In the nose there is an anatomical formation in the form of a vertical plate dividing the cavity into two halves. It is called the nasal septum and consists of two parts. The largest part is the back. It is motionless and formed by thin bone tissue. In the middle and front are moving parts. They are formed by cartilage and membranous tissue, respectively. The front is the smallest. If the plate is curved and interferes with breathing, nasal septum surgery may be necessary.
Symptoms of septum curvature
Deviations of the septum from the midline are dangerous, as they can make breathing difficult through one or both nasal passages. This is because the air, which normally should pass through the nose in an arcuate manner (first up to the middle nasal chamber, then down to the inner nasal openings), when bent, is forced to go along the lower nasal passage. A strong deviation of the plate from the midline in general can lead to the fact that the wing of the nose will be sucked into it due to negative pressure, and one of the nasal parts will turn off from the breathing process.
In this case, outflow of fluid from the sinuses is impaired. Because of this, a tendency to sinusitis, tonsillitis, various types of rhinitis and other inflammatory and allergic diseases can increase.
You can notice the problem in time by paying attention to symptoms such as respiratory failure, constant runny nose or sinusitis, dryness in the nose, bleeding from it, decreased smell, pain in the head and ears, snoring. The deviation obtained through trauma is also characterized by a change in the shape of the nose.
The severity of symptoms depends on the degree of curvature. If it is small, symptoms may not appear, and then treatment is not required.
Types and degrees of severity of curvature
The partition may be curved for various reasons. Depending on this, types of deviations are distinguished. So, the physiological one arises due to the abnormal development of the facial skeleton, when the growth rates of the tissues of the cartilage and bones do not correspond to each other. This may be due to heredity and is usually diagnosed in adolescence.
The curvature that occurs after the growth of the mucous membrane, the impact on the cartilage of a foreign body or some other irritating factor is called compensatory, and as a result of a dislocation or fracture of the nasal bones - traumatic. The latter is 3 times more often diagnosed in men than in women.
Depending on the direction of deviation of the septum from the midline, an S-shaped, C-shaped or anteroposterior curvature is distinguished. It may be due to the formation of spikes, ridges, thickenings, dislocations of the quadrangular cartilage. In children, it can occur during childbirth (congenital) or after them (acquired).
According to the severity of the curvature, three degrees are distinguished, where I means slight deviations, II - the protrusion of the site halfway between the median line and the lateral surface of the nose, III - the practical touch of part of the septum of the side surface.
Conservative and surgical treatment and diagnosis
A slight curvature, difficulty breathing in which is caused by swelling of the mucous membranes, is treated conservatively. For this, washing the nose, introducing vasoconstrictive drops, antibiotics, sprays and other drugs into its mucosa, laser therapy is used.
But if nasal breathing is difficult due to osteo-cartilaginous structures, sinusitis, runny nose, otitis media and eustachiitis constantly occur, blood often flows from the nose, people snore severely, and the curvature looks like a significant cosmetic defect, and the nasal septum is aligned.
In preparation for surgery, the degree of difficulty in nasal breathing is assessed. Such a study is called rhinomanometry and is carried out using a special device (rhinoscope), placed in the patient’s nose and measuring air resistance.
Additionally, a computer or magnetic resonance imaging of the sinuses is performed. This study is mandatory for concomitant diseases of the nasal mucosa. Radiography of the skull is sometimes recommended, but it does not always reflect a reliable picture of curvature.
Studies to assess the degree of curvature are performed at least two times. First, an immediate state of the nasal cavity is examined, then vasoconstrictor drops or ointments with adrenaline are applied, and the results of instrumental analyzes are compared.
If after the examination, the doctor considers the operation appropriate, the patient should begin to prepare for surgery. To do this, he submits a standard set of tests and finds out the date of the alleged hospitalization. Women better coordinate the time of surgery with the menstrual cycle and appoint it 2 weeks after menstruation. This is due to the abundant blood supply to the nasal membrane and the possible loss of a large amount of blood during surgery.
10-14 days before hospitalization, it is advisable to abandon bad habits and eliminate foci of inflammation in the body, in particular, to cure diseased teeth. Before the operation, hypothermia and the occurrence of infectious diseases should not be allowed. If the doctor insists on an additional examination before the procedure, it must be passed.
Depending on how the nasal septum surgery is performed (under general or local anesthesia), the patient is prepared on the day of the procedure. With general anesthesia, you should not eat or drink in the morning. An hour before the intervention, medications are prepared that prepare the body for pain relief.
