Deviated nasal septum: what is dangerous, treatment “with” and “without” surgery

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 a high probability that the culprit is a deviated nasal septum. The consequences of this pathology can cause inconvenience for a long time.

Structure and functions of the nasal septum

The nasal passages are separated using a plate. In front, the septum has a quadrangular shape and consists of cartilaginous tissue. Below is the hard palate, behind is the ethmoid and sphenoid bones, and at the top is the frontal bone.

The nose performs a number of important functions:

• filtering of inhaled air;
• maintaining an optimal level of humidity;
• warming;
• odor recognition.

Violation of the structure of the plate can lead to partial or complete loss of some of them.

Causes of a deviated nasal septum

The complex structure of the septum makes it vulnerable and easily deformed.

The main reasons for plate shape violation may be:

1. Injury. Half of the cases involve injuries to the facial part of the skull or nose. Most often, injuries occur at a young age. Deformation in a newborn may be the result of illiterate manipulations by the midwife or too rapid movement along the birth canal.

2. Inconsistency in the growth of the bones of the facial part of the skull. This pathology is present in 30% of patients. Uneven development of parts of the nose disrupts its symmetry.
3. Diseases - tumors, polyps, growth of the nasal concha. Chronic rhinitis can also be the cause - a person inhales air only through one of the nasal passages, which leads to deformation.
4. Hereditary predisposition.
5. Hypertrophy of the vomeronasal organ, which contains olfactory cells. Normally, it is atrophied, but in some cases it can increase, causing curvature.

Types and types of deviated nasal septum

A deviated nasal septum (the operation depends on the type of injury) can have varying degrees:

• Group 1 – slight slope from the center;
• Group 2 – the septum protrusion is located in the middle between the side wall and the central line;
• Group 3 – the curved plate touches the side wall.

There is also a more detailed classification that takes into account morphological, pathogenetic and clinical features:

1. A one-sided ridge located vertically in the depths of the nasal cavity.
2. Two protrusions located in a vertical plane on different sides of the partition (S-shaped bend).
3. A small ridge in the front of the nose that does not interfere with free breathing.
4. A crumpled plate with many fracture lines.
5. There is a pronounced protrusion in the anterior part of the septum, the lower edge of the cartilaginous quadrangle is shifted back. Breathing is impaired.
6. An ascending ridge, shaped like a saber, located on one side almost horizontally.
7. Two almost horizontal protrusions located opposite each other on the front of the nose and in the middle section. There is a characteristic groove on one side.

In addition to the listed types, multifragmented deformities of the nose can be distinguished, when fragments of the septum are superimposed on one another at different angles.

Prices

Where can I have the surgery and how much does this procedure cost? The operation can be performed in government institutions where there is a medical insurance policy. But often a private clinic takes on the solution to this problem.

Straightening the nasal septum is possible in many cities where there are specialized hospitals and clinics. The cost in most cases varies and can reach significant limits. This is due to the degree of deformation, the shape of the nose, the extent of the curvature and other features.

Basically the price ranges from 20,000 to 150,000 rubles.

Symptoms of a deviated nasal septum

A curvature of the nasal septum (the operation is important due to the severe narrowing of the nasal passage) impedes the passage of air, the number of cilia on the ciliated epithelium decreases, which negatively affects the natural protection and cleansing of the mucous membrane. Lack of oxygen affects the activity of the entire body.

Most often, patients note the following signs of deformation:

1. Breathing disorders, manifested in nasal congestion, the appearance of mucous discharge, sometimes mixed with pus, and a feeling of dryness. The symptom may affect only one side.
2. Chronic inflammatory diseases of the nasal sinuses (sinusitis).

