The main function of the nasal septum is the correct distribution of air flows between the right and left halves of the nasal cavity.
The nasal septum divides the inhaled air into two equal streams, which ensures their linear movement along the respiratory tract. Optimal conditions are achieved for the nasal cavity to perform its functions (warming, cleansing, humidifying the air). If the configuration of the nasal septum is disrupted, these functions are also disrupted.
In a newborn baby, the nasal septum is always straight and even. It is difficult to distinguish between the bone and cartilaginous parts: almost all of it is cartilage, in which there are several foci of ossification. Gradually they turn into bones and grow together. Violation of this process leads to the occurrence of curvature of the nasal septum. The initial causes of violations that occur cannot always be accurately determined.
Causes of a deviated nasal septum
Classification of causes of deviated nasal septum
| Physiological reasons : associated with heredity and impaired growth of the skull bones. | Traumatic causes | Compensatory reasons : the nasal septum is deformed due to the presence of other pathological formations in the nasal cavity. *** |
| According to statistics, a deviated nasal septum is more common in teenage boys and men. This is the population among which skull and facial injuries are most common. As a result of a strong blow, the nasal bones are displaced. It can lead to curvature of the nasal septum, even if it is minor. The most severe deformities are caused by improper fusion of the nasal bones after a fracture. |
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Consequences that can result from a deviated nasal septum
Swelling of the nasal turbinates
Due to deformation of the nasal septum, the air flow changes. This irritates the mucous membrane, and subsequently the nasal turbinates swell.
They increase in size, fill the nasal cavity and close the entrance to the sinuses. This contributes to the manifestation of the so-called “greenhouse effect”, which can cause purulent sinusitis, polyps and cysts.
Another consequence of swelling of the nasal turbinates is the feeling that mucus is flowing down the back wall of the throat, and patients also complain of a lump in the throat that does not go away. They want to cough up, spit out this lump, but they can’t. The fact is that the edema does not allow physiological fluid to pass through the larynx, which is released, and it seems to “get stuck”.
Problems with nasal breathing (to complete absence)
The most common symptom of a deviated septum is difficulty breathing or no breathing. Most often, once in this situation, patients quickly realize the need for septoplasty, since it is difficult to live with complicated nasal breathing.
Sinusitis of the paranasal sinuses
Sinusitis is an inflammation of the sinuses. This disease can occur due to the fact that a deviated nasal septum blocks the outflow of inflammatory secretions and mucus from the sinuses, and this will lead to their inflammation (sinutitis). Sinusitis can provoke the development of the following complications:
- pharyngitis (inflammation of the mucous membrane of the back of the throat);
- bronchitis, pneumonia (pneumonia);
- otitis (inflammation of the ears);
- meningitis (inflammation of the lining of the brain or spinal cord).
Snoring and mouth breathing = problems with ENT organs
A deviated nasal septum is one of the most common causes of snoring. Daily snoring and mouth breathing can lead to:
- tracheitis (inflammation of the trachea: upper respiratory tract);
- laryngitis (inflammation of the mucous membranes of the larynx);
- sinusitis.
Oxygen deficiency of the brain
The main signs of oxygen deficiency are:
- drowsiness;
- fatigue;
- fatigue;
- lethargy.
Often doctors, when examining these patients, shrug their shoulders and cannot find the true reason for this feeling. Patients spend a lot of time trying to get a correct diagnosis. But everything is quite banal: due to the curvature of the nasal septum, swelling of the nasal turbinates occurs, which complicates the access of oxygen to the brain.
How is a deviated nasal septum treated?