Types of operations
In general, surgical interventions to correct deformed elements of the nose are called rhinoplasty. But in this section of plastic surgery there are several types of surgery. This is a closed, open, revision and non-surgical rhinoplasty. All of them differ in technology, but have one goal, namely, the restoration of the correct shape of the nose. Sepotoplasty stands out separately - nasal septum surgery, used to improve nasal breathing.
Rhinoplasty
In most cases, closed rhinoplasty is performed, in which either there are no external incisions, or they are located on the leg of the columella in an inconspicuous place. In this case, the patient needs general anesthesia. The operation of the nasal septum, through closed rhinoplasty, lasts about an hour.
An open type of intervention is used when a large amount of exposure to the nose is necessary. In this case, incisions are made in its cavity or in the area of the columella.
Another name for revision rhinoplasty is secondary. As the name implies, it is carried out to correct both minor and difficult problems remaining after the previous operations. According to the technology, it can be open and closed.
Non-surgical rhinoplasty deserves special attention . Its implementation is possible only with minimal defects, which are diagnosed in no more than 5-7% of patients in need of treatment. In this case, fillers, absorbable preparations or special threads can be used.
Fillers in most cases give a temporary effect from several months to a year and a half. The duration of action depends on their quality, but in any case, after a certain time, they resolve, and repeated injections can lead to changes in the structure of tissues. The exception is cases when fibrous tissue forms at the injection site. However, there is the likelihood of filler migration. Therefore, they resort to their use only because of the relatively low cost of the operation, as well as due to the short and easy recovery period.
Hormonal absorbable preparations in precisely calculated dosages are introduced pointwise into the convex parts of the elements of the nose. Irregularities are eliminated in 2-3 weeks. If necessary, the procedure can be carried out in several stages, since an overdose of the drug can lead to irreversible changes, and an insufficient amount will not be able to fix the problem.
Specialized Aptos threads tighten the necessary sections of the elements through the punctures made in the nose. But in practice, they are rarely used, since coarse scarring may form at the injection site, and it may break due to the mobility of the nose.
Septoplasty
The complexity and duration of the operation to straighten the nasal septum, called septoplasty, depends on the individual structure and condition of the plate separating the cavity. On average, it is successfully completed in 30-60 minutes. Sometimes rhinoseptoplasty is performed - a complex operation of the nasal septum, combined with correction of the shape of the nose.
Septoplasty is performed in a hospital under general or local anesthesia. The first type of anesthesia is usually used for children, and the second for adults. The doctor does not make incisions from the outside, the intervention is carried out endonasally (through the nostrils), the mucosa is dissected and pushed to the side. During surgery on the nasal septum, most of the plate is not exposed, only its curved sections are removed or rebuilt. They can be both bone and cartilage. After successfully cutting out the parts of the septum, the mucosa is sewn into place. The plate remaining in the nose is fixed with a bandage, special silicone inserts and gauze swabs saturated with hemostatic medicinal solutions, which should be in the nasal passages for 2-3 days after the operation. All this time the patient should breathe through his mouth. To reduce the discomfort of dry mouth and lips, you need to regularly drink water and juices through a straw and use hygienic lipstick.
The result of the operation of the nasal septum will depend not only on the professionalism of the surgeon, but also on the correctness of the cleaning and treatment of the nasal cavity. The first reorganization is carried out by the doctor, the subsequent ones by the patient himself. For better tissue healing, the procedure is carried out 2-3 times a week for a month.
Reviews about the operation to correct the nasal septum using septoplasty in most cases are positive. Patients report high efficacy to facilitate breathing and rapid rehabilitation after the intervention.
Laser beam exposure
A fairly innovative method is laser surgery. The curvature of the nasal septum is eliminated by heating the deformed sections of the cartilage and their subsequent fixation in the correct position with special tampons. The duration of the manipulation itself does not exceed 15 minutes, the fixation time is 24 hours. The entire procedure is performed under local anesthesia on an outpatient basis. At the same time, the patient does not feel discomfort.
The advantages of this method are minimal trauma to the tissues and virtually no blood loss. In addition, the laser has antiseptic properties. After surgery to correct the nasal septum, made using a laser, rehabilitation measures are practically not required. Due to this, the method is used quite successfully, but still it has a number of limitations. Its use is not possible with curvature of the bone part and broken cartilage of the septum, and these pathologies are observed in 90% of adults with operable curvature.
Reviews after nasal septum surgery with a laser are only good. In the absence of contraindications, it is ideal for children and adults, does not require hospitalization and allows you to quickly return to your usual way of life.
