the accumulation of pieces of cartilage and blood clots between the layers of the nasal mucosa. Prevention of development purulent complications after rhinoplasty it comes down to careful processing surgical field, active preoperative sanitation of purulent foci, antibiotic therapy in the postoperative period.

TO late complications operations to correct nasal curvature include deformation of the external nose, caused by the need for high resection of the quadrangular cartilage and the individual characteristics of the patient.

Development risks postoperative complications after nose surgery are extremely small due to extensive experience in performing such operations.

If a person constantly has a stuffy nose and difficulty breathing, then this problem should not be ignored. If this condition is not caused by a cold or allergy, there is Great chance that the culprit is a deviated nasal septum. The consequences of this pathology can cause inconvenience for a long time.

For adequate treatment of a disease, it is always important to correctly determine the cause of its occurrence. A deviated nasal septum can be caused by various factors.

Modern medicine divides them into:

• physiological;
• traumatic;
• compensatory.

TO physiological reasons include:

1. Different growth rates of the sections of the cranium.
2. Different growth rates of body tissues. Considering that the nasal septum consists of various tissues, the uncoordinated growth of these components leads to disruption of the symmetry of the nasal septum.
3. Strong growth of Jacobson's organ. It is located in the nasal cavity and is considered obsolete, just like appendicitis. Its excessive size can lead to a decrease in space for the organic development of the septum.

Compensatory reasons are justified by the presence of other pathologies:

• enlargement of the nasal concha;
• tumors and polyps located in the nasal cavity.

Enlarged turbinates (normal/pathological) Nasal polyps

To eliminate these pathologies, the nasal septum bends, thereby compensating for these diseases.

TO traumatic reasons include all types of injuries that contribute to the displacement of tissue in the nasal cavity. Most injuries occur in childhood and adolescence. Serious deformities occur when bones do not heal properly.

A deviated nasal septum is very rarely detected in childhood; most often this problem affects children aged 14-17 years.

Types and types of pathology

In modern medical practice There are 2 classifications: according to the causes of occurrence and according to the form that the plate takes in the nasal cavity. Most of the curvature occurs in the anterior part of the bony component of the plate.

1. Classic deformation is a slight deformation at the front of the plate. This type of pathology may not bother a person and may not require treatment.
2. The ridge is a thickening in the nasal cavity that is associated with a curvature.
3. The spine is a process formed in the bony part of the nasal septum. It happens on one or both sides. Depending on its length and structure, it can injure the mucous membranes.
4. A combination of the three types above.

The curvature of the plate itself can be:

• vertical or horizontal;
• front or back;
• on one side or both;
• s-shaped or c-shaped.

The occurrence of complications and the occurrence of discomfort depends on the type and severity of the curvature. Almost all adults have a slight deviation from the norm, but it does not always entail consequences.

Signs and symptoms of a deviated nasal septum

A person is symmetrical only at first glance. In fact, in nature there are no absolutely symmetrical living organisms, because their formation is influenced by many factors. The same situation applies to the nasal septum. 85% of people have slight curvatures. Many live with this and do not even suspect that they have a disorder. A person may not feel discomfort when breathing or may not associate discomfort with this defect. In most cases, pathology of the nasal plate is revealed only during examination.

Even the degree of deformation does not affect the appearance of symptoms. There are cases where people with severe deformation did not feel any discomfort. There are also the opposite situations, when even the slightest defect required serious treatment.


There are no symptoms unique to this pathology. There are only a few complaints with which people with a curvature of the nasal plate come to the doctor:

1. Difficulty breathing is the most common complaint. In humans for a long time I have a stuffy nose, and the drops don’t help and only make the situation worse. Sometimes, with a severe degree of deformation, a person is able to breathe only through his mouth.
2. Frequent inflammation of the mucous membrane of the sinuses, chronic sinusitis.
3. Otitis.
4. Inflammation in the lacrimal sac. Problems with the passage of tear fluid through the nasopharynx lead to this disease.
5. Snore. The main danger of this symptom is that it can occur in a dream. short stops breathing.
6. Problems with the sense of smell.
7. Regular headaches.
8. Nosebleeds.
9. Hearing loss.