As already noted in this article, a deviated nasal septum is essentially a violation of the structure (anatomy) of the nasal cavity. Therefore, the only treatment for this disease is surgery. The operation is a plastic one and is performed through the nose – endonasally. Therefore, no incisions are made on the facial skin. The purpose of the operation is to remove, model (remove) and reimplant back the part of the nasal septum that was curved while preserving the mucous membrane. The operation is called septoplasty. The operation can be performed under endoscope control (endoscopically). I would like to draw your attention to the fact that ONLY SMALL curvatures of the cartilage can be operated on using a laser , however, this type of surgery is suitable for less than 1% of patients . I will not dwell on the intricacies of the operation, but I will note several points related to it. I will only say that a qualified ENT surgeon will always select the optimal method of surgical intervention for the patient. Unfortunately, patients often come to me who are focused not on the result, but on the treatment method. THOSE. they say: “I want to operate on the septum with a laser” or “operate on me with an endoscope”... Yes.., the Internet does its job, but believe me, dear patients, one or another surgical method is not always applicable. Personally, I know all the known methods of nasal septum surgery, but what exactly I can offer the patient is determined during a face-to-face consultation
- The operation is performed in a hospital (ENT department), as planned: the patient undergoes the necessary examination on an outpatient basis, and then is admitted to the hospital. The duration of hospitalization, as a rule, does not exceed 3-4 days. If you are interested, I can send the list of necessary examinations to my email upon request.
- The operation must be performed by a qualified ENT surgeon.
- Pain relief for this operation can be local or general (anesthesia). With local anesthesia, the operation is similar to dental treatment. The patient is injected with an anesthetic solution into the nasal mucosa. If the patient wishes, the operation can be performed under general anesthesia. In our clinic it is possible to perform surgery under any type of anesthesia. Personally, I never insist and suggest that the patient independently choose the method of pain relief.
- In children, the operation is performed when they reach 14-16 years of age, and in case of severe nasal breathing disorders - from the age of 6. Only general anesthesia is performed.
- The duration of the operation depends on the experience of the surgeon. I often hear during consultations that the patient was told that the operation would take 2 hours, or even more... Personally, I perform the operation for about 15-20 minutes
- After the operation, special tampons are inserted into the patient's nasal cavity, which are removed after 24 hours. Currently, small latex tampons or gel tampons are used, as well as special sponge tampons with a small tube inside, which allows the patient to breathe through the nose after surgery .
- The patient's ability to work is restored within 5 to 7 days. After surgery, the patient should avoid physical activity for a month.
- In the presence of exacerbations of concomitant chronic inflammatory diseases of the nasal cavity (for example, chronic sinusitis, sinus cysts, polyps), it is possible to perform several operations at the same time. I prefer not to separate operations.
- Since the operation is not accompanied by significant blood loss, it is not performed on women during menstruation.
- Complications from this operation are rare. These include: nosebleeds, perforation (violation of the integrity) of the nasal septum, synechiae (fusion) of the nasal cavity.
- After the operation and removal of tampons, it is mandatory to perform a nasal toilet at least once a day for a week, which should be performed by an ENT doctor at a hospital or clinic.
In conclusion, I would like to note that it is better to undergo surgical treatment, which will take no more than a week, than to experience impaired nasal breathing and its consequences throughout your life. Personally, I have performed more than a thousand operations to correct the nasal septum and I can say with confidence that patients tolerate it well.
For questions regarding the operation, you can contact the author. See CONTACTS
Sincerely, ENT surgeon, Candidate of Medical Sciences, Head of the surgical ENT department of the clinic for diseases of the ear, nose and throat, First Moscow State Medical University named after I.M. Sechenova Petr Aleksandrovich Kochetkov
[email protected] 8-962-957-11-22 8-495-978-65-07
| Use of materials from the website of Dr. Kochetkov P.A. on other Internet resources is allowed if there is an active hyperlink to the site. Any other use of materials without the written consent of the author is prohibited! |
Is it necessary to have septoplasty if nothing bothers you?
Be careful: even with a deviated septum, your nasal breathing may not change in a way that you will notice. In this case, you must follow all the instructions of your treating otolaryngologist.
In such cases, loss of nasal breathing function may occur after several years, when compensation from other structures has passed.
