Deviated Septum

The cartilage and bone between the two nostrils that divides the inside of the nose into a left and right side is known as the nasal septum. There is no such thing as a “perfectly straight” nasal septum. A deviated nasal septum occurs when the nasal septum is deflected into one or both sides of the nose and causes symptoms such as difficulty breathing.  Medical conditions caused by a deviated septum include snoring, sleep apnea or even sinus infections. A deviated nasal septum may inherited from your family, from normal aging, or as a result of trauma. Diagnosis of a deviated nasal septum is based on a complete history and examination of the nose.

nasal septum side view

Side View of Nasal Septum

A significant amount of people experience some type of nasal airway obstruction. This can include allergies, nasal polyps, nasal valve collapse, inferior turbinate hypertrophy, or a deviated septum. Some people have poor airflow through the nose, but if it does not bother them or cause symptoms, they do not need to address the obstruction. A deviated septum will require treatment only if it decreases your quality of life. You should seek treatment if you become aware that your breathing is poor. Allergens and pollution, especially in major cities like New York, can increase inflammation inside your nose and further compromise breathing.

What are enlarged turbinates?

Turbinates are the large mucosal covered bony structures on either side of the nasal septum inside the nose. Enlarged turbinates, or turbinate hypertrophy, are caused by turbinate irritation or allergies and may grow to fill an area left by a deviated nasal septum. The swelling may be treated by nasal sprays or oral medication. Allergy testing may be needed to determine the triggers that contribute to the nasal congestion, so they can be avoided or treated.

deviated septum surgery catscan

Sinus CT scan of a Deviated Nasal Septum

Causes of a Deviated Septum

A deviated septum can be caused by compression of the nasal area during childbirth. It also has a significant appearance as a normal family trait or with genetic conditions such as Ehler-Danlos syndrome, Homocystinuria and Marfan syndrome. It can also be caused by a blunt impact injury to the nose area of the face.

Symptoms of a Deviated Septum

Symptoms of a deviated septum almost always include nasal obstruction. This nasal congestion is typically chronic and generally manifests itself more on one side than the other. Another symptom is irritation of the nose at the front of the septum on the deviated side. This can lead to frequent nosebleeds, crusting on that side, and facial pain in that area of the nose. Other common symptoms of a deviated septum include headaches and postnasal drip. A deviated septum can also predispose you to episodes of acute or chronic sinusitis.

Another sign that can be brought on or worsened by a deviated septum is loud breathing and snoring during sleep. This is usually something a bed partner will let you know about. Nasal obstruction can also cause or contribute to obstructive sleep apnea. If you feel tired during the day, have morning headaches, are told that you snore loudly or stop breathing while you are sleeping, you have symptoms of sleep apnea and want to get it checked out. The type of sleep apnea caused by nasal obstruction is known as obstructive sleep apnea (OSA), but no matter the type, the patient is rarely aware that he has the condition, even after waking. The condition can exist for years or even decades without diagnosis. When left untreated, sleep apnea can cause heart and lung problems as well as a general decrease in your productivity and quality of life.

what is sinus surgery side by side

Deviated Septum After Surgery

Deviated Septum Surgery

To straighten the nasal septum, a corrective surgical procedure called a Septoplasty is performed. Septoplasty may be indicated when medication and other treatments have failed. The purpose of the procedure is to allow easier breathing, decreased snoring, or improved sinus function. Dr. Bennett works through the nostrils to straighten the twisted cartilage and bone. The surgery is normally performed as an outpatient procedure. Most of these surgeries will take approximately sixty minutes and general anesthesia is usually required. You will usually go home about an hour after surgery. Dr. Bennett rarely finds it necessary to pack the nose.

If there are cosmetic deformities of the nose, the surgery may be combined with rhinoplasty — a procedure then called a septorhinoplasty.

The deviated portion of the septum is removed leaving a straighter and better functioning nasal cavity. If a full septorhinoplasty is conducted, a week or two of swelling and bruising afterward is normal. If just the septoplasty was performed, there will be little or no swelling on the outside of the nose.

Turbinate surgery, or turbinoplasty, may also be necessary when medication and allergy avoidance do not improve breathing. The turbinate size is reduced by outfracturing or removing the front of the enlarged inferior turbinate bone and shrinking the mucosa. Breathing will usually get better over the first couple of weeks and can i continue to improve over the next year or more. Turbinoplasty and septoplasty can be combined with sinus surgery as well as with rhinoplasty (nasal reshaping surgery).

 

More frequent complications of septoplasty include:

  1. Nasal septum bending or shifting after surgery.
  2. Crusting inside the nose.
  3. Nosebleeds.
  4. Persistent congestion or obstruction.

Some very rare complications of septoplasty include:

  1. Nasal septum perforation.
  2. Septal hematoma and septal abscess.
  3. Adhesions and synachiae.
  4. Saddle nose.
  5. Dropped nasal tip.

References

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