3. Tendency to respiratory infections.
4. Nosebleeds.
5. Vasomotor rhinitis associated with the proliferation of the vascular network.
6. Soreness in the facial area.
7. Noisy breathing, snoring.
8. Discomfort in the nose, itching, swelling of the mucous membrane.
9. A deviated nasal septum often touches the trigeminal nerve, irritating it. This provokes regular migraines, respiratory spasms, chronic coughing, and sneezing.
10. Fatigue, depression, decreased ability to concentrate and remember due to oxygen deprivation. Children may experience developmental delays, both physical and mental.
11. Forced inhalation through the mouth leads to chronic pharyngitis, bad breath, and dry mouth. The air does not undergo purification and does not warm up, which poses a danger to the lower respiratory tract. The likelihood of developing bronchitis and pneumonia increases.

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Indications for surgery

The reason for contacting a surgeon may be:

• Frequent bleeding from the nose.
• Breathing noise and snoring that cause discomfort to the patient.
• Tendency to colds.
• Headache.

• Swelling of the mucous membrane.
• Sinusitis, allergic rhinitis.

Preparatory stage

To clarify the diagnosis, you need to contact an otolaryngologist.

The inspection may include:

1. Assessing the appearance of the nose. This stage allows you to identify serious deformations.
2. Testing the strength of inhalation and exhalation through each nostril and the ability to smell.
3. Rhinoscopy – examination of the nasal cavity using special equipment. To do this, a dilator is inserted into the nostrils, and the mucous membrane is probed with a thin probe to assess the presence of tumors, ulcers, and polyps. When penetrating through the oral cavity, it is possible to detect hypertrophy of the posterior side of the nasal concha.

4. Endoscopy, which involves a more detailed examination of the mucous membrane, is performed using local anesthesia. Through a probe with a video camera you can clearly see the lower shell.
5. CT scan showing the presence of spines and ridges on the septum.

Before the operation you must:

• for men to shave;
• stop drinking alcoholic beverages and smoking;
• Do not take medications that affect the rate of blood clotting.

Two weeks before surgery, you should undergo a number of tests:

• blood for syphilis, human immunodeficiency virus, viral hepatitis;
• determination of Rh factor and blood group;
• fibrinogen concentration, platelets, coagulation level;
• urine analysis for the presence of protein, sediment composition;
• blood test - leukocyte formula, hemoglobin, leukocytes, erythrocytes and platelets.

Anesthesia

Depending on the location of the deformed area, local or general anesthesia is used:

1. Local anesthesia acceptable if the curvature does not affect bone tissue. The mucous membrane is moistened with a desensitizing solution using a spray or tampons.

2. General anesthesia. In children and patients with deformation of bone structures, the operation is performed in a state of anesthesia.

Is it possible to correct the bony part of the nasal septum?

It is known that the nasal septum includes cartilage and bone tissue. The first is characterized by free mobility, as a result of which deformations may occur. It is easier to straighten the curvature of cartilage than bone, because it is much stronger and when fractured it is expressed by the formation of sharp angles.

Therefore, with severe deformation of bone tissue, additional devices, such as plates, are often required for surgery. They support the shape of the nose and replace bone.

Methods of surgical treatment

Septoplasty is performed using several methods. The choice of one method or another depends on the type of deformity, as well as on the policy of the clinic where the patient is observed.

Operation Killian

It does not require any incisions on the skin, therefore eliminating the formation of scars. Using a small scalpel, incisions are made in the perichondrium and mucosa on both sides in turn. An anesthetic is injected under the perichondrium, and through the incisions made, the membrane is shifted to the desired position.

If there are spines or ridges, the detachment is done only around them so as not to disturb the structure of the mucosa over the projections. After this, the septum is straightened using a mechanical method, the elevations are cut off and the deformed areas are excised.

The aligned nasal septum is fixed with tampons, pressing the mucous membrane to the bones and cartilage. A sling dressing is often recommended.

Redressation of the septum

Using a scalpel, an incision is made into the mucous membrane and perichondrium in one of the passages of the nose. The separation is done only from the side of the incision. From the same edge, the cartilage is dissected in four places so that its deformed part is connected only to the perichondrium, mucous membrane, and also to the periosteum of the second nasal meatus.

After this, the septum is cut at the point where its base is curvature. After this, the nasal septum becomes mobile and takes its natural position, in which it is secured with tampons.