If a patient complains of pain in the nasal septum, then most likely the problem is not a curvature. In this case, other causes are likely: neuralgia, sinusitis, etc.


Even an experienced doctor is not always able to diagnose a curvature of the nasal plate based solely on symptoms. Surgical correction of pathology is prescribed only if conservative treatment does not lead to positive dynamics.

Treatment of deviated nasal septum without surgery

A deviated nasal septum cannot be cured without surgery. Conservative therapy is used only if there are contraindications for surgical intervention and gives only a temporary effect.

Treatment with medications is used symptomatically. Depending on what discomfort the patient experiences, the doctor prescribes complex therapy from the following medicinal groups:

• Internal GCS (Beconase, Rinoclenil, Mometasone) - aimed at treatment allergic rhinitis and elimination of medicinal rhinitis.
• Cromones (Cromohexal, Cromoglin) - used in combination for inflammatory processes and allergies.
• Antibiotics (Bioparox) – are applied locally and stop the growth of bacteria.
• Mucolytic sprays (Rinofluimucil, Sinuforte) - thin mucus and remove it from the sinuses.
• Vasoconstrictor drugs (Nafazolin, Sanorin) - help reduce swelling and make breathing easier. By reducing swelling, the clearance for air passage increases.

Basic surgical treatment methods

Septoplasty is a type of rhinoplasty (nose job), an operation to correct the shape of the nasal plate. Septoplasty is usually prescribed after 17-18 years of age. By this time, the nasal septum is fully formed. For certain indications, surgery may be performed earlier. Lack of surgical intervention early age is that the nasal plate may become bent again.

The operation lasts no more than 2 hours and is performed under local or general anesthesia. During this time, the doctor removes the deformed areas and applies absorbable sutures. At the end of the procedure, turundas are inserted into the nasal passages. They help stop bleeding and prevent infection.

Together with classical septoplasty, aimed at making the septum anatomically correct form, you can also get a nose job. Rhinoplasty for a deviated nasal septum will help not only get rid of annoying breathing problems, but also correct the tip of the nose or correct the hump.

Laser septoplasty

With this type of septoplasty, correction occurs by heating the nasal septum with a laser and giving it the required shape. This operation takes no more than 15-20 minutes and is performed under local anesthesia.

Benefits include:

• non-traumatic;
• painlessness;
• no bleeding;
• slight swelling;
• there is no need to place the patient under long-term observation.

This method of correction is much better than traditional septoplasty, but its use is limited. Only the cartilaginous part of the septum is amenable to laser treatment, and in most cases the bone tissue also needs correction. In addition, this operation is not free and you will have to pay at least 20,000 rubles to carry it out.

Do I need to straighten a deviated septum?

Not all people immediately agree to surgical intervention. A constantly stuffy nose and difficulty breathing become habitual, and the drugs settle firmly in the home medicine cabinet. Of course, pathology does not require emergency measures, and any operation carries a certain risk. In this situation, we should not forget about such a concept as quality of life. No drug will help for a long time with deformation of the nasal plate, and only after septoplasty will a person be able to breathe full breasts. It is better to survive the operation, and in the future be able to fully sense smells, get rid of headaches and forget about constant problems with the nose.

When is surgery necessary, and when can you do without it?

Surgery is offered to the patient only when medication treatment does not help, and a deviated septum interferes with normal life. Indications for surgical intervention are the following complications:

• difficulty breathing not associated with allergies or colds;
• frequent inflammation of the nasal mucosa, in the case where the pathology impedes the outflow of contents;
• otitis;
• sinusitis;
• headache.

If the patient has complexes about the shape of the nose and wants to have it done plastic surgery, that is, it makes sense to immediately correct the pathology of the septum.

