Definition and Overview

Deviated nasal septum is a physical disorder of the nose that occurs when the wall (nasal septum) that separates the two nostrils shifts away from the centre, making one nasal passage smaller than the other.

Also referred to as nasal septum deviation, the condition is very common, affecting about 80% of the world’s population. However, it only becomes a problem if it causes nasal congestion, breathing difficulty, and drainage issues that result in chronic sinus infection. Medications can be used to treat symptoms, but the definitive cure for severe cases is a surgical procedure called septoplasty.

Causes of Condition

Nasal septum deviation can be caused by a congenital disorder or trauma to the nose. There is one theory suggesting that it occurs during vaginal childbirth in which the nasal septum suffers from microscopic bone and cartilage fractures due to pressure.

A deviated septum can also occur as a result of a nose injury or trauma to the nose during active play, contact sports or automobile accidents. Other possible causes include repetitive cocaine use and some genetic connective tissue disorders including Homocystinuria, Marfan syndrome, and Ehlers-Danlos syndrome.

Older people are more prone to developing the condition than younger individuals because ageing causes the cartilage in the nose and connection between them to stretch and grow.

Key Symptoms

Many people with a deviated septum do not experience any symptoms. In fact, many are not even aware that they have it. However, when it is severe, the following signs and symptoms can be observed:

  • Frequent nosebleeds - If the septum is deviated, the air that enters the nose hits the curve of the septum, making its lining dry and more prone to cracking. This increases the risk of nosebleeds.

  • Obstruction of the nostrils - The most serious symptom of a deviated septum is breathing difficulty because one or both nostrils are obstructed. This symptom is more noticeable when a person is suffering from allergies or upper respiratory infection.

  • Facial pain - Some patients suffer from pain around the eye and over the cheek.

  • Snoring

  • Dry mouth due to chronic mouth breathing

  • Recurring sinus infections

  • Disturbed sleep

  • Headaches

  • Post-nasal drip

  • Noisy breathing during sleep

Who to See and Types of Treatments Available

A deviated septum is diagnosed during a physical examination. The doctor will visualise the nasal septum using a bright light and a nasal speculum. If more information is required to make a diagnosis and assess the severity of the condition, a computed tomography (CT) scan is also carried out.

The initial treatment for a deviated septum focuses on relieving symptoms using medications. Nasal tissue swelling and allergy symptoms can be adequately managed with decongestants, antihistamines, and nasal steroid sprays.

If the condition is not responding well to medications or if the symptoms are severe, a surgical procedure called septoplasty is considered. The surgeon will review the patient’s medical history to ensure they qualify for surgery and discuss its expected risks and benefits to manage patient expectations.

Septoplasty is a routine procedure performed under local or general anaesthesia on an outpatient basis. It normally takes between 60 and 90 minutes.

For the procedure, the surgeon will make an incision on one side of the nose to access the septum. The mucous membrane, or the protective covering of the septum, is then gently lifted, allowing the surgeon to trim, reposition, or replace cartilage or bones. Stitches and soft silicon splints are sometimes used to hold the membrane and septum in place until they are fully healed.

Septoplasty is a fairly safe procedure. However, there’s a small risk of complications, such as:

  • Scarring

  • Bleeding

  • Perforation of the septum

  • Infection

  • A decreased sense of smell

  • An adverse reaction to the anaesthetic used

  • Septal haematoma

  • Numbing sensation in the upper gum or teeth

Most people are satisfied with the results of septoplasty and enjoy long-lasting symptoms relief. However, some patients suffer from the same symptoms even after surgery and have to undergo revision septoplasty to achieve the desired results.

References:

  • Liong, Kyrin; Lee, Shu Jin; Lee, Heow Pueh (2013). "Preliminary Deformational Studies on a Finite Element Model of the Nasal Septum Reveals Key Areas for Septal Realignment and Reconstruction." Journal of Medical Engineering. 2013: 1–8. ISSN 2314-5129. doi:10.1155/2013/250274.

  • Goyal, P. (n.d.). Septoplasty and turbinate surgery. http://care.american-rhinologic.org/septoplasty_turbinates

  • Mayo Clinic Staff. Deviated septum. http://www.mayoclinic.com/health/deviated-septum/DS00977

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