Deviated nasal septum - what to do? Treatment of a deviated nasal septum - which method to choose

Thanks to the nasal septum, the inhaled air is divided into equal streams. This ensures its linear movement into the respiratory tract and more uniform warming, moisturizing and cleansing. Any disturbance in the configuration of this part of the respiratory system leads to disruption of the above-described functions and predisposes to the development of various allergic and inflammatory diseases respiratory organs, headaches, heart problems, nervous system and other organs.

Causes of a deviated nasal septum

• physiological;
• compensatory;
• traumatic.

• uneven growth of the bones of the brain and facial parts of the skull - active growth brain section skull leads to a decrease in the size of the nasal cavity and a bend of the nasal septum;
• uneven growth of foci of bone and cartilage tissue of the nasal septum - more active growth of bone tissue leads to deformation of areas of the nasal septum consisting of cartilage tissue;
• excessive growth of the rudimentary Jacobson's organ, located in the olfactory region of the nose and consisting of an accumulation of nervous tissue - the active growth of this rudiment leads to a limitation of space for the normal development of the nasal septum and its curvature.

• hypertrophy of one of the nasal conchas - an enlarged nasal concha puts pressure on the nasal septum and causes its deformation and displacement;
• tumors and polyps of the nasal mucosa - when they are large, nasal breathing is disrupted, and the nasal septum compensates for this condition and becomes bent.

The original reason Deviations of the nasal septum cannot always be identified. Most often, this deformation is detected in children 13-18 years old, and extremely rarely makes itself felt in early childhood.

Types and types of deviated nasal septum

• curvature;
• crest.

• S-shaped anterior-posterior;
• S-shaped;
• C-shaped;
• curvature in relation to the bone crest upper jaw;
• curvature of the bone crest of the upper jaw and nasal septum.

Symptoms of a deviated nasal septum

Patients with a deviated nasal septum often experience:

• chronic inflammation of the sinuses (sinusitis);
• increased susceptibility to viral respiratory tract infections;
• nosebleeds;
• constant discomfort in the nose;
• vasomotor rhinitis (due to excessive proliferation of blood vessels);
• pain in the nose and face;
• noisy breathing through the nose during sleep (especially in children);
• swelling of the mucous membrane on the affected side;
• headache;
• fast fatiguability ;
• tendency to depression;
• decreased concentration and memory.

When the nasal septum is deviated due to injury (fractures or dislocations of cartilage), the nose may shift to the left or right and the shape of the nose may change. These signs are the result of improper fusion of the cartilage of the nasal septum.

Deviated nasal septum in a child

In such children, respiratory infections are often complicated by frontal sinusitis or sinusitis, which can become chronic. Deformation of the nasal septum can provoke inflammatory diseases of the auditory tubes (tubo-otitis), adenoiditis and vasomotor rhinitis.

Impaired nasal breathing in a child can lead to the aggravation or appearance of allergic rhinitis. At the same time, such children experience itching in the nose and constant discharge of mucus from the nose. As allergic processes progress, attacks of bronchial asthma may occur.

Due to the lack of normal functioning of the respiratory system, the brain of a child with a deviated nasal septum experiences constant oxygen starvation. Lack of oxygen leads to:

• headaches;
• fatigue;
• poor memorization of new information;
• decreased attentiveness;
• frequent whims.

Consequences of a deviated nasal septum

• tendency to frequent colds;
• rhinitis (vasomotor, hypertrophic, atrophic, allergic);
• frontal sinusitis;
• sinusitis;
• sinusitis;
• tubo-otitis;
• otitis media;
• spasms of the larynx;
• bronchial asthma;
• convulsive epileptiform seizures;
• astheno-vegetative syndrome;
• disorders of the heart, eyes and other organs;
• decreased immunity.

Treatment

Septoplasty

Septoplasty is performed after the formation of the nasal septum is completed. Most often it is prescribed at the age of 18-21 years, but in some exceptional cases carried out in more early age. This is explained by the fact that until the end of the complete formation of the bone septum, there is a chance that it will correct itself. In addition, surgery at an early age may cause the need for a repeat operation, since before the end of the final formation of the nasal first year, it may become distorted again.

Septoplasty can be performed using traditional surgical techniques or using endoscopic minimally invasive techniques. Indications for this operation may include:

• often exacerbating chronic sinusitis;
• chronic swelling of the nasal mucosa;
• frequent colds;
• persistent itching or dryness in the nose;
• frequent headaches or facial pain;
• snore.

IN last years The most popular is endoscopic septoplasty, which is performed using special equipment and surgical instruments. This minimally invasive operation is performed with minimal damage to soft tissue and cartilage, provides a more aesthetic result and reduces the duration of the recovery period.

Like any operation, septoplasty has a number of contraindications:

• bleeding disorders;
• infectious diseases;
• oncological diseases;
• serious illnesses internal organs.

Laser treatment

Laser septoplasty can only be performed in cases where only the cartilaginous part has undergone deformation and the cartilage has not been broken. To perform this operation, special equipment is used that allows the surgeon to control the depth of penetration of the laser beam into the tissue.

