| Deviated septum | |
|---|---|
| Other names | Deviated nasal septum (DNS) |
 | |
| An MRI image showing a congenitally deviated nasal septum, bowed to the left between the eye sockets | |
| Specialty | Otorhinolaryngology |
Nasal septum deviation is a physical disorder of the nose, involving a displacement of the nasal septum. Some displacement is common, affecting 80% of people, mostly without their knowledge. [1]
The nasal septum is the bone and cartilage in the nose that separates the nasal cavity into the two nostrils. The cartilage is called the quadrangular cartilage and the bones comprising the septum include the maxillary crest, vomer, and the perpendicular plate of the ethmoid. Normally, the septum lies centrally, and thus the nasal passages are symmetrical. [2] A deviated septum is an abnormal condition in which the top of the cartilaginous ridge leans to the left or the right, causing obstruction of the affected nasal passage.
It is common for nasal septa to depart from the exact centerline; the septum is only considered deviated if the shift is substantial or causes problems. [3] By itself, a deviated septum can go undetected for years and thus be without any need for correction. [3]
Symptoms of a deviated septum include infections of the sinus and sleep apnea, snoring, repetitive sneezing, facial pain, nosebleeds, mouth breathing, difficulty with breathing, mild to severe loss of the ability to smell, [1] [4] and possibly headaches. [5] Only more severe cases of a deviated septum will cause symptoms of difficulty breathing and require treatment. [1]
It is most frequently caused by impact trauma, such as by a blow to the face. [3] It can also be a congenital disorder, caused by compression of the nose during childbirth. [3] Deviated septum is associated with genetic connective tissue disorders such as Marfan syndrome, homocystinuria and Ehlers–Danlos syndrome. [6]
Nasal septum deviation is the most common cause of nasal obstruction. [7] A history of trauma to the nose is often present including trauma from the process of birth or microfractures. [7] A medical professional, such as an otorhinolaryngologist (ears, nose, and throat doctor), typically makes the diagnosis after taking a thorough history from the affected person and performing a physical examination. [7] Imaging of the nose is sometimes used to aid in making the diagnosis as well. [7]
Medical therapy with nasal sprays including decongestants, antihistamines, or nasal corticosteroid sprays is typically tried first before considering a surgical approach to correct nasal septum deviation. [7] Medication temporarily relieves symptoms, but does not correct the underlying condition. Non-medical relief can also be obtained using nasal strips.
A minor surgical procedure known as septoplasty can cure symptoms related to septal deviations. The surgery lasts roughly one hour and does not result in any cosmetic alteration or external scars. Nasal congestion, pain, [8] drainage or swelling may occur within the first few days after the surgery. [9] Recovery from the procedure may take anywhere from two days to four weeks to heal completely.[ citation needed ] Septal bones never regrow. If symptoms reappear they are not related to deviations. Reappearance of symptoms may be due to mucosal metaplasia of the nose.[ citation needed ] There are times also when the surgery also may be unsuccessful, leading to a continuation of the symptoms.
A randomised controlled trial found that people who had septoplasty had a greater improvement in their symptoms and quality of life after 6 months than people who managed their nasal airway obstruction with nasal sprays. [10] [11]
Otorhinolaryngology is a surgical subspecialty within medicine that deals with the surgical and medical management of conditions of the head and neck. Doctors who specialize in this area are called otorhinolaryngologists, otolaryngologists, head and neck surgeons, or ENT surgeons or physicians. Patients seek treatment from an otorhinolaryngologist for diseases of the ear, nose, throat, base of the skull, head, and neck. These commonly include functional diseases that affect the senses and activities of eating, drinking, speaking, breathing, swallowing, and hearing. In addition, ENT surgery encompasses the surgical management of cancers and benign tumors and reconstruction of the head and neck as well as plastic surgery of the face, scalp, and neck.