The sooner you find out whether you have a deviated septum or not, the better for your health.
Are there any other ways to treat a septum?
No, the curvature can only be corrected through surgery. The only difference is that the surgery can have different volumes, determined by the doctor during diagnosis.
Indications
In mild cases, when the deformation of the septum does not interfere with the movement of air, surgery is not indicated. Surgical correction is necessary if:
- breathing through the nose is so impaired that the quality of life suffers;
- sinusitis (inflammation of the mucous membranes of the paranasal sinuses) recurs;
- frequent nosebleeds;
- significant cosmetic defect;
- pronounced snoring.
Figure 2. On the left is a deviated septum.
On the right - healed, after surgery. Source: houstonadvancedsinus.com Sometimes septoplasty is performed as a stage of a complex operation to correct maxillofacial malformations (cleft palate or cleft lip).
Differences of septoplasty
Partial removal
In case of any local (small) curvature of the septum (in cases where it protrudes towards the side wall of the nose), an operation is performed during which only that part of the septum in which locally changed cartilage or bone is present is removed. At the Pirogov clinic, only partial removal with correction is practiced, and we use endoscopic equipment.
Removing all hard base
One of the complex operations is the complete removal of the hard base of the septum: the specialist will remove both the bone and the curved cartilage. He will fix them and put them back. This method is considered outdated; it is not used in Pirogov’s clinic.
Endoscopic equipment
Previously, septoplasty was performed using a special hammer. It was a rather bloody method. Nowadays, endoscopic equipment is used to ensure minimal trauma, more careful operation and faster rehabilitation. Therefore, you don’t have to worry that they will break something for you. In fact, doctors will very carefully and with the help of specialized instruments lift the nasal mucosa (without damaging it in any way), carry out all the necessary manipulations, and then put the mucous membrane back in its original place.
By the way, in the Pirogov clinic on Vasilievsky Island, endoscopic septoplasty is most often performed (using a special device - an endoscope). It differs from other methods in that it involves the least amount of trauma, which leads to rapid rehabilitation of the patient.
Preparing for surgery
First of all, you need to conduct a thorough diagnosis. Diagnostics is carried out in several stages:
- Examination and consultation with an ENT doctor. The doctor examines the outer part of the nose to see if there are any visible abnormalities.
- Checks breathing through each nostril separately to identify difficulty breathing
- Evaluates the sense of smell: right and left nostrils, finding out how much it is damaged
The anterior one is carried out with a nasal dilator, each nostril is examined separately.
During posterior rhinoscopy, the nose and nasopharynx are examined
- If the examination is unsatisfactory, tests and additional laboratory tests are prescribed: x-ray
- computer graphics
- endoscopic examination
- taking tests
Rehabilitation after septoplasty
At the Pirogov Clinic, the patient is discharged after septoplasty the very next day! At the very end of the operation, tampons will be placed in your nose to help fix the new septum in the desired position. After some time (depending on the complexity of the surgical intervention), they will be removed for you (it won’t hurt as much as before), and then you will remember what it means to “breathe deeply.”
It is worth noting that tampons have also changed: if previously they were long and homemade (from bandages), now small tampons are used that absorb blood, but at the same time heal the mucous membrane. Also, modern tampons enlarge and occupy the nasal cavity, thereby squeezing the vessels to prevent bleeding.
You should not put any strain on your body for 1-2 weeks, although you will not need bed rest. For a quick recovery, it is important to correctly follow all the instructions of your treating specialist.
What types of surgery are there?
There are two options for nasal septum correction: the traditional open method and the endoscopic method. The first involves direct access to the osteochondral wall through the nostrils. The second allows you to visualize the surgical field in all details using an optical device - a rigid endoscope. Such operations are performed quickly, and the risk of postoperative complications is negligible.
Types of septoplasty:
- The traditional open method (submucosal resection of the nasal septum) involves direct access to the osteochondral wall through the nostrils.