The operation is almost bloodless, because the laser, cutting the tissue, almost immediately “seals” the damaged blood vessels. The areas of cartilage tissue that need to be removed are heated to a certain temperature. After the operation is completed, the nasal septum is fixed in the required position using gauze swabs and a plaster cast.

Advantages of treating deviated nasal septum with laser:

• bloodlessness;
• minimal trauma to soft tissues and cartilage;
• antiseptic effect on soft fabrics nose;
• stimulation immune system patient;
• extremely rare postoperative complications;
• reduction of the rehabilitation period.

Contraindications for laser treatment are:

• history of seizures;
• oncological diseases;
• infectious diseases;
• some endocrinological diseases.

Rehabilitation after surgery

The tampons are removed after a few days, and most patients can be discharged from the hospital within 7-10 days after surgery. Even though the tampons are removed from the nasal cavity, the patient may experience difficulty breathing through the nose. This is due to the fact that swelling of the mucous membrane persists a long period time.

Recovery after endoscopic or laser septoplasty is faster short time. Swelling disappears earlier than after traditional surgery, and soft tissue healing occurs much faster.

After any type of septoplasty, you can return to your normal lifestyle within 2 weeks. For one month it is recommended to avoid severe physical activity And sharp changes temperatures

Operation price

• degree of curvature of the nasal septum;
• type of operation;
• type of anesthesia (local or general anesthesia);
• volume of rehabilitation measures.

The final cost of septoplasty must be clarified with the surgeon after all diagnostic measures have been completed.

The nasal cavity is divided into two halves by the nasal septum:

• the upper part is bone tissue;
• the lower part is represented by cartilage tissue.

Normally, it ensures an even distribution of air flow that enters through the left and right nostrils. Thus, the air enters linearly, is evenly warmed, purified, humidified and passes into the lower respiratory tract.

Reasons for violations

A deviated nasal septum can develop for several reasons. The most common of them is traumatic injury nose According to statistics, this pathological condition most often occurs in young and middle-aged men. This is due precisely to their susceptibility to injury.

Often, a deviated septum occurs when practicing boxing or other combat sports, as well as among those who like to fight.

However, trauma is not the only reason for the development of a deviated septum. After all, not only men get sick, but also girls, children, and teenagers. So, a deviated septum can occur as a result of the following reasons:

1. Features of the structure. In this case, the deformation occurs for physiological reasons. Most often, pathology occurs in adolescence, when the most intensive growth of bone and cartilage tissue is observed.
2. Consequences chronic edema and inflammation of one half of the nose. This often develops against the background of chronic rhinitis.
3. Formations in one of the nasal passages that deform the septum. These include polyps various kinds tumors.

The main manifestation of this pathological condition- violation of nasal breathing. Subjectively, a person feels that it has become more difficult to breathe, less air enters through the nose.

The lack of this type of breathing leads to changes in the mucous membrane of the affected half of the nose: the vessels in this place dilate, swelling appears, and epithelial cells atrophy. In addition, compensatory growth of the nasal turbinates occurs.

All this leads to the fact that the protective functions of the epithelial layer deteriorate: the mucous membrane is not cleared of foreign particles, the air is not warmed and not moistened in the nasal cavity. This is usually followed by the development of nonspecific inflammation of the mucous membrane in the form of rhinitis of various etiologies.

In addition to local changes, dysfunction of the septum can also affect the general condition of the body. As a result, chronic headache, constant weakness and fatigue, shortness of breath, sleep disturbances, and in children – retardation in physical and psycho-emotional development.

Treatment options

Conservative treatment of this pathology does not make sense, because the problem is organic, not functional. That's why medications can only alleviate the course of the disease. The main method of treatment is surgical. Surgery to correct a deviated septum is called septoplasty.

Surgical

Surgical intervention can be performed either openly or using endoscopic methods. Endoscopic surgery is less invasive, so the recovery period is less painful.

What is the essence of the operation? Regardless of which method is chosen, the surgeon excises the curved areas that narrow the nasal passage. Usually the operation is performed after the age of 18, which is due to the fact that it is by this period that the septum is already fully formed. However, in severe cases When the curvature significantly worsens the general condition of the child and affects the quality of life, surgery can be performed earlier.

Laser

IN Lately Laser therapy is gaining widespread popularity. And not without reason, because it has a number of advantages:

• less invasive intervention;
• short recovery period;
• fewer contraindications for use;
• practically painless;
• less risk of bleeding or infection.

The essence of laser therapy is that with the help of a laser, the curved part of the septum is heated and can change shape.

U this method there is only one significant drawback - the laser acts only on the cartilage part, bone tissue is unable to heat up and change shape. This significantly limits the use of laser therapy, since the curvature is often located on the bone part too.

Features of rehabilitation

After the surgical intervention, a rehabilitation period begins. The following is important during this period:

• restore the function of the nasal cavity;
• prevent the development of infection;
• prevent postoperative bleeding.

To do this, immediately after the operation, cotton swabs are inserted into the nose, which are pulled out only for 2 days. During this period, the doctor should constantly monitor the condition of the nose, as well as daily rinsing of the nasal cavity with antiseptic solutions. Rehabilitation takes longer with open septoplasty.

