Nasal septum deviation

Nasal septum deviation is one of the most common ailments treated by otolaryngologist. Nasal septum that divides nose into two cavities, is rarely perfectly symmetrically aligned. The decision on whether to undertake surgical correction is only made if the deviation is the cause of significant disorders of nasal patency.


Causes of nasal septum deviation


To simplify the case, you can divide the causes of nasal deformities in: congenital and acquired. Among the latter the dominant cause are nasal injuries, especially frequent in childhood and adolescence, due to increased physical activity and involvement in sports, especially contact. We have to distinguish traumatic nasal septum deformations and deformations of the external nose, as in the nasal septum deviation septoplasty provides an opportunity to reduce the complaints, in the case of an external nasal deformity to achieve a good functional and cosmetic effect, rhinoplasty surgery is required, or a combination of these operations (septorhinoplasty).


Among traumatic nasal deformation, a typical example is the luxation of quadrangular cartilage. Often, however, patients do not recall any injury to the nose (which of course does not exclude the fact of injury), and the nasal septum deviation is manifested in the form of dislocation of cartilage or bone, located in the posterior part of nasal septum, beyond the reach of the forces acting at the time of injury – if so we assume that there is a congenital deformity. The reason for this is believed to be among the disorders of the growth rate of cartilage and bony nose, as well as micro-crakcs that happened in utero. Remembering that perfectly straight nasal septum is rare, some inherent deviations of this type, that do not cause discomfort to the patient, may be considered as physiological.


Indications for surgery


As much deviation of nasal septum is not an indication for surgery, you can not assess indications for surgery based only on rhinoscopic examination or evaluation of computed tomography( classic X-ray do not bring a lot of information in the diagnostic process, hence the move away from their performing in the favor of the CT scan ). Many times even substantial nasal septum deviation does not give problems if nasal patency is good and do not co-exists other anatomical dissimilarities.


It is therefore important to gather medical history from the patient and determine together the impact of the symptoms caused by deviation of the nasal septum in his daily functioning.


The symptoms of nasal septum deviation are:


  • Nasal permeability disorders - a feeling one or both sides "clogged" nose
  • impaired sense of smell
  • recurrent infections of the paranasal sinuses and throat and chronic persistent rhinitis
  • periodically recurring hearing problems caused by difficult of equalizing pressure in the middle ear
  • bleeding from the nose
  • headaches


Only after collecting medical history from the patient regarding these complaints and examining the patient follows the process of qualifications for possible surgery. This decision should always be based on an interview between a doctor and a patient, where one (the patient) makes clear his problems and expectations, and the other one (otolaryngologist) shows the potential results. There are many important additional circumstances, such as:


  • age of the patient
  • associated diseases (eg concomitant allergies, diabetes, and other diseases that can impair the healing process)
  • other anatomical dissimilarities in anatomy of the nose
  • Additional factors such as the patient's occupation


Shape change of the nose after surgery


As briefly mentioned earlier, nasal surgery - as the name suggests concerns septum, not the bone or cartilage nose scaffold. Do not expect change of the look of the nose after nasal septum surgery. But sometimes it happens that the removal of the deformation within the anterior aspect of the nasal septum, may cause a discreet lower tip of the nose or change in the shape of the columella. Typically, these changes are not noticeable even to relatives of the patient. However, among the possible complications of nasal septum surgery is a breakdown of nasal septum skeletal due to loss of support due to overly extensive resection of deviation – but fortunately they are rare.


Surgery and postoperative healing


Many patients fear of pain related to the operation and recovery period. The procedure is performed in the Department of Otolaryngology, Medical University of Warsaw under general anesthesia, and therefore does not involve any pain during surgery. The pain may occur during the healing and recovery – effective pain medications are used then.


Another problem is tamponade, which is a kind of dressing that stops bleeding, inserted at the end of surgery and being removed after 24 – 48 hours after surgery. Usually the first day after surgery is a source of some discomfort for patients, but it is usually associated with the need to breathe exclusively by mouth (as the nasal cavity filled with tamponade). Worth noting that currently pneumatic dressing is used more often, topped with hydroxyethyl starch with excellent bleeding stopping, much better tolerated by patients.


Usually the day after surgery, nasal tamponade is removed, which is usually associated with short-term bleeding from the nose and the patient usually leaves the clinic on the same or next day. After removal of the tamponade, patients are recommended to flush nose with saline or similar solutions, which allows for a faster decrease in the post-operative swelling of tissues, promotes the rapid removal of blood clots from the nose after operation and faster recovery.


Typically, patients are recommended to refrain from work for 7 to 14 days, due to the necessity to avoid exertion (this may be the cause of bleeding) and due to the a limited permeability of the nose and therefore worse concentration and exercise tolerance. Typically, during this period, the patient reports on a control visit, during which the otolaryngologist remove teflon plates left in the nasal cavity for stabilization of the new nasal septum. It is usually painless procedure.


Keep in mind, opting for surgery, it is never possible to determine nasal permeability after surgery by a referring doctor, so be sure to take into consideration the differing effects of the treatment. Each patient is different and experiences can not be moved (good or bad) with third party on each other.


Grzegorz Januszek MD, Arkadiusz Paprocki MD