Mobilization of the septum

The nasal septum is broken in several places using special surgical instruments. After this, the fragments are stabilized and the plate is straightened.

In most cases, dissection of the mucosa is not required. If it becomes necessary to make incisions, they are stitched with self-absorbing suture material - catgut.

Circular resection

If, after mobilization, the quadrilateral cartilage has not acquired sufficient mobility and the septum has not straightened, a circular incision is made and a thin layer of cartilage is cut around the quadrilateral. After this, the bony base of the septum is redressed.

Partial resection

One nasal passage is operated on. The mucosa is dissected to the cartilage along almost the entire length of the septum. Using a special tool, the membrane is separated from the perichondrium. Through the resulting incision, the cartilage is dissected so that it becomes possible to separate it from the mucous membrane on the opposite side.

After this, the deformed parts of the septum are removed using scissors, and the mucous membrane is put in place and fixed with tampons. If bleeding is profuse, tampons are impregnated with a hemostatic compound.

Resection-reimplantation

Recognized as the most advanced method of septoplasty. The deformed cartilage plate is cut using a metal knife.

After this, the pieces are flattened with a special device, giving them the correct shape, returned to their original place and fixed.

Laser septoplasty

A deviated nasal septum (an operation done with a laser) is corrected by a surgeon using equipment that allows you to regulate the depth of penetration of radiation into the tissue.

There is practically no blood released during the process, since the laser “seals” the damaged vessels. The cartilage tissue that violates the shape of the septum is evaporated, after which the plate is fixed with a plaster bandage and gauze swabs.

Advantages of this technique:

• antiseptic effect;
• stimulation of tissue regeneration and immunity;
• bloodlessness;
• minimal trauma;
• short recovery period.

Endoscopic septoplasty

Refers to low-traumatic, gentle methods. Resection is performed inside the nose on the mucous membrane, which helps prevent the formation of scars on the facial skin. The duration of the operation is 30-40 minutes.

During the process of detachment of the mucous membrane, its integrity is maintained, with the exception of injuries in which the damaged areas must be removed to give the septum a vertical position.

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Septum surgery

Correction of a deviated nasal septum
What to do if there is a deviated septum, how to correct the situation? In most cases, this problem can only be solved through surgery. Because when the nasal septum is deviated, bone and cartilage tissue is involved, which is difficult to align. Only minor deformities can be restored with the help of massage and wearing special clothespins that straighten the nose without surgery.

Modern and current methods of correcting the nasal septum without surgery are discussed in this article.

• Plastic surgery to correct a deviated septum is called septoplasty. Surgical intervention is prescribed when the septum is severely curved, the nose does not breathe, there is a noticeable displacement along its axis, and there are sensations of lack of oxygen.
• Plastic surgery includes some stages of the operation; the septum can be straightened in two ways: closed and open. In total, it lasts 2-2.5 hours, provided that there are no complications. Only noticeable deformations of the nasal septum are subject to straightening.
• In order for a correction to correct the septum to be carried out, one thing is not enough; the operation is done after undergoing a medical examination, where the crooked area is examined, and the patient undergoes general clinical tests. After all the results, if they are satisfactory, they perform an operation and straighten the crooked area.
• The septum will be straightened and surgery will be performed if the nose is crooked and severe symptoms will occur. Trauma and bruises are also prerequisites for surgery. In addition, if the septum has been displaced or broken, the shape of the nose changes, resulting in a cosmetic defect.
• With the help of surgery, all deformations of the deviated septum are eliminated. During it, the shape, nose and tip are corrected. The curved area is subject to change from the inside, the cut is possible both from the outside and from the inside. When performing plastic surgery, the cartilage tissue is broken, then leveled and fixed with cosmetic sutures.
• The operation is characterized by positive results, reoperation is rare, it helps restore breathing, the nasal septum and tip are corrected, the shape and appearance are improved.