There are cases when pronounced curvature is observed, but there are no complaints. The patient can breathe well through the other half of the nose and not feel any discomfort. At first glance, there are no direct indications for surgery, but with age, the body’s compensatory capabilities decrease and problems arise. In old age, surgery is more difficult, and the presence of contraindications can make surgery unacceptable. If there is a serious deformation of the septum, then it is better to undergo septoplasty without waiting for complications.

The effect of injury on the body: consequences, complications

According to statistics, adolescents and men most often face the problem of a deformed nasal plate. This is the category of people among whom facial and skull injuries are most common. In some cases swipe does not go away without a trace and entails displacement of the nasal bones and cartilage. Even if the shift was insignificant, a curvature of the nasal septum may occur, which leads to difficulty breathing and other complications.

Features of pathology in children

A deviated nasal septum in young children is diagnosed much less frequently than in adults. Despite this, this feature of the body can cause difficulty breathing in the child, oxygen starvation, nasal sound and may cause developmental delays.

The causes of pathology in childhood include:

• trauma during childbirth;
• blow to the nose;
• discrepancy between bone growth and cartilage tissue in adolescence.

Externally, the changes may not be noticeable, but upon examination, an experienced doctor may notice that one sinus narrowed, and the air circulates poorly in it. A child may often suffer from a runny nose and otitis media.

Due to the fact that the child’s nasal septum is still developing, surgery is not prescribed until the age of 16, but conservative therapy is used. The goal of medication treatment is to relieve swelling and restore breathing.

What is a deviated nasal septum? We will discuss the causes of occurrence, diagnosis and treatment methods in the article by Dr. R. A. Musaev, an ENT specialist with 14 years of experience.

Definition of disease. Causes of the disease

Curvature (deformation) of the nasal septum is a persistent deviation of the nasal septum to one or both sides from the midline, as a result of which nasal breathing is impaired, leading to a number of serious diseases. This pathology is one of the most common diseases of the nasal cavity. According to statistics, half of the adult population suffers from a deviated nasal septum, and it occurs more often in men than in women.

The diagnosis can be established only after consultation with an otorhinolaryngologist, which includes examination (anterior rhinoscopy), medical history, and additional methods research.

There are a number of reasons for the formation of a deviated nasal septum.

Physiological curvature

This is the most common cause of curvature. Since the nasal septum consists of a bone and cartilaginous part, during the constant growth of the facial skeleton, often non-simultaneous, uneven growth of these tissue structures, i.e. one part is ahead or behind the other.

Deformation due to nasal injury

Arises in view birth injuries, microtraumas from falls, injuries from fractures of the external bones of the nose, as well as occupational injuries (mainly among athletes).

Curvature caused by other diseases

Gradual curvature of the nasal septum can occur when various diseases intranasal structures, such as polyps of the nasal cavity, hypertrophy of the inferior turbinates, foreign bodies (compensatory curvature). At different common diseases(for example, rickets and ) softening of the bone part is possible, which can lead to overtightening and retarded growth of the nasal structures.

Symptoms of a deviated nasal septum

The main symptoms of a deviated nasal septum include the following:

• Difficulty nasal breathing(partial or complete). It all depends on which direction the septum is curved and in which section. Very often, patients do not feel a lack of nasal breathing, as the body gradually adapts to this volume of breathing.
• Frequent inflammatory processes in the paranasal sinuses (sinusitis). This occurs due to impaired aeration in the nasal cavity and paranasal sinuses, complications of the free passage of air flow, impaired outflow of secretion contents from the sinuses and its stagnation, and thereby creates favorable conditions for the growth of pathogenic microflora.
• Snoring and OSA (obstructive sleep apnea-hypopnea syndrome). If nasal breathing is impaired, a person adapts and begins to open his mouth during deep phase sleep, which causes vibration of the uvula of the soft palate and a noise effect. Snoring itself is not as bad as stopping breathing, which can occur.
• Dry nose and oral cavity . There is a violation of such important processes as purification of inhaled air, its warming and humidification.
• Changes in the shape of the entire nose. During the formation and growth of the facial skeleton, “tightening” of the nose (usually the tip) may occur.