Prevention measures

Traumatic deviated septum can influence the development and prevent it. To do this, you need to take a responsible approach to your health after an injury. You should immediately apply for medical care. The doctor will conduct a thorough examination and prescribe appropriate tests (x-ray or computed tomogram). If the septum is damaged, it is necessary to carry out appropriate treatment (reposition of fragments).

The nasal septum is a bone and cartilaginous formation that protrudes to the surface; it can easily be felt with your fingers and, if necessary or carelessly, moved to the side. In other words, if you touch the tip of the nose, it is cartilage, higher up is the bone that connects to the skull.

There is another bone inside the nose. All this is the bridge of the nose. The anatomical structure serves as a separation of the left and right nostrils, designed to evenly distribute and heat the air to the temperature required by the body. 95% of the population has an uneven nose bridge.

There may be several reasons why a deviated nasal septum occurs. Among them are physiological ones, which appear since childhood, and traumatic ones, which can be suffered at any age.

The nose serves to ensure that the body is saturated with oxygen, and if you have a crooked bridge of the nose, and therefore do not breathe normally, 10-15% of the necessary oxygen may not reach the brain. As a result, a person develops headaches, disruption of the nervous system, and even the reproductive and urinary systems may not function properly.

Causes of deviated nasal septum

There are several options due to which the nose develops incorrectly.

Physiological

The nasal septum is formed between 12 and 16 years of age. Most often, cases of improper development of the bridge of the nose are observed, since the cartilage grows faster than the bone, the nose is bent to the right or left. But there are cases when the bone tissue of the septum begins to develop incorrectly in the womb. Growths, so-called ridges and thorns, may appear.

If the curvature of the nose is physiological, it often happens that it only affects the shape of the nose, so it is not recommended to perform any surgical interventions on children under 18 years of age. If this brings discomfort to the child, he breathes heavily and even snores, then, starting at 5 years old, correction can be made.

Compensatory

Develops due to constant irritation. Can polyps or others foreign objects irritate the cartilaginous part of the nasal septum, as a result of which it does not form correctly. Also, due to the fact that at an early age, air entered one nostril under greater pressure than the other, so that the nostril into which the air flow was not so intense was more closed, the nose bent in its direction.

Traumatic

One of the most common causes of curvature, from which, in most cases, men and boys suffer due to blows and injuries. These can be sports injuries, hits with a ball, fights, which subsequently cause fractures. At a very young age, you can get a contortion due to a blow without severe consequences, the injury will not be felt, and the nose will begin to form incorrectly.

Types of deviated nasal septum

There are several types of curvature, but most often they can be combined in one patient.

• Mixed, appearing in a C or S-shape.
• Spikes are sharp protrusions of the nasal septum.
• The ridges are growths, oblong in shape.

There may also be the following varieties:

• Curvature of the horizontal or vertical plane.
• One-sided, two-sided.
• Localized in the anterior or posterior part of the septum.

Symptoms and consequences

A deviated nasal septum, the symptoms of which are not pleasant, according to patients, is best treated with surgery. Treatment methods such as the use of tablets, a variety of vasoconstrictors, drops, breathing exercises and other methods may bring relief for a while, but not for long and not always.

Through a curved bridge of the nose, 10-15% of the required oxygen may not reach the human brain.

Those who have a crooked nose often suffer from difficulty breathing. At first glance, it may seem that everything is fine with breathing, but the body adapts to changes in the nasal cavity and compensates for the lack of air by using only the right or only the left nostril.

If the nasal septum becomes deviated at an older age, then a lack of oxygen may be felt, because with age the body loses the ability to adapt qualitatively.

If the septum is strongly curved, such a person notices that it is difficult to breathe through the nose, as if pushing air through a channel that is physiologically unnatural. In addition to the fact that the nasal cavity is narrowed, the work deteriorates nerve fibers inside, blood circulation worsens. This all leads to even greater difficulty breathing.

As a result, a person becomes irritable, the mucous membrane loses its natural moisture and frequent colds, allergies begin, in the worst cases, sinusitis, sinusitis, polyps form, persistent runny nose from allergies.

Discomfort and dryness may occur. Often people who have a crooked nose bridge have chronic diseases. Among them are frontal sinusitis, sinusitis, ethmoiditis. This is because there is no free, proper breathing, due to which the discharge from the paranasal sinuses stagnates, and this is a favorable environment for the development of bacteria. Those suffering from the above chronic diseases should see a doctor for surgical intervention. If the disease persists for a long time, polyps may appear.

A person needs a nose in order to breathe and smell, and in the case of a crooked nasal septum, a person loses his sense of smell due to the fact that the passage of air is difficult.

A deviated nasal septum causes discomfort not only to the patient, but also to others due to constant snoring. Such patients often suffer from allergies, constant discharge or dryness.

Consequences of curvature

According to former patients who suffered from a crooked nose bridge, The best way treatment – surgical intervention.

After blows, injuries, illnesses, the shape changes, the nose moves to the left or right. If you don't do it right away surgery, do not correct the shape of the nose, then the cartilage and bone tissue will remain in this position. Freedom of breathing, which is influenced by the shape of the nose, is directly related to human immunity. Blood circulation also changes and may suffer vascular system, the body weakens, becomes sensitive to hypothermia and adverse factors.