Submucosal resection

Submucosal resection of the nasal septum

A long-time proven method of treating a deviated septum. Plastic surgery is performed in a clinic under general anesthesia. It is characterized by the absence of scars on the skin, since a small incision is made through which the surgeon performs the reduction.

This method is considered the most effective and is used even with severe deformation due to bruises, injuries and fractures. After the operation, the patient receives stitches and is under the supervision of a specialist for the first day.

Endoscopic correction

Correcting a deviated septum using an endoscope

It is the elimination of nasal defects, which involves only a certain part of the cartilage tissue. Plastic surgery can be performed under local and general anesthesia. It is characterized by the use of an endoscope, which is inserted into the nasal cavity.

Features of surgery using an endoscope on a deviated nasal septum

With its help, the progress of the operation is monitored. There is a laser at the end of the endoscope, so the operation is more gentle because the laser radiation cauterizes the blood vessels, reducing the possibility of bleeding and has a bactericidal effect.

Laser cristotomy

Laser correction of the cartilaginous part of the nasal septum

A modern method of treating a deviated septum, laser thermoplasty, is determined by the use of laser beams. With their help, a small incision is made and the cartilage is adjusted.

We invite you to learn more about this operation here; today it is a modern method for simple correction of the cartilaginous part of the nasal septum.

Thanks to the laser, the operation is almost bloodless and the risk of infection is reduced, since laser radiation has a bactericidal property. The duration of plastic surgery is no more than 2 hours, if there are no complications.

Removing the septum

Deformations on the removed septum are cut off and reinserted

This method of treatment is considered quite common; the septum can be removed under various external influences, severe bruise, fracture or displacement. Plastic surgery is divided into two types: complete or partial removal.

In the first case, the entire area of ​​the deformed septum is removed. The operation is performed under general anesthesia and may leave small cosmetic stitches. Plastic surgery helps restore nasal function and reduces the growth of the mucous membrane.

Partial excision involves cutting off a small area of ​​cartilage tissue that is curved and the mucous surface. This method is characterized by improving the patient’s well-being and normalizing breathing.

Partial or complete removal of the septum can be carried out both in private clinics and government institutions.

Rehabilitation

After the operation is completed, tampons with antibacterial and hemostatic compounds are placed in the nose for a day. If the operated area continues to bleed, the used tampons are replaced with new ones and left for another 1 day. If necessary, the nose is additionally fixed with a gel bandage. During this period you have to breathe through your mouth.

The following symptoms may occur:

• pain in the upper jaw;
• migraine;
• dry mouth and thirst;
• increased body temperature;
• dizziness, loss of strength, drowsiness.

During the rehabilitation period, doctors recommend taking antibiotics, hemostatic medications, and pain-relieving medications.

For successful tissue healing it is necessary:

• drink drinks that are not too hot;
• do not take a warm bath or hot shower;
• do not blow your nose forcefully;

• after removing the tampons, rinse the nasal passages every day with antiseptic and saline solutions;
• For a month after the operation, you should refrain from going to the bathhouse, heavy physical activity, and drinking alcohol.

Typically, patients spend the first 5-6 days after correction of the septum in the hospital, but discharge is possible already on the second day after removal of the hemostatic tampons, subject to daily visits to the doctor.

Free breathing is not restored immediately; at first, swelling remains in the nasal passages. Most patients regain the ability to fully breathe and smell within 7 days, but for some, recovery takes a month.

Video when you need to do the operation:

Complications

A deviated nasal septum (correction surgery is quite simple) is rarely accompanied by complications.

Unpleasant symptoms during the rehabilitation period can manifest themselves as follows:

• bloody discharge from the nose;

• poor sense of smell;
• hematoma is a blood-filled cavity between the mucous membrane and cartilage or bone tissue;
• inflamed ulcers;
• unnatural, sinking shape of the bridge of the nose;
• adhesions in the nose;
• chronic sinusitis;
• opening connecting the nasal passages.