• Are common systemic diseases : hypoxia, anemia, nervous fatigue due to lack of sleep.
• Frequent exacerbations of pharyngitis. Their appearance is facilitated by problems in the oropharynx and the occurrence of assisted oral breathing. Since the air enters the throat unpurified and unhumidified, irritation and drying of the mucous membrane gradually occurs. It also spreads to the lower respiratory sections.
• Nosebleeds. On the side where the bulge is located on the nasal septum, the mucous membrane is very thin, so even with a slight impact it is easily damaged.

Pathogenesis of deviated nasal septum

Initially (from birth) the nasal septum is not solid: it consists of separate islands of cartilaginous tissue. Then, during the process of growth, these islands begin to ossify and unite into an osteochondral skeleton, which becomes a support for the back of the exoskeleton of the nose. However, during formation, a malfunction may occur, caused by injury or another cause: the islands overlap each other and the developing nasal septum becomes distorted, preventing free nasal breathing.

The resulting curvature of the nasal septum entails a change in the movement of air through the nose (air flows). This, in turn, leads to constant irritation of the nasal mucosa, maxillary sinuses and nasopharynx, resulting in swelling of the mucous membrane and narrowing of the nasal opening, maxillary sinuses and Eustachian tube.

With slow and gradual development deviations, a person does not have the feeling that breathing is difficult due to getting used to this species violations.

Classification and stages of development of deviated nasal septum

Exist different classifications curvature of the nasal septum.

In the Russian usual classification, the following nasal curvatures are distinguished:

• deformation of the nasal septum;
• septal ridge;
• septum thorn;
• deformation of the anterior (cartilaginous) or bony part of the nose.

There is also a classification proposed by Dr. Ranko Mladin, a leading European rhinosurgeon (Croatia, Zagreb). It divides the deformation of the nasal septum into seven main types:

1. a slight lateral displacement of the nasal septum in the area of ​​the valve, which does not interfere with its function;
2. slight lateral displacement of the nasal septum in the area of ​​the valve with disruption of its function;
3. deviation of the nasal septum opposite the anterior end of the middle turbinate;
4. a combination of the second and third types on opposite sides of the nasal septum;
5. the location of the ridge in the basal sections of the nasal septum is on one side, the opposite side is straight;
6. the location of the ridge in the anterobasal sections on one side, the “gorge” on the opposite side;
7. a combination of all of the above types of deformities (the so-called crushed nasal septum with post-traumatic deformities).

This classification is most convenient for operating rhinologists. It allows you not only to determine the type of curvature of the nasal septum, but also makes it possible to choose the method of surgical correction that is best suited.

In addition to the above classifications, there is a division of curvatures of the nasal septum into C-shaped deviation, S-shaped deviation, as well as the ridge or spike of the nasal septum, their various combinations, complex post-traumatic deformations of the nasal septum that do not fit into any of the above mentioned categories.

Complications of a deviated nasal septum

A deviated nasal septum can cause patients to develop reflex neuroses caused by irritation nerve endings nasal mucosa. This is especially true for types of deformation such as spines and ridges, which in some cases cut into shells quite deeply. Irritation can be provoked by reflex changes, both in the nose and in organs that are nearby or distant.

Rhinogenic reflex disorders, that is pathological processes in the nose, lead to the development of hypertension, eye diseases, laryngeal spasms, headaches and other conditions.

Diagnosis of a deviated nasal septum

In order to find out whether surgery on the nasal septum is required, it is necessary to undergo a comprehensive diagnosis: visual inspection ENT doctor, rhinoscopy (anterior and posterior), as well as additional laboratory research and analyses.