The influence of a curved bridge of the nose on other organs

1. Ears. Due to a deviated septum, mucus and infections that are retained in the nasal cavity can enter the tympanic cavity and auditory tube.
2. Nose. This area may be subject to an inflammatory process, and subsequently patients may suffer from diseases that arise as a result of inflammation of the frontal sinus and the mucous membrane of the maxillary sinus (meningitis and sinusitis).
3. Eyes. The tear sac takes the hit.

A person can treat symptoms that were caused by a crooked nose bridge, including:

• chronic runny nose;
• bronchial asthma;
• coughing attacks;
• headache;
• epilepsy attacks;
• nosebleeds;
• eye diseases.

Another disadvantage may be mouth breathing, which is not natural, and, accordingly, this is fraught with negative consequences for the body, namely:

• If you inhale air through your mouth, it does not heat up to the desired temperature as the air that passes through the respiratory system. In this case, the lungs cannot process it effectively, and the body does not receive the amount of oxygen it should.
• Breathing through the mouth does not have the same protective functions as breathing through the nose, naturally Therefore, the body in such people is less protected from respiratory diseases.
• An adenoid may develop, one of the consequences of mouth breathing, as a result of which the pharyngeal tonsils become inflamed.

Diagnostics

It takes place in four stages:

• external examination by a doctor, determining how far the tip of the nose is displaced;
• rhinoscopy – determination of the proportions of the left and right nostrils;
• X-ray of the paranasal sinuses and bone condition;
• tomography of the head.

A doctor can diagnose nasal deformities by first performing an external examination. At this stage, scoliosis and displacement of the tip of the nose are detected. Rhinoscopy is used to determine the displacement.

During the procedure, the size of the nasal cavity and the proportions of one nostril in relation to the other are examined. If the septum has irregular shape, the size of one nostril will be significantly larger than the other. On the side in which the nose is turned, the nasal turbinates are not visible.

Deviated nasal septum: how is it treated?

To avoid the above unpleasant consequences, and those that can develop against the background of improper breathing, you need to consult a doctor for a nose straightening operation, which is called septoplasty. It is not done without any complaints. There are several types of operations for a deviated nasal septum:

• Standard.
• Gentle endoscopic.
• Laser.

The standard septoplasty method is the oldest. The nasal mucosa is cut in an arcuate manner and the quadrangular cartilage is cut off. Then, using a hammer or chisel, the area that is bent is removed. The mucosal flaps, periosteum and perichondrium are brought together and fixed with tampons.

The modern method is gentle endoscopic septoplasty, performed using an endoscope. Having carefully examined the nasal cavity, use special forceps to remove areas that narrow the breathing passage.

Treatment

Both methods may have different scenarios, for example, in the first case, the resected cartilage can be aligned and placed in its place, and over time it will return to its natural position. During one operation, several manipulations can be performed, such as conchotomy and vasotomy.

This operation for adults is performed under local anesthesia; for children and sensitive patients there may be exceptions in the form general anesthesia. The surgical intervention, which takes place without additional manipulations, such as removal of polyps and overgrown nasal turbinates, takes no more than 40 minutes.

Everything is fixed with special tampons, which are equipped with tubes, which immediately allows the patient to start breathing normally. The patient is in the hospital after the operation, if everything went smoothly, the stay is no more than 2-3 days. And until the wounds heal completely after surgery in the nasal cavity, he independently carries out hygiene procedures.

The operation lasts no more than 40 minutes and after 2–3 days the patient is discharged.

How to treat a deviated nasal septum

The newest method that practically does not cause discomfort to the patient, which lasts no more than 15 minutes, is laser correction, or laser treatment. By heating the cartilage with a laser, it becomes more elastic. It is straightened and fixed. This method is not suitable for everyone, in particular, those whose cartilaginous septum was damaged as a result of a fracture need to choose a different treatment.

Before any surgical intervention, you need to undergo a general examination to determine whether there are any contraindications. The following examinations are carried out:

• general blood and urine tests;
• blood chemistry;
• fluorography;
• checking blood coagulation status;
• general examination by a therapist.

List of contraindications for this type of surgery:

1. Acute infections.
2. If there is poor blood clotting.
3. Chronic diseases.
4. Advanced age.
5. Mental illnesses.

It is not advisable to perform unnecessary operations before the age of 18.

For women, it is best to schedule nose surgery for a deviated septum two weeks after the end of your period.

Possible complications

After surgery, early and late complications. Early ones can be attributed to hematomas and bleeding, which are eliminated with tampons. Rarely, complications such as perforation may occur as a result of trauma to the nasal septum during surgery with a sharp object. The doctor must disinfect everything to avoid abscesses, which can occur due to a blood clot or purulent sinusitis. To avoid unpleasant consequences resulting from infections and blood clots, doctors prescribe a course of antibiotics a couple of days before the operation and after it.

