What is Deviated Nasal Septum?
In the majority of individuals, the nasal septum is not straight, causing one nasal passage to be smaller than the other. Often the individual is unaware of the deviation as no symptoms are experienced. The nasal septum is considered deviated from its central position when the shift is substantial and causing the individual problems.
Deviated Nasal Septum can be classified as:Simple:
This is a mild deviation of the nasal septum that does not cause any symptoms in patients.Obstructed:
This is a severe deflection of the septum which may touch the lateral wall of the nasal cavity causing symptoms in patients.Impacted:
This represents marked angulation of the nasal septum with a bone spur causing severe symptoms in patients.
Simple deviations cause no symptoms and may remain undetected in many people. When marked deviation is present it can cause the following symptoms:Nasal Obstruction:
Nasal obstruction causing difficulty breathing. This may be unilateral or bilateral due to swollen mucosa or hypertrophied turbinate in the opposite nasal cavity.Headache:
Headache due to sinusitis or due to irritation of the nerves on the lateral wall of the nasal cavity caused by impacted deviationDryness:
Dryness of the mucosa in the nose causing crust formationExternal Deformity: Noisy Breathing:
Noisy breathing and snoring causing disturbed sleep
Causes and Risk Factors of Deviated Nasal Septum
Trauma to the nose is the most common cause of a deviated nasal septum. Other causes and risk factors include the following:
- Prolonged mouth breathing
- High arched palate
- Neoplasms, abnormal growth of tissue, in the nose
- Abnormalities during development of the nose
- Birth molding during delivery
- Prolonged second stage of labor
- Forceps delivery
- Malpresentation (abnormal position of fetus at birth)
- Face presentation of fetus during delivery
Deviated Septum should be evaluated by an ENT physician for proper diagnosis and treatment.
Your doctor will perform the following:Medical History:
Your doctor will ask you about any trauma to the nose and any symptoms such as nosebleeds and congestion.Physical Examination:
Your doctor will use a nasal speculum to spread the nostril to view the inside passages of your nose.
Conservative Treatment Options
Depending on the severity of your symptoms, your doctor may opt for conservative treatment measures instead of surgery. Surgery is usually not performed on patients under 18 because the nasal septum continues to grow until then.
Conservative treatment measures involve medications to treat the symptoms associated with the condition. These can include the following:Decongestants:
These relieve nasal congestion allowing easier breathing.Antihistamines:
These medications block histamine which is released in the body with allergies or infections causing congestion, sneezing, watery eyes, and itching.Nasal Cortisone Sprays:
These medications are sprayed into the nasal passages to reduce swelling and inflammation.
It is important to understand that medications will not fix a deviated septum. They can however provide relief of the symptoms associated with a deviated nasal septum.
Surgical Treatment Introduction
Surgery is the only option for repairing symptomatic deviated nasal septum. Before surgery, your physician may order routine blood tests. X-rays of the paranasal sinuses and nasal endoscopy may also be done to rule out sinusitis.
Septoplasty is the corrective surgery to repair deviated nasal septum and is done either under local or general anesthesia. It involves reconstruction of the nasal septum by repositioning the septal cartilage and removing bony deflections, thus relieving nasal obstruction. This procedure is performed through the nostril and without any external incision therefore bruising will not occur post operatively to the face.
In case of external deformity of the nose, Rhinoplasty surgery, plastic surgery to reshape the nose, is combined with Septoplasty and is called septorhinoplasty. In this surgery, you would have bruising and swelling to the face post operatively. Septoplasty may also be combined with sinus surgery depending on the patient’s needs.
Septoplasty is performed under sterile conditions in the operating room with the patient under general anesthesia or local anesthesia with sedation. This operation is performed as outpatient surgery enabling the patient to go home the same day.
Your surgeon will perform the surgery through the nasal passages with no external incision. An incision is made to the nasal septum inside the nose through one of the nostrils. The mucous membrane is lifted away from the septum
Your surgeon will then remove any obstructions such as polyps, tumors, or bone spurs.
The nasal septum is then reshaped into proper position straightening the septum.
Occasionally severely deviated portions of the septum are completely removed or repaired and replaced inside the nose.
Mucous membranes are then returned to their normal position covering the nasal septum.
Dissolvable sutures, splints and/or packing are placed inside the nose to minimize postoperative bleeding.
Your surgeon will give you guidelines to follow depending on the type of repair performed and the surgeon’s preference. Common Post-operative guidelines include:
- You will need someone to drive you home after surgery due to the drowsy effects of the
- Your nostrils will be packed with sterile cotton gauze and will usually be removed 24-36 hrs after surgery at your follow up appointment.
- You will be given pain medications to manage your pain. Do not use aspirin or ibuprofen products as these can cause bleeding to occur.
- Take all medications given to you as prescribed. These may include antibiotics, decongestants, or steroids.
- Do not drink alcohol while taking antibiotics and pain medications.
- Get plenty of rest. You should avoid strenuous activity as well as bending and lifting for two weeks after surgery as this may cause increased bleeding.
- Sleep with your head elevated on extra pillows.
- Sneeze with your mouth open so as not to dislodge the nasal packing.
- Do not smoke as smoking delays healing and increases your risk of developing complications.
Risks and Complications
As with any major surgery there are potential risks involved. The decision to proceed with the surgery is made because the advantages of surgery outweigh the potential disadvantages. It is important that you are informed of these risks before the surgery takes place.
Complications can be medical (general) or specific to nose surgery. Medical complications include those of the anesthetic and your general wellbeing. Almost any medical condition can occur so this list is not complete. Complications include:
- Allergic reactions to medications
- Blood loss requiring transfusion with its low risk of disease transmission
- Heart attacks, strokes, kidney failure, pneumonia, bladder infections
- Complications from nerve blocks such as infection or nerve damage
- Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death.
Complications are rare in septoplasty surgery, but unexpected events can follow any operation. Your surgeon feels that you should be aware of complications that may take place so that your decision to proceed with this operation is taken with all relevant information available to you.
Possible complications following septoplasty can include the following:
- Septal Hematoma Septal Perforation
- Loss of smell
- Problem Unresolved