Rhinoplasty, commonly called nose job, medically called nasal reconstruction, is a plastic surgery procedure for altering and reconstructing the nose. There are two types of plastic surgery used – reconstructive surgery that restores the form and functions of the nose and cosmetic surgery that changes the appearance of the nose. Reconstructive surgery seeks to resolve nasal injuries caused by various traumas including blunt, and penetrating trauma and trauma caused by blast injury. Reconstructive surgery can also treat birth defects, breathing problems, and failed primary rhinoplasties. Rhinoplasty may remove a bump, narrow nostril width, change the angle between the nose and the mouth, or address injuries, birth defects, or other problems that affect breathing, such as a deviated nasal septum or a sinus condition. Surgery only on the septum is called a septoplasty.
Nasal polyps are noncancerous growths within the nose or sinuses. Symptoms include trouble breathing through the nose, loss of smell, decreased taste, post nasal drip, and a runny nose. The growths are sac-like, movable, and nontender, though face pain may occasionally occur. They typically occur in both nostrils in those who are affected. Complications may include sinusitis and broadening of the nose.
Septoplasty, or alternatively submucous septal resection and septal reconstruction, is a corrective surgical procedure done to straighten a deviated nasal septum – the nasal septum being the partition between the two nasal cavities. Ideally, the septum should run down the center of the nose. When it deviates into one of the cavities, it narrows that cavity and impedes airflow. Deviated nasal septum or “crooked” internal nose can occur at childbirth or as the result of an injury or other trauma. If the wall that functions as a separator of both sides of the nose is tilted towards one side at a degree greater than 50%, it might cause difficulty breathing. Often the inferior turbinate on the opposite side enlarges, which is termed compensatory hypertrophy. Deviations of the septum can lead to nasal obstruction. Most surgeries are completed in 60 minutes or less, while the recovery time could be up to several weeks. Put simply, septoplasty is a surgery that helps repair the passageways in the nose making it easier to breathe. This surgery is usually performed on patients with a deviated septum, recurrent rhinitis, or sinus issues.
Upper airway resistance syndrome (UARS) is a sleep disorder characterized by the narrowing of the airway that can cause disruptions to sleep. The symptoms include unrefreshing sleep, fatigue, sleepiness, chronic insomnia, and difficulty concentrating. UARS can be diagnosed by polysomnograms capable of detecting Respiratory Effort-related Arousals. It can be treated with lifestyle changes, functional orthodontics, surgery, mandibular repositioning devices or CPAP therapy. UARS is considered a variant of sleep apnea, although some scientists and doctors believe it to be a distinct disorder.
The nasal septum separates the left and right airways of the nasal cavity, dividing the two nostrils.
A nasal septum perforation is a medical condition in which the nasal septum, the bony/cartilaginous wall dividing the nasal cavities, develops a hole or fissure.
Nasal congestion is the partial or complete blockage of nasal passages, leading to impaired nasal breathing, usually due to membranes lining the nose becoming swollen from inflammation of blood vessels.
Wry nose is a deviation of the rostral maxilla, meaning that the upper jaw and nose are deviated to one side. This usually causes the nasal septum to be deviated as well, resulting in obstruction of the airway, and breathing difficulties. Wry nose is most obvious in species with long faces, such as horses and cattle. It is a congenital abnormality, meaning that it is present at birth.In horses two groups of congenital abnormalities, namely malformations or deformations are seen. In the case of the former a frequent result is foetal abortion. These true malformations include, but are not limited to, cleft palate, heart defects, microphthalmia, microencephaly and hydrocephalus. Deformations, include wry nose and flexural limb deformities, and are due to restricted movement of the foetus in the womb.
Mouth breathing, medically known as chronic oral ventilation, is long-term breathing through the mouth. It often is caused by an obstruction to breathing through the nose, the innate breathing organ in the human body. However, by the early 20th century, the term "mouth-breather" had developed a pejorative slang meaning connoting a stupid person.
Hypopnea is overly shallow breathing or an abnormally low respiratory rate. Hypopnea is typically defined by a decreased amount of air movement into the lungs and can cause hypoxemia It commonly is due to partial obstruction of the upper airway, but can also have neurological origins in central sleep apnea.