Late complications may include changes in the shape of the nose in exceptional cases due to high resection of the quadrangular cartilage.

conclusions

• A crooked bridge of the nose can develop from childhood or adolescence as a result of intensive growth of cartilage tissue, or it can occur as a result of injuries or fractures at any age.
• Because due to heavy breathing the body is not completely saturated with oxygen in the required amount, not only the lungs suffer, but the entire body as a whole, including the reproductive and nervous systems.
• It provides the discomfort of curvature both to the patient himself due to constant respiratory diseases, sometimes severe sinusitis and meningitis, and to those around him due to constant snoring.
• A specialized specialist must diagnose the disease and prescribe surgical intervention to eliminate the curvature.
• Before the operation, you need to undergo a general examination to find out if there are any contraindications, such as poor clotting blood, chronic or mental illness etc.
• How to cure a deviated nasal septum? The most effective way is surgery. The patient can choose one of several correction options, ranging from the oldest, in which broken cartilage tissue is removed, and ending with an innovative laser correction method, if this type is suitable for treatment.
• The correction operation takes little time, if there are no complications - no more than 40 minutes, and after 2-3 days the patient can continue treatment at home, carry out hygiene procedures at least once a day until complete healing.
• In rare cases, complications may occur after surgery.

If you have difficulty breathing, are constantly plagued by a runny nose, or suffer from headaches, it is better to consult a doctor for help, because everything listed symptoms may be a consequence of a crooked nose bridge, but the root cause of all diseases must be eliminated.

Displacement of the nasal septum: causes and types of deformities. When a deviated septum requires treatment. Methods for correcting a deviated nasal septum.

Deviation of the nasal septum

How does a displacement (curvature) of the nasal septum manifest and why is it dangerous? Does this morphological anomaly always lead to functional disorders? In what cases do doctors strongly recommend treatment? What methods of straightening the septum exist, is it possible to correct the defect without surgery? You will receive answers to these and other questions from this publication.

A displaced nasal septum is a congenital or acquired deformation of the bone and/or cartilage formations that normally divide the nasal cavity into two equal sides. This anomaly can cause persistent problems with nasal breathing, development secondary pathology in adjacent structures and allergic diseases.

Causes of septal deformation

A defect in the anatomical structures that form the nasal septum may be due to different rates of development of the elements of the brain and facial skull. In such cases, curvature or displacement is formed already in childhood or adolescence. It should be said that one degree or another of curvature occurs in 85% of people, and in many this developmental anomaly occurs without any clinical symptoms.

The cause of curvature can also be compensatory processes in the structures of the nasal cavity, caused by hypertrophy of the shells, the presence of a tumor or polyps. The third group of causes is represented by post-traumatic deformities after fractures, bruises and other injuries of the nose.

Types of deviated nasal septum

Depending on the location, prevalence, severity and specificity of the deformation, the following types of curvature of the nasal septum are distinguished:

• horizontal/vertical;
• partial/full displacement;
• curvature of the cartilaginous/bone section;
• bilateral curvature or unilateral;
• deformation with the formation of a “ridge”;
• defect with the formation of a “spike”;
• S-shaped deformation;
• C-shaped deformity.

Symptoms and accompanying illnesses

Difficulty in nasal breathing is the main symptom of deformation and curvature of the nasal septum. Along with breathing problems, patients complain of:

• Snore.
• Headaches, decreased performance.
• Frequent colds.
• Allergic reactions, chronic runny nose.
• Dryness of the nasal mucosa.

In addition to the complaints listed above, when the nasal septum is deformed, secondary changes occur in adjacent anatomical structures. Impaired air movement through the nasal cavity in combination with hypertrophy of epithelial tissues leads to narrowing of the openings of the paranasal sinuses. Because of this, their pneumotization worsens, and conditions appear for the development of infectious diseases. inflammatory processes. For the same reasons, inflammation often develops eustachian tube and middle ear.

A number of patients develop severe allergic diseases, including bronchial asthma. If a person abuses vasoconstrictor drops to ease breathing, vasomotor rhinitis develops. Deterioration of pulmonary ventilation creates the preconditions for the development of infection; the state of hypoxia negatively affects the functioning of the heart and internal organs. Even problems with the reproductive sphere and the genitourinary system can be a consequence of a deviated septum.

Diagnostics

To diagnose a deviated nasal septum, objective and instrumental examination methods are used. Already during the external examination, the doctor receives general idea about the shape of the nose and anterior section partitions. To obtain full picture To determine the location, degree and type of deformation, the following examinations are carried out:

• rhinoscopy (anterior, posterior, endoscopic);
• X-ray examination of the facial skeleton;
• CT scan;
• other instrumental methods.

Rhinoscopy is an informative research method that provides the attending physician full information about the condition of the nasal mucosa, the specifics of the deformation, the degree of its severity and localization. For a comprehensive assessment of the shape and relative position An X-ray examination of all bones and cartilaginous structures of the facial skeleton is performed. During X-ray diagnostics, it is also possible to assess the airiness of the maxillary and frontal sinuses. According to indications, the patient may be prescribed computed tomography and other diagnostic methods.

Treatment options

The results of the diagnostic examination are used to formulate strategy and tactics surgical treatment. Unfortunately, truly effective medicinal methods There is no correction for deformed elements and pathologically altered nasal mucosa. Any fancy exercises, braces or massages do not help. The normal anatomy and function of the nasal passages can only be restored through surgical correction.