Postoperative care
A patient who wakes up from anesthesia after surgery on the nasal septum should not eat and drink cold and hot dishes and drinks, as well as soda, during the day. After removing tampons from the nose, you can blow your nose, but you need to do this very carefully to avoid bleeding. Care for the nasal mucosa is carried out by removing dry crusts, lubricating it with medicinal ointments, washing with physiological saline and agents containing sea water. Sutures are not required to be removed. In rare cases, after nasal septum surgery, the nose hurts, in which case analgesics are prescribed. Antibiotics can also be prescribed, with the help of which the prevention of infectious complications is carried out.
If the patient feels well, he will be discharged 2 days after the operation, but then he must be visited by an ENT doctor several times within a month to monitor the condition of the nasal cavity. Edema should disappear within 1-2 weeks after surgery, after which nasal breathing will fully recover without the use of drops.
If during the rehabilitation there are any problems (bleeding, severe pain a week after the operation, fever, purulent discharge), you should consult a doctor.
The consequences of a violation of aerodynamics in the nose
Sometimes, after surgery, large hematomas and abscesses form under the mucous membrane, nosebleeds begin, defects in the form of holes form in the septum, sinusitis and deformation of the nose occur. The latter happens due to the retraction of the back, when the resection of the septum is performed too high. These complications are extremely rare and they are correctable. Nevertheless, fearing them, some patients avoid nasal septum surgery, despite the indications for its implementation.
This is wrong, as the refusal of the necessary surgical intervention can lead to serious complications and greatly degrade the quality of life. The fact is that shortness of breath leads to desiccation of the nasal mucosa, as well as the accumulation of fluid in the cavity of the sinuses. Because of this, susceptibility to respiratory viral infections increases, immunity decreases. The brain does not receive 10-15% of oxygen, which negatively affects the ability to work of adults and the mental development of children.
Breathing through the mouth, the only possible with curvature, is inferior. Because of it, inflammation of the pharyngeal tonsil can occur, and also it does not allow the protective properties of nasal mucus to manifest. Not enough air enters the lungs, moreover, it is not humidified and will not warm. As a result, the efficiency of gas exchange decreases, and oxygen deficiency forms in the blood.
Another problem for patients with a curved septum may be respiratory arrest in sleep, in which pulmonary ventilation stops for 10-30 seconds. In advanced cases, stops can reach a duration of 2-3 minutes, as a result of which a person will not breathe more than half of the total sleep time. The consequences of this process will not be long in coming: angina pectoris, hypertension, headache, fatigue, decreased concentration or even depression will appear. Reflex disorders can occur: asthma, short attacks of suffocation, epileptic seizures, problems with the menstrual cycle. The organs adjacent to the nose are also affected: the Eustachian tube and middle ear, the lacrimal ducts and the lacrimal sac.
Limitations and contraindications for surgical intervention
Surgery on the nasal septum can be postponed if the patient has not reached the age of 16-18 years, since the facial skeleton will finally form only by this time. However, with severe negative consequences of respiratory failure, surgery can be performed at 14 years of age. Sometimes it is also performed for children from 6 years old or even younger, but for this, in the process of a thorough examination, it must be reliably proved that the severe symptoms are precisely the result of curvature.
Also, indications for the operation are narrowed for people over 48 years old, and in old age it is almost never performed. This is due to the fact that over the years, respiratory failure is partially compensated. Symptoms are alleviated even without surgery to align the nasal septum, especially since surgery due to mucosal atrophy is difficult, and the risk of complications increases.
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When applying to a private clinic, you can be more confident in the professionalism of the surgeon, but you will have to pay for his work. The price of the procedure will largely depend on the status of the clinic and its location. So, in Moscow, the operation of the nasal septum is usually a little more expensive than in other regions.
On average, rhinoplasty in the country costs from 35 to 250 thousand rubles, septoplasty - 20-45 thousand, laser surgery - 30-130 thousand. The final price depends on the qualifications of the doctor and the amount of work. The price also includes a preliminary examination, anesthesia and a stay in a 1-2-bed ward.
Conclusion
Ideally a direct partition can boast no more than 5% of people. However, this does not mean that the vast majority of the population requires treatment for nasal septum curvature and surgery. In fact, only 26% of people with this problem are indicated for surgical intervention, since they actually lead to difficulty breathing, and the rest is enough to monitor the hygiene of the nose, rinse it, and try to be less likely in dusty and smoky rooms.
In addition, it will be useful to everyone to avoid hypothermia and timely and completely cure colds. To prevent traumatic curvature, care should be taken when practicing extreme sports. However, if the doctor speaks of the need for surgery to straighten the nasal septum, his recommendations should be followed in order to prevent health complications and preserve the aesthetic appearance of the nose.