Disease sexually transmitted:

Visceral syphilis

A deviated septum

  • What is a deviated septum
  • What triggers / Causes Curvature of the nasal septum
  • Pathogenesis (what happens) while the Curvature of the nasal septum
  • The symptoms of Curvature of the nasal septum
  • Diagnosis of Curvature of the nasal septum
  • Treatment of Curvature of the nasal septum
  • Which doctors should be consulted if You have a deviated septum

What is a deviated septum -

Nasal septum is a plate that separates the nasal cavity into two approximately equal halves. In front of it is formed by cartilage, at the back thin bone and covered on both sides with a mucous membrane.

Curvature of the nasal septum (lateral displacement, spikes, ridges) cause different according to the degree of violation of nasal breathing, until its termination. This, in turn, significantly increases the susceptibility to inflammatory and allergic diseases of the respiratory system, leads to the development of neurotic States, headaches, affects the cardiovascular and genitourinary systems. Deformity of the nasal septum may be the result of trauma to the nose or uneven growth of the facial skeleton in children.

What triggers / Causes Curvature of the nasal septum :

Curvature of the nasal septum occur in early childhood are extremely rare. They usually develop between the ages of 13 to 18 years.

The cause of the curvature of the nasal septum , many authors see in incorrect correlation between the growth of facial bones and cranial skeleton, resulting in nasal septum is necessary in the course of its development, as would be bent at too narrow for her frame. Others point to an uneven or irregular growth of the skeleton partitioning occurring because of the presence of the above-mentioned growth areas.

Some doctors believe that the cause of the curvature of the nasal septum in the vast majority of cases is the differential permeability of the two halves of the nose due to hypertrophy of the sink with one hand. This creates while breathing the difference in the pressure of the air flow in the nasal septum and causes deflection narrowed her side, where the pressure (pressure) of the jet is weaker.

All these, like other existing theories of the origin of the curvature of the nasal septum, cannot be considered conclusive, since it is not established whether the deviations from the neighbouring departments of the cause of curvature of the septum, the result of his or coincidence.

A significant role in the cause of the curvature of the nasal septum, clearly played an injury.

It is well known that the pronounced curvature of the nasal septum occur in men more often than women (by L. T. Levin, 3 times). This fact speaks about the important role of trauma in the etiology of curvature of the septum, as men, and especially boys and teenagers, it is much more likely to suffer injury than females.

In rare cases some role in the curvature of the nasal septum plays an overly-developed embryo albanova body (in the anterior lower division septum).

Pathogenesis (what happens) while the Curvature of the nasal septum :

The most common symptom of a deviated septum is nasal breathing obstruction on one or both sides. This violation depends not only on the immediate narrowing of the nasal cavities in connection with the deformation, but, as pointed out by V. I. Voyachek, also from improper air flow, turbulence and availability of low blood pressure. Pathological impulses received in this regard from the receptors of the nasal mucosa to the Central nervous system, causing in turn a response to vasomotor nose, leading to a breach of the proper blood circulation in the mucous membrane, swelling of the turbinates and narrowing of the lumen of the nose.

In addition, as is known from the works of A. A. Atkarsk, mine, etc., in the normal flow of air during inspiration by purely physical laws is not on the shortest path along the lower nasal the go, and an arcuate first climbing high up to the middle shell and above and then only down to Joan. Conversely, during the expiratory current of air goes through the lower nasal the go. Due to this, in the case of narrowing (from the curvature of the septum) of the lumen of the nose in the middle of its divisions with the free lower division current of air when you inhale should be sent forcibly unusual direction, i.e. along the lower nasal the go. The same difficulties occur in the case of narrowing of the lower nasal passage at the time of expiration. So free or lower middle course does not exclude the possibility of disorders of nasal breathing.

Disorder nasal breathing also depends on the relationship between the curvature of the nasal septum, turbinates. As you know, when the deviated septum we often see in the wide half of the nose with hypertrophy of the turbinates, the so-called compensatory hypertrophy and hyperplasia of the ethmoid labyrinth. In some cases, a deviated septum (usually in the anterior part) in posterior rhinoscopy may note the hypertrophy of the posterior ends of the turbinates, mainly bottom.

These changes may explain the fact that when the deviated septum to one side of the patient often complains of difficulty breathing on both sides, often even stronger on the side of the concavity of the septum.