People with a deviated septum often use it to ease nasal breathing. vasoconstrictor drops. This approach gives a satisfactory and even good short-term effect, but harms the patient in the long term. Let us briefly consider the mechanism of their action. Nasal drops cause spasm of the blood vessels that supply epithelial tissue. As a result of the spasm, the thickness of the mucous membrane decreases for a short time, the nasal passages widen, and breathing becomes easier. The drops do not act directly on the septum, that is, the cause of the problem.

Let's see what happens next. Vasospasm provokes compensatory changes in epithelial tissues, namely, hypertrophy of the mucous membrane. Hypertrophy is a process that is characterized by the growth and thickening of tissue, as a result of which the narrowed nasal passage becomes even narrower, and breathing through the nose becomes even more difficult. to a greater extent. The patient has to instill drops more often and use higher dosages, which in turn leads to further stimulation of hypertrophic processes. The circle is closing, and it can only be broken with the help of operational correction.

Indications for septoplasty

Does the above mean that in case of curvature, displacement of the septum or deformation of the structures that form it, it is necessary to undergo surgery? No. As already mentioned, a certain degree of displacement or curvature occurs in 8 out of 10 inhabitants of the planet. Not all of them decide to undergo surgery, and not all of them are candidates for surgery at all.

In otorhinolaryngological and rhinosurgical practice there are three diagnostic criteria, in the presence of which a person with deformed elements of the nasal skeleton is recommended (or strongly recommended) to undergo surgical treatment:

1. Persistent difficulty in nasal breathing is the first and main diagnostic sign. If the deformation is not accompanied by a violation respiratory function, snoring, impaired sense of smell, surgery is not indicated (exceptions to this rule will be discussed below).
2. Tendency to colds and allergies. If a person easily “catch” a runny nose and ARVI, if he often develops allergic rhinitis or there are other manifestations of allergic pathology from the respiratory system, the deformation needs to be corrected.
3. The presence of secondary changes in the sinuses, middle ear, Eustachian tubes and mucous membrane. Secondary changes include polyps, cysts, chronic inflammatory processes, and decreased pneumotization of the sinuses.

Types of operations

Operations during which straightening of deformed bone and cartilaginous structures are carried out are united by the term septoplasty. Currently, there are many surgical techniques and techniques, and the first method of correcting a deviated nasal septum - submucosal resection - was developed more than a hundred years ago by a surgeon named Killian. It is performed using traditional surgical instruments or using endoscopic equipment.

During submucosal resection, the doctor dissects the mucosa above the septum on the right and left sides, exfoliates the integumentary tissue, separates the perichondrium from the cartilage, and the periosteum from the bone. The incisions are made from the side of the nasal passages; there are no scars left after the operation. After separating the perichondrium and periosteum, the surgeon removes the deformed elements of bone and cartilage, straightens the septum and closes the wound with absorbable suture material.

Today, many modifications of the Killian operation are used in rhinosurgery. Among the most common partial resection cartilage or bone, as well as resection of cartilage tissue with reimplantation. The final choice of tactics for surgical correction of a deviated nasal septum depends on the degree, specificity, location and type of deformity.

If there is significant hypertrophy of the mucous membrane, simultaneously with manipulations aimed at correcting the curvature of the nasal septum, a vasotomy is performed - the intersection of the vessels that feed the epithelial tissue. This simple manipulation is necessary for full recovery air conduction of the nasal passages. In the presence of polyps, a polypectomy is performed; in the presence of sinusitis (inflammatory processes in the frontal or maxillary sinuses), unilateral or bilateral endoscopic sinusotomy is indicated.

For septoplasty and rhinoseptoplasty, general anesthesia (inhalation anesthesia) is used, which allows complete control of the patient’s vital functions and minimizes the risk of complications. Breathing during surgery is carried out and controlled using an anesthesia-respiratory apparatus.

Treatment without surgery: laser septochondrocorrection

Is it possible to correct a deviated nasal septum without surgery? As already mentioned, there are no medicinal methods, but currently the minimally invasive (gentle) method of laser septochondrocorrection is becoming increasingly popular.

Laser septochondrocorrection is a method for correcting a deviated nasal septum and restoring nasal breathing without damaging the mucous membrane. In other words, no cuts are required. Straightening is performed after heating the cartilaginous part of the septum with a laser. Thermal exposure leads to an increase in the temperature of the cartilage, as a result of which it becomes plastic. Plastic cartilage can be “straightened” with manual manipulation within a few minutes. This is the essence of this technique.

Cartilage thermoplasty - interesting and promising direction treatment, but not without its drawbacks. With the help of laser septochondrocorrection, only the minimal degree of curvature of the nasal septum in the anterior (cartilaginous) section can be corrected. Severe deformity with pathological changes in bone formations can only be corrected through surgery; thermoplasty is ineffective here.

The laser thermoplastic technique has been used recently, for only a few years, and therefore official medicine does not yet have any reliable data on the results of the procedure in the long term. All statements that laser septochondrocorrection provides lifelong results are still purely speculative and have not been confirmed clinical practice.