Types of nasal septum correction

Laser surgery to correct the nasal septum is performed using two methods:

• Corrective – the laser beam heats up the cartilage, making it flexible. The cartilage tissue is given the required shape, secured with a cotton swab. This method can be used only if there is no deformation of the bone tissue. The operation lasts only 20 minutes. It is safe, there is no risk of injury, no bleeding. After the procedure, the patient can go home immediately. It is worth considering that this type of treatment is rarely used in practice, since it is only suitable for straightening isolated cartilage.
• Plastic - in essence, this method is similar to classic nose surgery. The advantage of laser surgery for a deviated nasal septum is that the beam seals the vessels, so blood loss is significantly lower than when working with a scalpel.

IMPORTANT! The laser cannot be used in all cases. The laser beam affects only cartilage tissue, but it is powerless against bone tissue. Also, it is not able to remove ridges and thorns, but is prescribed only to give the correct shape. In addition, the laser is powerless in cases of deviated septum due to the opportunistic factor.

See how a septum is corrected with a laser:

Classic surgical correction of the nasal septum is an intervention using a scalpel with or without an endoscope. Depending on the complexity of the deformation, several operations are distinguished:

• Redressing the nasal septum - an incision through one nasal passage with dissection of the cartilage tissue at the site of deformation;
• Bilateral dissection of cartilage tissue. All work is carried out under control through an endoscope. The incisions are made inside the nasal passages, so no scars are left.

See how the operation is performed surgically:

Radio wave correction is a quick and painless procedure performed with the Surgitron apparatus and an endoscope. Duration – 1-1.5 hours. Rehabilitation – no more than 3 days in hospital. The radio beam evaporates the cells, the capillaries close immediately, so there is no bleeding. The development of infection is almost impossible, since local disinfection with radio waves occurs at the incision site. Using the beam, you can work out an area in great detail without touching neighboring tissues. This is very convenient, since the affected area is significantly reduced.

Ultrasound correction is used in cases where the curvature is minimal. The method is called ultrasonic cristotomy. A special tool - an ultrasonic saw - removes the ridges and spines of the septum. But defects should be minimal.

Contraindications for surgical treatment

Septoplasty is prohibited in the following cases:

1. The presence of a concomitant inflammatory process in an acute form or in an aggravated chronic form.
2. Coagulopathy is a blood clotting disorder.
3. Tuberculosis of the lungs and upper respiratory tract.
4. Menstrual bleeding and the first week after it.

   
   Deviation of the nasal septum cannot be done during menstrual bleeding and the first week after it. The operation is done later.

5. Atrophic changes in the epithelium of the nasal septum.
6. Psychical deviations.
7. Decompensation of somatic pathologies.
8. The patient's age is over 50 years or younger than 16-18 years.

Treatment

A crooked nasal septum is an anatomical problem, so it is impossible to straighten the plate with medication. If, as a result of its deformations, breathing and hearing disturbances are noted, a disorder of smell develops, the middle concha is additionally enlarged, or hypertrophy of the lower one is observed, we will definitely talk about surgical interventions, mainly traditional ones - septoplasty or endoscopic surgery. In rare cases, a deviated septum can be corrected with a laser.

Treatment without surgery

Conservative therapy can be aimed at eliminating chronic inflammation, polyps, adenoids (a consequence of a deviated septum), helping to alleviate the condition of allergic diseases, restoring breathing and strengthening the immune system. However, correcting a crooked septum is impossible, so doctors question the effectiveness of such treatment. Mostly experts can advise:

• removal of adenoids, polyps;
• osteopathy (manual therapy);
• a long course of drugs to eliminate swelling.

Operation

The doctor may recommend surgical correction of the curvature in case of serious deviations in the development of the cranial bones, which provoke a large number of complications: among them, concha hypertrophy, persistent sinusitis, and the inability to breathe through a narrowed nostril. Surgery is performed only on persons over 16 years of age (exceptions are possible). Resection of the nasal concha can be performed with an endoscope, which is less painful. In case of severe injuries, rhinoplasty is performed simultaneously with classical surgery.

