Deviated Nasal SeptumDeviated Nasal Septum

Def: A deviated nasal septum refers to a Def: A deviated nasal septum refers to a deformity of the partition in the nose that deformity of the partition in the nose that separates the two nostrils. separates the two nostrils.

Composed of bone and cartilage, this Composed of bone and cartilage, this partition (nasal septum) is covered with a partition (nasal septum) is covered with a mucous membrane. mucous membrane.

The nasal septum usually is straight and The nasal septum usually is straight and reasonably centered, dividing the nasal reasonably centered, dividing the nasal passage into two equal halves. passage into two equal halves.

Etiology:Etiology: In some individuals, however, the septum is bent (deviated), a In some individuals, however, the septum is bent (deviated), a

condition either present at birth (congenital) or, more commonly, condition either present at birth (congenital) or, more commonly, the result of injury to the nose. The bending or deviation may be shifted the result of injury to the nose. The bending or deviation may be shifted

severely from the midline so as to partially or completely block the severely from the midline so as to partially or completely block the nasal passage.nasal passage.

Individuals who play contact sports such as karate or football without Individuals who play contact sports such as karate or football without protective headgear are at higher risk. Not wearing a seatbelt protective headgear are at higher risk. Not wearing a seatbelt increases risk of injury to the face or nose in the event of a high impact increases risk of injury to the face or nose in the event of a high impact automobile accident.automobile accident.

Differential growth between nasal septum and palate Differential growth between nasal septum and palate Types:Types:

There are two main types of deviation. One occurs when the more There are two main types of deviation. One occurs when the more flexible cartilage of the lower end of the septum becomes dislocated flexible cartilage of the lower end of the septum becomes dislocated and pushed to one side, and pushed to one side,

narrowing one of the nostrils. The other type results when the septum narrowing one of the nostrils. The other type results when the septum deforms into an S-shape, causing a partial or complete blockage of deforms into an S-shape, causing a partial or complete blockage of both nostrils.both nostrils.

SymptomsSymptoms

The individual may report a history of injury to the The individual may report a history of injury to the nose or face. The most common symptom nose or face. The most common symptom associated with a deviated septum is difficulty associated with a deviated septum is difficulty breathing. Depending on the severity of the breathing. Depending on the severity of the obstruction, the individual may report chronic obstruction, the individual may report chronic nasal congestion, sinusitis, repeated ear nasal congestion, sinusitis, repeated ear infections, headache, or nosebleeds. Scuba divers infections, headache, or nosebleeds. Scuba divers with a deviated septum may have difficulty with a deviated septum may have difficulty equalizing the pressure in their ears when they equalizing the pressure in their ears when they dive. dive.

SignsSigns

Visual inspection may reveal an inequality in the Visual inspection may reveal an inequality in the size of the nostrils and/or a deformity in the size of the nostrils and/or a deformity in the septum. A deformity of the external nose septum. A deformity of the external nose sometimes is apparent. When there is a history of sometimes is apparent. When there is a history of injury, the septal bending is usually toward the injury, the septal bending is usually toward the injured side. Examination of the nasal cavity may injured side. Examination of the nasal cavity may reveal blockage of one or both nostrils. Noisy reveal blockage of one or both nostrils. Noisy breathing may be noted. Signs of chronic sinusitis breathing may be noted. Signs of chronic sinusitis or allergic rhinitis may be present, such as post-or allergic rhinitis may be present, such as post-nasal drip, nasal inflammation, and swelling of nasal drip, nasal inflammation, and swelling of nasal cavity walls.nasal cavity walls.

DiagnosisDiagnosis

We can diagnose the case based on history We can diagnose the case based on history and examination.and examination.

It will be conformed by investigation.It will be conformed by investigation.

InvestigationInvestigation

X-rays of the face and sinuses may be X-rays of the face and sinuses may be taken to confirm the nasal septal deviation taken to confirm the nasal septal deviation and to evaluate for sinus infection.and to evaluate for sinus infection.

TreatmentTreatment

Mild forms of nasal septum deviation require no Mild forms of nasal septum deviation require no medical intervention other than treatment of medical intervention other than treatment of occasional nasal congestion, sinusitis, or allergy occasional nasal congestion, sinusitis, or allergy symptoms. These may be treated with symptoms. These may be treated with decongestants, antibiotics, or antihistamines and decongestants, antibiotics, or antihistamines and nasal inhaled steroids, respectively. A general nasal inhaled steroids, respectively. A general practitioner should monitor long-term use of practitioner should monitor long-term use of decongestants because misuse can cause decongestants because misuse can cause rebound symptoms.rebound symptoms.

Surgical treatmentSurgical treatment When the deviation is more severe and obstructs When the deviation is more severe and obstructs

breathing, surgical intervention is necessary. breathing, surgical intervention is necessary. septoplasty septoplasty A surgical procedure called septoplasty is performed under A surgical procedure called septoplasty is performed under

local or general anesthesia. With an endoscope, the local or general anesthesia. With an endoscope, the surgeon makes an incision inside the nose, lifts up the surgeon makes an incision inside the nose, lifts up the lining of the septum, and realigns and/or removes the lining of the septum, and realigns and/or removes the deviated portions of the septal bone and cartilage. The deviated portions of the septal bone and cartilage. The septum may be held in place with splints placed inside the septum may be held in place with splints placed inside the nostrils.nostrils.

submucous resection (SMR)submucous resection (SMR) A submucous resection (SMR) is a more extensive A submucous resection (SMR) is a more extensive

resection of cartilage and bone, removing part of the flat resection of cartilage and bone, removing part of the flat bone from the inside and back of the nasal septum (vomer) bone from the inside and back of the nasal septum (vomer) and the ethmoid bone that defines the sinus above the and the ethmoid bone that defines the sinus above the septum, as well as correcting the deviated septum itself septum, as well as correcting the deviated septum itself (Watson). The usual goal, however, is to leave as much (Watson). The usual goal, however, is to leave as much supporting cartilage in the septum as possible.supporting cartilage in the septum as possible.

PrognosisPrognosis Prognosis usually is good after either Prognosis usually is good after either

septoplasty or submucous resection. septoplasty or submucous resection. Normal breathing typically is restored and Normal breathing typically is restored and other symptoms resolve completely. Most other symptoms resolve completely. Most individuals are up and about within a few individuals are up and about within a few days and can return to sedentary work in days and can return to sedentary work in about 1 week. Swelling may be present for a about 1 week. Swelling may be present for a few months after surgery.few months after surgery.

ComplicationsComplications A deviated nasal septum can interfere with A deviated nasal septum can interfere with

normal drainage from the sinuses and result normal drainage from the sinuses and result in recurrent sinus infections. Drainage of in recurrent sinus infections. Drainage of mucus from the middle ear also can be mucus from the middle ear also can be hindered by a deviated nasal septum and hindered by a deviated nasal septum and result in repeated ear infections or a result in repeated ear infections or a condition called "glue ear."condition called "glue ear."