Considering the disadvantages of laser thermoplasty (effective only for deformation of the cartilage, there is no data on long-term results, very high cost), the feasibility of using this technique is questionable. However, a non-surgical method for correcting a deviated nasal septum does exist, and it is used in many clinics.

Preparing for surgery

The task of the surgical team during septoplasty lies not only in the medical, but also in the aesthetic plane. It is extremely important not only to improve and completely normalize the function of nasal breathing, but also to maintain and, if necessary and at the request of the patient, improve the aesthetics of the nose. To successfully solve these problems preoperative preparation includes 3D modeling of the correction result.

Also, before septoplasty, a comprehensive examination is carried out, which includes the previously discussed methods instrumental diagnostics(CT scan, x-ray of the facial skeleton, rhinoscopy). A general diagnostic study allows you to obtain complete information about the patient’s health status and minimize operational and anesthetic risks. If the diagnosis reveals deviations from the norm that are not a contraindication to surgical intervention, the patient is prescribed consultations with specialists and drug treatment.

2-3 weeks before the planned date, the patient must completely give up alcohol and smoking. It is extremely important to stop taking medications and nutritional supplements that slow down blood clotting (anticoagulants, anti-inflammatory drugs from the NSAID group). The patient stops playing sports a week before septoplasty.

Rehabilitation after straightening the septum

Immediately after the operation, special inserts (“splints”) made of silicone or cotton swabs soaked in a hemostatic solution are inserted into the right and left nasal passages. A plaster or retainer is applied to the middle third of the face and nose. The splints are removed 2-3 days after surgery, the plaster is removed after 7-10 days.

In the early period of rehabilitation, which lasts 3 weeks, swelling persists. In the first days, body temperature may be elevated. Breathing through the nose after surgery is difficult or even impossible. The nasal mucosa is swollen and accumulates a large number of discharge mixed with blood. This is normal and should not cause concern.

To cleanse the nasal cavity, you must use soft cotton swabs or turundas. Blowing your nose after any rhinosurgery operation is strictly prohibited! The patient can rinse the nasal cavity with a weak saline solution; with the doctor’s permission, use vasoconstrictor drops, anti-exudative agents and anti-inflammatory ointments. As a preventive measure, a short course of antibiotics is prescribed after surgery.

The final result of septoplasty depends not only on the skill and experience of the plastic surgeon, but also on the patient’s responsible attitude to the rules of the recovery period. Below are the basic rules that must be followed:

• After surgery on the nasal structures, glasses cannot be worn.
• You can only sleep on your back and on high pillows (or with a raised headboard).
• You can't blow your nose.
• Facial massage, dental and cosmetic procedures are contraindicated.
• You can only sneeze with open mouth.
• Facial care should be as gentle as possible. Even brushing your teeth needs to be done very carefully.
• Cleansing the nasal cavity should be done regularly and very carefully.
• You cannot play sports for 3 months.
• Do not expose the body to high temperatures; You should avoid solariums, saunas and hot baths.

Experienced craniofacial surgeons say that ideal nasal anatomy does not occur in nature. An insidious disruption of the formation process in early childhood is not noticeable to the naked eye. But in most cases, a crooked nasal septum remains within normal limits and does not create obstacles to the physiological process of breathing, and sometimes the changes become pathological. Exist various reasons formation of such an anomaly.

A deviated nasal septum in children and adults can be aggravated by various injuries or after suffering from inflammatory diseases. In this case, treatment by an otolaryngologist and possibly even plastic surgery is required. Usually, the consequences of a crooked nasal septum can be very disastrous; you can read about what difficulties can arise in this material.

Anatomy, physiology and abnormalities

If you look at medical statistics, you can see that the bulk of diagnosed cases occur in adolescence (11-15 years). Before the age of 10, it is very difficult to identify an abnormality in the formation of nasal structures. The anatomy and physiology of the upper respiratory tract is such that compensation mechanisms allow even significant deviations from the norm. However, it is precisely in adolescence, against the background of rapid and rapid development of the facial skeleton and hormonal changes, that such deviations can develop even without the influence of external negative factors.

The anatomy of the nose divides the organ into structural parts:

• entrance paths - nostrils and cavities (air penetrates here, undergoes primary cleaning and heating);
• the nasal passages originate from the lower passage from the cavities, then continue with the middle and upper section(the tortuous course allows you to effectively warm and clean the incoming air);
• The choanae precede the exit of air into the nasopharynx.

The nasal septum separates the two nasal passages. It consists of bone tissue in the posterior section and cartilage throughout the rest. The internal cavities are lined with mucous membrane, penetrated by small blood vessels. There is the ability to form a mucous secretion in order to eliminate pathogenic microflora and dust particles. The area of ​​smell (odor recognition) is located in the upper nasal passage. Therefore, even with mild congestion, the ability to smell is sharply reduced. The functioning of this organ is helped paranasal sinuses nose Physiological function:

• humidification and purification of air entering the upper respiratory tract;
• defence from pathogenic bacteria and viruses;
• ensuring the sense of smell and recognition of odors.

The role of the nasal septum is difficult to overestimate. It plays the role of a kind of natural barrier that prevents the connection of two air flows. Thanks to this, conditions are created for smooth physiological breathing. A deviated nasal septum disrupts the process of breathing through the nose and creates the preconditions for the development of chronic diseases upper respiratory tract.