An external (physical) examination by an otolaryngologist allows you to assess the appearance of the patient’s nose. In addition, nasal breathing is assessed: cotton wool is brought in turn to each nostril, the fibers of which vibrate with each inhalation and exhalation.

Also, the examination of each nostril separately is carried out to assess the patient’s sense of smell: by closing his eyes, the person must determine the smell emanating from the cotton wool. If the nasal septum is deviated, the threshold of smell will be reduced.

During rhinoscopy (anterior or posterior), the nasal cavity is examined using special instruments.

Anterior rhinoscopy is necessary for a better examination of the nasal cavity and the formations there. For this, a nasal dilator and a special probe are used. Using anterior rhinoscopy, you can see polyps in the nasal passages, hematomas, abscesses and tumors in the nasal cavity.

Posterior rhinoscopy is an examination of the nasopharynx and nasal cavity from the mouth, which is performed using a spatula and a special mirror.

In addition, they have now begun to carry out following methods research:

• X-ray of the skull: to assess condition paranasal sinuses nose and detection of developmental anomalies bone skeleton;
• CT scan of skull bones: to identify / deformation in the posterior parts of the nasal cavity;
• endoscopy of the nasal passages and nasopharynx- V modern world this method began to gain popularity.

Treatment of deviated nasal septum

Treatment is possible only surgically (emergency or planned); there is no alternative.

The operation is called septoplasty. It is performed endonasally - without incisions on the facial skin. The operation involves removing, modeling (straightening) and re-implanting part of the nasal septum that was deviated. In this case, the mucous membrane is preserved.

Conditions for surgical treatment:

• It is best to carry out treatment in a hospital for about 4-6 days, since complications may arise both during the operation and after (bleeding);
• Only a qualified doctor who has experience working in a hospital can perform the operation;
• prescribing anesthesia according to indications - can be endotracheal or local (nasal injection with ultracaine solution);
• the patient must undergo full examination to identify concomitant diseases;
• after the operation, tampons are inserted into the nasal passages, which are removed on days 2-3, so during this period it is imperative to carefully care for the nasal passages in order to avoid adhesions (synechias);
• children can undergo surgery at the age of 14-16 years, but if necessary, the child can be operated on at an earlier age; this should be done by a pediatric ENT surgeon and only in a specialized children's hospital;
• physical activity after surgery is possible no earlier than a month, general ability to work the patient recovers in 5-8 days; You should also not overcool.

IN Lately Patients often have questions about laser correction curvature of the nasal septum. What kind of method is this, and how effective is it?

Talking about laser technique, its differences from septoplasty should be noted:

1. Laser correction is carried out by cutting the nasal mucosa with a laser beam (to avoid bleeding from the wound), and then the operation is carried out traditional way. It is worth noting that for this cut it is not necessary to use a laser; you can use any coagulator with a cutting attachment (for example, surgitron);
2. If there is a slight deformation of the cartilaginous (anterior) part of the septum, during laser correction an incision is also made, detachment of the mucous membrane along with the perichondrium from the cartilage, isolation of the cartilage and heating with a laser beam to the state of “plasticine”; Afterwards the cartilage is straightened and the wound is sutured. Although no complications were observed after such an operation, the essence of the technique is no different from septoplasty: still an operation, still an incision and tamponade.

It follows that laser correction essentially similar to classic method treatment. However, the choice of therapy and tactics of surgical treatment should be made by a doctor with experience.

As with any operation, there are also complications in the treatment of a deviated nasal septum:

• formation of septal hematomas;
• nosebleeds in the early and late postoperative period;
• perforation of the septum;
• formation of septal abscess.

Forecast. Prevention

In general, the forecast for timely diagnosis and treatment (operation) favorable. It is not recommended to delay treatment, citing fear of surgery or searching alternative treatment. Apart from surgical treatment, a deviated septum cannot be corrected. And therefore, it is better to spend one hour on an operation than to suffer for the rest of your life from lack of nasal breathing.