Laser chondroseptoplasty

Classic septoplasty is performed only in cases of severe forms of curvature, and for minor deformities the doctor may suggest laser treatment. This method is used only if it is necessary to straighten the cartilage tissue - the laser will not perform resection of spines and correct the bending of bone tissue, nor will it help with traumatic curvature. According to reviews, the procedure is painless, but it is not recommended for children and elderly people.

Is it possible to treat a deviated nasal septum without surgery?

There are no reliable methods to straighten the septum without resorting to surgery. Using alternative methods aimed at relieving the symptoms of deformity, it is important to contact experienced specialists so as not to aggravate the situation.

The following methods are most widespread among opponents of the operation:

Correcting the nasal septum at home

A severe deformation of the septum cannot be corrected on its own, because it involves bone and cartilage tissue. Treatment of curvature is allowed at home if it is minor. In this case, therapy is determined by the use of massages, clothespins, and traditional medicine is also used, which help improve breathing and ease general symptoms.

In other cases, when the displacement is noticeable, the signs are clearly expressed, only surgical intervention will help. Because it is necessary to pierce the septum, make a small incision and give the plate the correct shape, securing it with a cosmetic stitch.

Is it possible to prevent deviated nasal septum?

In order to prevent deformation of the central plate of the nose, it is necessary:

• promptly treat ENT diseases;
• avoid traumatic activities;

• strengthen the immune system.

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Where can I have the operation and how much does it cost?

The total cost of septoplasty is calculated depending on several factors:

• types of surgical intervention;
• type of anesthesia;
• degree of nasal deformation;
• list of measures aimed at restoration.

A deviated nasal septum can be corrected free of charge by contacting the clinic at your place of registration. The ENT specialist will issue a referral to a regional hospital, where you will need to stand in line and undergo all the required tests. After some time, an invitation for surgery will follow.

The disadvantage of this route is that you cannot choose your own surgeon. The specialist may be a beginner, although interns are usually supervised by more experienced doctors.

The cost of a standard operation, which also includes a hospital stay, is about 20,000 - 100,000 rubles. Often the price is increased, explaining this by using wave scalpels, but given the minimal size of the incisions, the use of expensive equipment may not be justified.

Prices for laser septoplasty vary from 30,000 to 40,000 rubles.

The operation to correct the curvature of the nasal septum, as well as the rehabilitation period, under the supervision of a qualified specialist, takes place without serious complications. If there are indications, you should not postpone surgical intervention and endure unpleasant symptoms. After surgery, it is important to monitor the healing process in order to detect abnormalities in time.

Article design: Oleg Lozinsky

Where is the best place to have septum plastic surgery?

In public clinics, correction of the nasal septum is carried out using the Killian method. It is worth mentioning that this is an outdated technique, it is quite traumatic.

In recent decades, many modern minimally invasive techniques have appeared that can reduce the rehabilitation period:

• endoscopic septoplasty;
• laser

All these types of interventions are not carried out under the compulsory medical insurance policy.

It is up to the patient to decide which clinic to go to, paid or free. Money is on one side of the scale, health is on the other. Of course, if there are no financial possibilities, then there is no choice, but if there is money, then it is better to do the operation for a fee. Plastic clinics that do not operate under compulsory medical insurance have the latest equipment, which can be used to perform interventions with the least amount of tissue damage.

If you decide to save money, you need to do the following:

1. Visit an ENT specialist.
2. Get tested.
3. Receive a referral on Form 057 for surgery.

Article on the topic: Paid clinics under compulsory medical insurance, treatment and a list of services under the policy.
The surgeon decides what type of anesthesia to choose, local or general.

Note! You can get septoplasty under compulsory medical insurance at the National Medical Research Center of Otorhinolaryngology "FSBI NMITSO FMBA of Russia", at the Institute of Otorhinolaryngology named after. L. I. Sverzhevsky.

In general, we would like to note that free does not mean bad. The main thing is to choose a qualified surgeon, then the operation will be successful.

Video on the topic of the article