- Endoscopic method - allows you to visualize the surgical field in all details using an optical device - a rigid endoscope. Such operations are performed quickly, and the risk of postoperative complications is negligible.
About physiological factors
In newborns, the nasal septum consists mainly of cartilage with small areas of ossification. As it develops, bone tissue is formed and its posterior part is transformed. The nasal plate is finally formed by the age of 10; as a rule, it is perfectly smooth. With age, the cartilaginous septum can become deformed due to physiological factors.
- Imbalance between bone and cartilage tissue. During development, tissue formation may be uneven. Such curvatures are manifested by a displacement of the cartilaginous septum to the side or the appearance of characteristic ridges and pronounced spines.
- The bones of the skull develop unevenly. This can lead to changes in the size of the nasal cavity and the septum does not have enough space and becomes deformed.
Postoperative care and observation
- — in a hospital, postoperative care includes, first of all, the regime and observation by a doctor of the healing process. The patient does not perform any actions independently without the recommendation of the surgeon.
- — after discharge from the hospital, the patient spends the first week at home. It is recommended to maintain a home regime, avoid increased physical activity, crowded places, and follow the recommendations. Often, nasal rinsing with large volumes of saline solution, up to 1 liter (Dolphin, Aqua-Maris, etc.) is prescribed.
- — after returning to work, the patient must gradually enter the natural rhythm of life, slowly increasing physical activity to the usual level. Significant, exhausting loads, visits to the pool, baths, saunas, exercise in the gym, flights, business trips are recommended to be postponed for 1 month after the operation for normal recovery of the body. Often, the surgeon will schedule a follow-up examination 2-4 weeks after surgery to monitor the recovery process.
Possible complications:
Photo: Allergy & rhinology (Providence, RI) / Open-i (Attribution-NonCommercial-NoDerivs 3.0 Unported)
- uncontrolled bleeding;
- infection;
- perforation of the septum;
- changing the shape of the nose;
- impaired sense of smell;
- temporary numbness of the gums of the upper dentition;
- hemorrhage under the mucous membrane of the septum.
Cost of treatment
The complex cost of treatment for a deviated nasal septum (septoplasty in St. Petersburg) ranges from 65,000 rubles. up to 78,000 rub.
Depends mainly on the comfort of the room and the length of stay in the hospital.
You must understand that the final price does not consist of the cost of the operation itself (which is 17,500 rubles), but of the prices for all services provided during the treatment process: surgery on the nasal septum and nasal turbinates, anesthesia, hospital stay, doctor’s manipulations and nurses. In the presence of concomitant pathology, such as chronic sinusitis (sinusitis), neoplasms of the paranasal sinuses (cysts, polyps), the cost increases when eliminating this pathology.
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Diagnostics
An ENT doctor may detect a deviated septum during an examination. Bright light and a nasal speculum are usually sufficient to make the diagnosis. If concomitant pathology of the nasal structures is suspected, a computed tomography scan is prescribed.
Before the operation, the following examinations will be prescribed:
- clinical and biochemical blood tests;
- chest x-ray (especially important for patients over 45 years of age, smokers, and those with heart or lung disease);
- electrocardiogram.
Our services
The administration of CELT JSC regularly updates the price list posted on the clinic’s website. However, in order to avoid possible misunderstandings, we ask you to clarify the cost of services by phone: +7
| Service name | Price in rubles |
| Appointment with a surgical doctor (primary, for complex programs) | 3 000 |
| X-ray of the paranasal sinuses | 2 200 |
| Septoplasty | 68 000 — 98 000 |
All services
Make an appointment through the application or by calling +7 +7 We work every day:
- Monday—Friday: 8.00—20.00
- Saturday: 8.00–18.00
- Sunday is a day off
The nearest metro and MCC stations to the clinic:
- Highway of Enthusiasts or Perovo
- Partisan
- Enthusiast Highway
Driving directions