Bibliography

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• 2. Lopatin A.S. Nasal septum surgery: septoplasty or submucosal resection? // Russian rhinology. 1996. No. 2-3. - pp. 89-90.
• 3. Piskunov B.S. The significance of endonasal anatomical structures in normal and pathological conditions: Abstract of thesis. dis. Ph.D. honey. Sciences / B.C. Piskunov. - Kursk, 2002. - 24 p.
• 4. Guide to otorhinolaryngology. Ed. Soldatova I.B., M., 1994
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• 8. Mladina R, Cujić E, Subarić M, et al. Nasal septal deformities in ear nose and throat patients: an international study. Am J Otol. 2008;29(2):75–82. doi: 10.1016/j.amjoto.2007.02.002.

In this article, I will allow myself to dwell on the most common disease among ENT pathologies - Deviated nasal septum. One of the leading ENT surgeons of our time once said: “The presence of a nasal septum in a person is already an indication for surgery on it.” There is quite a bit of truth in this saying. After all, breathing is the basis of life. Let's dwell on this for a moment. Humans have two types of breathing: nasal and oral. Nasal breathing is more physiological for the body, since the nasal cavity performs a number of important functions for the body. Passing through the nasal cavity, the inhaled air is moistened, cleared of impurities, warmed and resonated, which gives the voice a characteristic sound tint. Therefore, inadequate nasal breathing entails a number of pathological conditions. Among the diseases leading to impaired nasal breathing, the leading place is occupied by anatomical deformations of the structures of the nasal cavity, one of which is the curvature of the nasal septum. For better understanding of this disease nasal cavity design should be considered.

What is a nasal septum?

The nasal cavity is a canal that runs from front to back and is shaped like a prism. The nasal cavity is formed by several walls: lateral, upper and lower. In the middle of the nasal cavity there is a vertical formation that divides the nasal cavity into two equal halves: right and left. This formation is the nasal septum. The septum has a bone section - formed by the bone structures of the nasal cavity and cartilaginous. Anterior section The nasal septum protrudes from the nasal cavity to the outside and participates in the formation of the external nose. This part of the septum can be felt by running your finger along the midline of the nose from top to bottom. The cartilaginous part of the septum is softer than the bone part and, if desired, it can be moved to the side. Therefore, this part is more susceptible to injury. In children, the nasal septum is formed by the age of 10. To date, it has been proven that only 5% of people have a straight nasal septum. In most people, the septum has various curvatures. Typically, the septum deviates from the midline to the right or left, but other variations are possible. For example, it is possible that a small area of ​​the septum may be distorted in the form of a so-called ridge or spike.

Why do deviated nasal septums occur?

Deviations of the nasal septum are divided into physiological, traumatic and compensatory, depending on the cause. Physiological curvatures- occurring during the growth and development of the body - arise due to the fact that the nasal septum consists of structurally different tissues (bone and cartilage), the growth of which occurs unevenly, and the growth of the bone skeleton does not always correspond to the growth of the cartilage, i.e. growth of one part of the septum outstrips the other. This is the most common reason the occurrence of curvature of the nasal septum. In this case, curvature of the entire nasal septum (i.e., its displacement to the side) or the formation of ridges and spines are more typical. Traumatic curvature arise as a result mechanical damage and can be very diverse. Often traumatic curvatures of the nasal septum are combined with fractures of the nasal bones. In children, traumatic curvatures can occur already at birth, since during childbirth the child may experience dislocation of the cartilage of the nasal septum. In the process of growth and development of the bones of the facial skull, even a minor injury to the nasal septum can lead to further abnormal growth and there will be a need for surgical treatment. Compensatory curvatures- combined violation of the anatomy of several formations of the nasal cavity. The fact is that on the side walls of the nasal cavity there are formations - the nasal turbinates - which, like the septum, in the process of their growth and development can acquire the most different shape. The most common occurrence is hypertrophy (enlargement) of the nasal turbinates. In this case, there is constant contact of the nasal concha with the nasal septum and over time, a compensatory curvature of the nasal septum occurs at the point of contact. On the side of the enlarged nasal concha, a depression forms on the septum, and on the opposite side - a protrusion or ridge. Such curvatures can occur with nasal polyps, vasomotor rhinitis, foreign bodies nasal cavity, with the difference that the septum is in contact with another formation.