Sometimes when the curvature of the nasal septum, especially the front its divisions, marked effect of negative pressure sucking in the breath of the corresponding wing of the nose to the wall, with off this half of the nose from the act of breathing.
Difficult access the stream of air to the olfactory division of the nasal cavity deviated septum in its upper division leads to disruption of olfactory function. In connection with disorder of blood circulation and trophism of the olfactory nerve may occur violation of smell not only respiratory but also essential, is already irreversible.

It should be noted that often the curvature of the nasal septum installed in his youth, manifest themselves clinically much later, sometimes only in old age. It depends on the adherence of local diseases of the nose and paranasal sinuses or General disorders - disorders of the cardiovascular system, lungs, etc., because of which the patient becomes more difficult to overcome when breathing resistance of the narrowed nasal passages.

Curvature of the nasal septum can give rise to the development of reflex neurosis due to irritation numerous endings of the nerves, which are so richly supplied with mucous membrane of the nose. This is particularly true of the ridges and spikes, which are sometimes deeply gresivaudan in the sink. Irritation may cause reflex changes in the nose (in the form of vasomotor disorders, hypersecretion, etc.), and in neighboring and distant organs.

To rhinogenous reflex disorders rank as bronchial asthma, spasms of the larynx, a number of eye diseases, disorders of the cardiovascular system, headaches, epilepsy, dysmenorrhea, reflex cough, sneezing, etc. According to our observations, this relationship is quite rare. All these neuroses with the simultaneous presence of marked deformities of the nasal septum increases the indications for resection of the nasal septum or resection of thorns (prolonged cessation of bronchial asthma after surgery, we observed only one case). However, the patient should not be given guarantees that after surgery will disappear all of these neuroses.

If the ventilation of the nose and rhinitis secondary in connection with the deformation of the nasal septum can, however, in rare cases, entail changes in the Eustachian tube and middle ear, as well as abnormalities of the paranasal sinuses and slezoprovodyaschie ways. Almost more important deformations of the nasal septum in the pathogenesis of acute and chronic sinusitis.

To the listed symptoms should still add cosmetic defects, sometimes coming with a deviated septum, especially in dislocation of the quadrangular cartilage.
Искривление носовой перегородки
A deviated septum

The symptoms of Curvature of the nasal septum :

The curvature of the nasal septum is manifested by the following symptoms:
1. Obstruction of nasal breathing. Can be observed as a moderate violation, and the complete absence of nasal breathing. If the patient has unilateral deviated septum, impaired nasal breathing will be celebrated by the right or left half of the nose. Here we should focus on a small aspect of this symptom. Often, when you visit an ENTdoctor, the patient is diagnosed with a deviated septum that leads him to a surprise since, according to him, his nose breathes well. It is possible to answer that in violation of nasal breathing because of the curvature of the nasal septum, the adaptation of the body and the nasal cavity compensates for this drawback at the expense of other structures. This also explains the fact that the sharp violation of nasal breathing in humans with deviated nasal septum may occur in old age, when the compensatory capacity of the organism are gradually depleted. In people who have a large nasal cavity, even when expressed curvatures of the nasal septum may be absent nasal breathing disorders, as through this is offset by the passage of air through the nasal cavity during breathing. In short - if You have a good nose breathing, it does not mean that You cannot be the curvature of the nasal septum.
2. The snoring. Arises as a consequence of impaired nasal breathing.
3. The dryness in the nasal cavity.
4. Chronic inflammatory diseases of the paranasal sinuses (sinusitis) sinusitis, ethmoiditis, frontal sinusitis.
5. One of the causes of these diseases may be a deviated septum. In the long course of chronic sinusitis on the curved background of the nasal septum develop polypoid changes of the mucosa, i.e. polyps are formed.
6. Allergic disease. Violation of nasal breathing keeps the flow in the body allergic processes, especially when the compensatory curvature of the nasal septum when in contact of the mucous membrane of the nasal cavity with a partition, a constant irritation, which can provoke asthma attacks, allergic rhinitis. The patient feels "uncomfortable in the nose", itching, nasal cavity recurrent or persistent mucus. Especially bright these symptoms appear when the patient has a combination of allergic rhinitis, hypertrophy of the turbinates and the curvature of the nasal septum.
7. Change the shape of the nose. For traumatic deflection of the nasal septum - dislocations, fractures of the cartilage of the septum of the nose is changed. There is a mixture of the nose to the right or left. As already noted, such States are usually combined with fractures of the nasal bones. If not carried out adequate treatment, the cartilage is fused incorrectly. These are the main symptoms that allow to suspect the deviated septum.