Causes of a deviated nasal septum - identifying risk factors

When developing measures to prevent various pathologies, we usually identify risk factors and develop a set of measures aimed at neutralizing them. The causes of a deviated nasal septum may include a huge number of external and internal factors pathogenic influence. Let's try to figure out the main ones:

• the physiological group is associated with a disruption of the development and formation of the facial bone part of the skull;
• traumatic group - these are the consequences of blows, fractures, development of cavities after hematomas;
• compensatory causes of a deviated nasal septum include polyps, sinusitis, adenoiditis, hypertrophy of the nasal sinuses, and chronic rhinitis.

Congenital risk factors are currently being actively studied by scientists. There is a theory of insufficient density of cartilage tissue. Such people suffer from systemic damage to hyaluronic structures. They may have arthritis and arthrosis, osteochondrosis spinal column, ankylosing spondylitis. If parents or older blood relatives have total difficulties with the joints and spine, then the likelihood of a crooked nasal septum in children will be very high. But there is no scientific basis for this theory yet.

What are the consequences of a deviated nasal septum?

Most patients feel that if external manifestations If there is no pathological condition, then you can not respond to periodic signals from the body. What can be the consequences of a deviated nasal septum in children and adults? The most diverse, sometimes it is even difficult to compare them with the underlying disease, they are so distant and not directly related.

The main problem is a disruption of the air exchange process through the nasal passages. Speaking in simple language- It becomes difficult to breathe freely through your nose. This is a consequence of the narrowing of one of the passages and a violation of the physiological dynamics of air flow.

Second Possible negative consequence- change in the structure of the mucous membrane. She becomes thinner and loses her protective properties. This entails constant viral infections, development of chronic rhinitis, often complicated by sinusitis, frontal sinusitis, sphenoiditis.

In the long term, chronic oxygen starvation of tissues may develop. A bouquet of chronic pathologies of pulmonary and cardiac tissue, the development of migraines, osteochondrosis and constant muscle spasms are all symptoms of such a pathology.

There may also be irreversible changes in the central nervous system. The risk of developing bronchial asthma of neurogenic origin in this category of people is very high. Patients are literally haunted by repeated attacks of suffocation, which are not so easy to relieve with conventional means. At pronounced violation nasal breathing may develop epileptic seizures, convulsive syndrome, migraine headaches. Over time, visual and hearing acuity decreases. In the cavity of the Eustachian tube, conditions are formed for the development of eustacheitis and otitis media.

Diagnosis and symptoms of a deviated nasal septum (with photo)

There are several types of deviated nasal septum, all of which form their own clinical picture. Diagnosis of all of them begins with a visual examination and radiographic examination. Very often there are combined options, when several types of curvature are present at once:

1. thorn or ridge;
2. vertical or horizontal arrangement;
3. posterior or anterior orientation;
4. deformation according to profile S or C;
5. with or without deformation of the vomer bone tissue.

Look at the photo for typical manifestations of various types of deviated nasal septum:

Typical symptoms of a deviated nasal septum, which a specialist pays attention to during the initial examination:

• complaints of difficulty breathing freely through the nose;
• constant feeling of congestion and secretion of mucous secretion (worsens after exposure to cold air);
• allergic reactions are not typical for this person, for example, the smell of citrus fruits;
• periodic bleeding from the nasal passages - they are caused by mechanical injuries and disruption of the blood circulation process in the capillaries;
• feeling of dryness in the nose, snoring during sleep, frequent pain in the throat;
• decreased performance and increased fatigue, headache and dizziness.

A change in the anatomical shape of the nose can be visually determined. During rhinoscopy, the doctor sees the uneven development of the passages and shells. An initial assessment of the uniformity of air flow distribution can be carried out using simple test with cotton wool. A dry cotton wool is brought to one nostril, the second nostril is closed, and the movement of the cotton wool is observed when breathing. The range of motion in both nostrils is then compared. In a similar way, you can test the function of smell using a cotton swab moistened with an aromatic substance.

If a deviated nasal septum is suspected, for the purpose of differential diagnosis, radiography of the skull bones, computed tomography, and endoscopy are performed.

Treatment methods for deviated nasal septum and surgery

The most effective way to correct the patient's condition is surgery. Methods for treating a deviated nasal septum without surgery usually provide only temporary, unstable results. To improve nasal breathing, it is recommended to use vasoconstrictor drops, which in turn negatively affect the condition of the mucous membranes.

An operation called nasal septoplasty is performed. It consists of restoring the normal anatomical structure of the nasal septum. It is prescribed to people with difficulty breathing, headaches, predisposition to bronchial asthma and serious cosmetic defects.

If surgery is scheduled to correct a deviated nasal septum, you should prepare for it in advance. To do this, it is important to stop smoking and drinking hot, spicy food. You should visit the dentist and have all diseased teeth treated. This will ensure the prevention of postoperative complications of an inflammatory nature.

The operation is performed in a surgical hospital under general anesthesia. After the intervention, nasal breathing is completely restored within the first week. Working capacity is restored after 21 days.