What causes a deviated nasal septum?

An accurate diagnosis of “Deviated nasal septum” can only be made by an ENT doctor, since this requires an examination of the nasal cavity using special medical instruments. However, there are a number of symptoms that will help the patient suspect this disease and contact an otolaryngologist. Additionally, computed tomography of the nasal sinuses (or cone-beam computed tomography) is used for diagnosis, which is more than capable of reflecting in more detail the nature of the curvature of the nasal septum. MRI is not used for diagnosis.

A deviated nasal septum is manifested by the following symptoms

1. Difficulty in nasal breathing. There may be both moderate impairment and complete absence nasal breathing. If the patient has a unilateral curvature of the nasal septum, then impaired nasal breathing will be more noticeable on the right or left side of the nose. Here we should dwell on a small aspect of this symptom. Often, when visiting an ENT doctor, the patient is diagnosed with a deviated nasal septum, which surprises him, since, in his opinion, his nose breathes well. This can be answered by the fact that if nasal breathing is impaired due to the curvature of the nasal septum, the body adapts and the nasal cavity compensates for this deficiency at the expense of other structures. However, such compensation does not last long and sooner or later this mechanism breaks down. This also explains the fact that sharp violation nasal breathing in a person with a deviated nasal septum can occur in old age, when the body’s compensatory capabilities are gradually depleted. In people who have a large nasal cavity, even with pronounced curvatures of the nasal septum, there may be no disturbances in nasal breathing, since this compensates for the passage of air through the nasal cavity during breathing. In a word, if your nose breathes well, this does not mean that the septum is perfectly straight. I have personally been convinced of this thousands and thousands of times!

2. Snore. It occurs as a result of impaired nasal breathing.

3. Dryness in the nasal cavity, possible nosebleeds

4.Chronic inflammatory diseases of the paranasal sinuses (sinusitis) - ethmoiditis, . The point is that the main condition for normal physiology the nasal cavity is adequate (free) nasal breathing. If the latter is violated, the outflow of discharge from the paranasal sinuses is disrupted. The discharge stagnates and becomes a favorable environment for the development of bacteria, which in turn causes inflammatory process. (This mechanism is described in more detail in the article “”). Therefore, patients suffering from chronic sinusitis should be examined for a deviated nasal septum and, if necessary, undergo surgical correction. With a long course of chronic sinusitis against the background of a deviated nasal septum, polypous changes develop - () the mucous membrane, i.e. polyps are formed.

5. Allergic diseases. Allergies do not develop from the presence of a deviated septum, but impaired nasal breathing supports the course of allergic processes in the body, especially with compensatory curvatures of the nasal septum, when when the mucous membrane of the nasal cavity comes into contact with the septum, constant irritation occurs, which can provoke attacks bronchial asthma, allergic rhinitis. The patient feels “uncomfortable in the nose,” itching, and mucus is periodically or constantly released from the nasal cavity. These symptoms are especially pronounced if the patient has a combination allergic rhinitis hypertrophy of the nasal turbinates and curvature of the nasal septum.

6. Changes in the shape of the nose. With traumatic curvatures of the nasal septum - dislocations, fractures of the septal cartilage - the shape of the nose changes. The nose shifts to the right or left. As already noted, such conditions are usually combined with fractures of the nasal bones. If adequate treatment is not carried out, the cartilage does not heal properly.