The effects of the curvature of the nasal septum is quite diverse. It is proved that the violation of nasal breathing occur changes in the blood, circulatory system, reproductive organs, the body more susceptible to hypothermia and adverse environmental factors, as there is a relationship between indicators of nasal breathing and immune status. It is therefore important to consult the ENT specialist and not risk their health.

Types of a deviated nasal septum.
Curvature of the nasal septum are extremely varied in their nature and localization. They occur in the form of curves in the sagittal and frontal planes, in the form of various ridges - ridges and spikes - or a combination of both strains. The bending of the nasal septum as the projections, can be bilateral and narrowing at the same time the various departments of the two halves of the nose. For the most part meet-bends, then warp in the form of the Latin letter S, most exciting quadrangular cartilage, rarely perpendicular to the plate and even more rarely Coulter. The curvature of the posterior nasal septum is exceptionally rare, and the rear edge of the opener is almost always keeps a strict sagittal position. Also rarely bends perpendicular to the plate reach close to the arch of the nose, i.e. the sieve plate. Curvature of the nasal septum traumatic etiology for the most part are characterized by curves with sharp corners. Often in traumatic deformities observed more or less abrupt displacement of the front edge of the quadrangular cartilage, which is usually called a dislocation. In some cases, injuries occur from sliding off the lower edge of the quadrangular cartilage from the vomer and then the top edge of the last as it is given freely in the nasal cavity.
Combs, as already mentioned, are located mainly on the upper edge, the opener, heading diagonally from front to back and top to bottom deep into the nasal cavity.

They often end with a sharp spike, deep into the middle and sometimes bottom shell, obtenir middle and posterior parts of the nasal cavity and outlet openings of the paranasal sinuses. In addition, the combs are often located on the bottom edge of the opener is almost at the bottom of the nose, but these projections usually occupy only the anterior parts of the nose. Sometimes the ridge descends in the form of a canopy. Ridges and spikes mostly bone, but often they also contain cartilage, which forms mainly the top, or the lateral part of the protrusions. All these features are easily explained embryonic development and subsequent formation of the nasal septum, which was spoken above.

Often in the place of the crest of the nasal septum on the opposite side forms a concavity, sometimes in the form of acute deep groove.

It should be noted that the mucous membrane on the convex side of bends of the nasal septum, especially on the ledges, usually thinning and separation is easily torn, and Vice versa, with the concave side it is thicker and comes off easily. Mucous, membrane is also more tightly adherent at the site of stitches, sometimes in the Bud albanova body on the quadrangular cartilage and in places the fractures in traumatic deformities of the nasal septum.

Diagnosis of Curvature of the nasal septum :

Deformation of the nasal septum can sometimes be set already by visual inspection - on the basis of scoliosis of the nose, the displacement of its tip septum or mobile. For the most part, however, the curvature will be clarified during rhinoscopy. Before all, conspicuous asymmetry of the nasal cavities, i.e., one half of the nose, all over or in a particular part, wider than the other, on one side are clearly visible nasal turbinates, and the other is worse or not at all visible.

For a detailed examination and for determining the exact nature and localization of all the curves and protrusions of the nasal septum must repeatedly and carefully lubricate the septum and the shell 5 cocaine solution with adrenaline. Only then can afford to give a clear account in the configuration of both the septum and lateral wall of the nose (turbinates, ethmoid cells, etc.), which is absolutely necessary for deciding about the surgery.

Anterior rhinoscopy should be supplemented by posterior rhinoscopy, which turns out (though very rare) curves of the posterior septum, hypertrophy of the posterior ends of the turbinates, and the presence of hypertrophy of the mucosa, usually located symmetrically on both sides of the rear of the opener.

X-ray examination provides little valuable additional data regarding the actual deformations of the nasal septum. However, such research is necessary in all cases to ascertain the condition of the paranasal sinuses.
Искривление носовой перегородки
A deviated septum

Treatment of Curvature of the nasal septum :

Since the deviated septum include violations of the normal anatomy of the nasal cavity, all conservative measures (vasoconstrictor drops, pills, breathing exercises) are temporary and are not always pronounced effect.

The clinical manifestations of the curvature of the nasal septum surgery – surgery endoscopic septoplasty. When performing surgery, no incisions are made on the face. As a result of its holding the shape of the external nose is not changed. The operation lasts on average 30 minutes to 1 hour and can be performed under local or General anesthesia. The operation ends inserted into the nasal cavity silicone plates – so-called splints and gauze swabs, which is removed in the following days after surgery. Thus, should a patient's stay in the hospital only 1 day, and then we let him go home. For 5-7 days after surgery will need to visit a special dressings to promote healing and prevent formation of adhesions.