Chronic atrophic rhinitis, or simply atrophic rhinitis, is a chronic inflammation of the nose characterised by atrophy of nasal mucosa, including the glands, turbinate bones and the nerve elements supplying the nose. Chronic atrophic rhinitis may be primary and secondary. Special forms of chronic atrophic rhinitis are rhinitis sicca anterior and ozaena. It can also be described as the empty nose syndrome.
The nasal cartilages are structures within the nose that provide form and support to the nasal cavity. The nasal cartilages are made up of a flexible material called hyaline cartilage in the distal portion of the nose. There are five individual cartilages that make up the nasal cavity: septal nasal cartilage, lateral nasal cartilage, major alar cartilage, minor alar cartilage, and vomeronasal cartilage.
The human nose is the first organ of the respiratory system. It is also the principal organ in the olfactory system. The shape of the nose is determined by the nasal bones and the nasal cartilages, including the nasal septum, which separates the nostrils and divides the nasal cavity into two.
Nasal septal hematoma is a condition affecting the nasal septum. It can be associated with trauma.
A concha bullosa is a pneumatized (air-filled) cavity within a nasal concha, also known as a turbinate. Bullosa refers to the air-filled cavity within the turbinate. It is a normal anatomic variant seen in up to half the population. Occasionally, a large concha bullosa may cause it to bulge sufficiently to obstruct the opening of an adjacent sinus, possibly leading to sleeping apnea or breathing disorder related to areas innervated by the trigeminal nerve. In such a case the turbinate can be reduced in size by endoscopic nasal surgery (turbinectomy). The presence of a concha bullosa is often associated with deviation of the nasal septum toward the opposite side of the nasal cavity.
A nasal fracture, commonly referred to as a broken nose, is a fracture of one of the bones of the nose. Symptoms may include bleeding, swelling, bruising, and an inability to breathe through the nose. They may be complicated by other facial fractures or a septal hematoma.
A turbinectomy or turbinoplasty is a surgical procedure, that removes tissue, and sometimes bone, of the turbinates in the nasal passage, particularly the inferior nasal concha. The procedure is usually performed to relieve nasal obstructions. In most cases, turbinate hypertrophy is accompanied by some septum deviation, so the surgery is done along with septoplasty.
An elongated soft palate is a congenital hereditary disorder that negatively affect dogs and cats' breathing and eating. A soft palate is considered elongated when it extends past the top of the epiglottis and/or past the middle of the tonsillar crypts. The soft palate is made up of muscle and connective tissue located in the posterior portion on the roof of the mouth. The soft palate creates a barrier between the mouth and nose. This continuation between the cavities makes it possible to chew and breathe at the same time. The soft palate only blocks the nasal cavity while swallowing. At rest the soft palate should only stretch caudally from the hard palate to the tip of the epiglottis leaving an opening between the nasal and oral cavities. When the soft palate is elongated, it partially blocks the throat thereby creating breathing and feeding-related issues. The elongation and other accompanying symptoms occur in breeds characterized with “smooshed faces” such as pugs, bulldogs, and Persian cats. This condition is a congenital, meaning it is present when the animal is born. The “smooshed” characteristics is the result of a genetic mutation. The animal’s genetic code causes the bones in their skull to grow to a smaller size. Because the bones are smaller, muscles and other tissues that surround the bones of the skull are out of proportion. These animals are often referred to as brachycephalic, derived from the Greek words for “short” and “head”. An elongated soft palate is a symptom of Brachycephalic Obstructive Airway Syndrome (BOAS) and is common in brachycephalic dog breeds and has been reported in brachycephalic cat breeds as well. Some of the other BOAS related symptoms include stenotic nares, everted laryngeal saccules, and laryngeal collapse.
Nasal surgery is a medical procedure designed to treat various conditions that cause nasal blockages in the upper respiratory tract, for example nasal polyps, inferior turbinate hypertrophy, and chronic rhinosinusitis. It encompasses several types of techniques, including rhinoplasty, septoplasty, sinus surgery, and turbinoplasty, each with its respective postoperative treatments. Furthermore, nasal surgery is also conducted for cosmetic purposes. While there are potential risks and complications associated, the advancement of medical instruments and enhanced surgical skills have helped mitigate them.