These are the main symptoms that allow you to suspect a deviated nasal septum. The consequences of this disease are quite diverse. It has been proven that when nasal breathing is disrupted, changes in the blood occur, vascular system, genital area, the body is more susceptible to hypothermia and exposure to adverse factors environment, since there is a relationship between nasal breathing indicators and the state of immunity. Therefore, it is very important to contact an otolaryngologist in a timely manner and not risk your health.

How is a deviated nasal septum treated?

As already noted in this article, a deviated nasal septum is essentially a violation of the structure (anatomy) of the nasal cavity. Therefore, the only treatment for this disease is surgical. The operation is classified as plastic and is performed through the nose - endonasally. Therefore, no incisions are made on the facial skin. The purpose of the operation is to remove, model (remove) and reimplant back the part of the nasal septum that was curved while preserving the mucous membrane. The operation is called - Septoplasty. The operation can be performed under endoscope control (endoscopically). I would like to draw your attention to the fact that ONLY SMALL curvature cartilaginous department can be operated on using a laser, however this type of surgery is suitable less than 1% of patients. I will not dwell on the intricacies of the operation, but I will note several points related to it. Let me just say that a qualified ENT surgeon will always select for a patient the best way surgical interference. Unfortunately, patients often come to me who are focused not on the result, but on the treatment method. THOSE. they say: “I want to operate on the septum with a laser” or “operate on me with an endoscope”... Yes..., the Internet does its job, but believe me, dear patients, one or another method of surgery is not always applicable. Personally, I know all the known methods of nasal septum surgery, but what exactly I can offer the patient is determined during a face-to-face consultation

1. The operation is performed in a hospital (ENT department), as planned: the patient undergoes the necessary examination on an outpatient basis, and then is admitted to the hospital. The duration of hospitalization, as a rule, does not exceed 3-4 days. Scroll necessary examination, if you are interested, I can send upon request to my email [email protected]


2. The operation must be performed by a qualified ENT surgeon.


3. Pain relief for this operation can be local or general (anesthesia). At local anesthesia The operation is similar to dental treatment. The patient is injected with an anesthetic solution into the nasal mucosa. If the patient wishes, the operation can be performed under general anesthesia. In our clinic it is possible to perform surgery under any type of anesthesia. Personally, I never insist and suggest that the patient independently choose the method of pain relief.


4. In children, the operation is performed when they reach 14-16 years of age, and when pronounced violations nasal breathing - from 6 years of age. Only general anesthesia is performed.


5. The duration of the operation depends on the experience of the surgeon. I often hear during consultations that the patient was told that the operation would take 2 hours, or even more... Personally, I perform the operation for about 15-20 minutes


6. After the operation, special tampons are inserted into the patient's nasal cavity, which are removed after 24 hours. Currently, small latex tampons or gel tampons are used, as well as special sponge tampons with a small tube inside, which allows the patient breathe through your nose after surgery.


7. The patient's ability to work is restored within 5 to 7 days. After surgery, the patient should avoid physical activity for a month.


8. In the presence of exacerbations of concomitant chronic inflammatory diseases nasal cavity (eg chronic sinusitis, sinus cysts, polyps) it is possible to perform several operations at the same time. I prefer not to separate operations.


9. Since the operation is not accompanied by significant blood loss, it is not performed on women during menstruation.


10. Complications from this operation are rare. These include: nose bleed, perforation (violation of the integrity) of the nasal septum, synechia (fusion) of the nasal cavity.


11. After the operation and removal of tampons, it is mandatory to perform a nasal toilet at least once a day for a week, which should be performed by an ENT doctor at a hospital or clinic.

In conclusion, I would like to note that it is better to surgical treatment, which will take no more than a week, than to feel impaired nasal breathing and its consequences throughout your life. Personally, I have performed more than a thousand operations to correct the nasal septum and I can say with confidence that patients tolerate it well.

For questions regarding the operation, you can contact the author. See section

Sincerely,

ENT surgeon, Candidate of Medical Sciences,

Head of the surgical ENT department of the clinic for diseases of the ear, nose and throat, First Moscow State Medical University named after I.M. Sechenov