Currently, the only treatment of all types of deformities of the nasal septum should be considered submucosal resection. Isolated resection of the same ridges and spikes should be used only in rare cases. First, usually there is a combination of distortion, secondly, with modern technology, a typical resection of the nasal septum is technically much easier than the isolated resection of the ridges and spikes.

Some authors suggest the elderly are producing is submucosal resection of the nasal septum through the excision of all of its layers. All the same, in our opinion, and in old age to prefer submucosal resection, which is not significantly complicates the operation.

Indications for resection of the nasal septum. Surgery on the nasal septum is indicated in cases when there are some disorders listed above, with sufficient clarity can be put in a causal relationship with the existing deformities of the nasal septum. Themselves of curvature, accidentally discovered, as they are expressed, usually do not serve as an indication for surgery. However, if there is a deformity of the nasal septum with moderate respiratory distress at a young age, you have to consider that in the future, in connection with age-related weakening of the cardiovascular activity, the tone of respiratory muscles, etc. this curvature of the septum can cause the occurrence of functional disorders. To operate the same in old age is harder and operation, designed for functional reconstruction of complex breathing apparatus and the adaptation of the organism to correct nasal breathing, can in this age does not give sufficient effect. Therefore, in such cases it is better to eliminate the deformation of the septum in his youth. It should, in our view, to operate, if a person of young age there is complete or almost complete obstruction of one half of the nose due to the curvature of the nasal septum, while the patient due to free breathing through the other nostril, no complaints.

Regarding the permissible age for resection of the septum we quite agree with L. T. Levin, performs the surgery with success for both children and adults, but how. rightly pointed out by this author, in children and in persons over the age of 48-50 years the indications for this operation should be significantly narrowed.

Very often when a more or less significant deviated nasal septum at the same time there is hyperplasia of the lower or middle shell (or concha bullosa), or both of these shells on the side opposite to the curvature. Often on this side is the strongest difficulty breathing. This can be established objectively and largest spot from a couple who have settled during exhalation, the charge to the nasal openings cold spatula. If in such cases be limited to resection of the nasal septum will not improve the patency of the nose is not only on the side where there is hypertrophy of the turbinates, but rather on the side of the curvature, because the hypertrophied shell, pushing became mobile after the operation the partition, will not allow her to accept the sagittal position, therefore, in such cases, simultaneously with the resection of the septum to produce and conchotomia (or partial resection of concha bullosa). It's easier and better to do it immediately after resection of the septum, unless unusual bleeding or risk of the occurrence of further adhesions, due to gross violation of the integrity of the mucous membrane of the septum during surgery, is not forced to postpone conchotomia to another session (after a month).

Often, when the curvature of the anterior nasal septum is observed hypertrophy of the rear end of the lower shell on the narrower side (this is set via the rear rhinoscopy before resection of the septum or anterior rhinoscopy at the end of this operation). If this hypertrophy pronounced, it is better immediately to fix it.

If the deviated septum narrow side more or less satisfactorily permeable to air and the other side obturated hypertrophied turbinates, it is best to produce only the first conchotomia. With little effect produced 2-3 months after resection of the nasal septum.

If there is hypertrophy of the soft tissues of the nasal septum, it is necessary to excise them with scissors (if hanging) or (when the pincushion hypertrophy) to destroy galvanometer, if possible by submucosal. Large technical difficulties often represents the elimination of hypertrophy of soft tissues of posterior opener. Usually they are available only after the resection (or mobilization) of the nasal septum. The destruction of these tissues galvanometer should be performed with extreme caution, not simultaneously cauterizing shells prevent further adhesions. It is better to use for this purpose conchetumare.

Often, when the deviated septum is marked asymmetry of the structure of the ethmoid bone. On the side where the partition wall forms a concavity, ethmoidal labyrinth increased in size compared with the opposite side.

In such cases, simultaneously with the operation on the nasal septum to make removal of the ethmoid labyrinth, without removing the possibility of the middle shell, and only putting it in a more lateral position.

In addition to the above indications for resection of the nasal septum, this intervention has also been used as a preliminary event to perform other operations or to ensure the best results of these operations.

This includes the opening of the frontal sinus, ethmoid cells and the sphenoid sinus, operations on the lacrimal SAC and others.

In rare cases, resection of the nasal septum is made to be able to ear the catheter to the Eustachian tube.

Which doctors should be consulted if You have a deviated septum :


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