Why is the septum deviated and when is it normal?
The septum consists of cartilage in the anterior part and thin bony plates in the posterior part. It grows unevenly and not always synchronously with the surrounding facial skeleton: if the cartilage grows faster than space allows, it bends and forms a ridge or spike. This process occurs during a period of active growth and ends around 16-18 years. The second large group of causes are injuries, and not necessarily severe ones: being hit by a ball in childhood, falling from a bicycle, being pushed into a doorway. A person often does not remember the episode itself, and the curvature is formed years later.
This leads to an important consideration about what is considered normal. Slight asymmetry of the septum is a common anatomical variation, the same as different foot lengths or asymmetrical eyebrows. The nose has a significant margin of flotation, and moderate curvature is easily compensated for. What makes it significant is not the shape as such, but the combination of three circumstances: the degree of narrowing, the level at which it is located, and the condition of the surrounding tissues. The ridge at the back of the nose may not interfere at all, while a slight deviation in the narrowest front part can significantly impair breathing.
- C-shaped deflection - a smooth bend in one direction, the most common option
- S-shaped - bending in different directions at different levels, narrows both halves of the nose
- A ridge or spine is a local bony protrusion that can push against the side of the nose and cause reflex headaches
- Dislocation of the anterior cartilage - visible visually, the septum protrudes into the nostril
- Post-traumatic deformity - often combined with curvature of the external bridge of the nose
- Compensatory enlargement of the nasal concha on the wide side: the body fills the excess space, and as a result, both halves of the nose narrow
How does it manifest itself?
Difficulty in nasal breathing is the main complaint, but far from the only one. The problem is that a person with a deviated septum has lived this way since his youth and has no experience of normal breathing for comparison. He does not consider himself sick, but is simply sure that “his nose is like that.” Because of this, the true scale of the consequences becomes clear only after the operation, when the patient suddenly discovers that he has begun to get enough sleep.
- Constant or periodic congestion of one or both halves of the nose
- Mouth breathing, especially during sleep, dry mouth and throat in the morning
- Snoring and restless sleep; at the same time, impaired nasal breathing aggravates sleep apnea, although it does not cause it in itself
- Decreased sense of smell - air with odorous substances reaches the olfactory zone in the upper parts of the nose worse
- Frequent sinusitis: impaired ventilation of the sinuses creates conditions for stagnation
- Repeated nosebleeds on protruding areas of the septum where the mucous membrane dries out
- Headaches and a feeling of pressure in the forehead and bridge of the nose, especially if there is a thorn
- Fatigue, decreased performance and absent-mindedness due to constant lack of sleep
- In children - a habitually slightly open mouth, restless sleep, and with prolonged mouth breathing, peculiarities in the formation of the bite
It is worthwhile to understand a phenomenon that confuses almost everyone. The nasal mucosa works cyclically: approximately every 2-6 hours, one half of the nose swells and breathes worse, while the other rests at this time. This is a normal nasal cycle, everyone has it, and in a healthy person it is unnoticeable, because the patency reserve is large. With a deviated septum, the same physiological wave makes the narrow side completely obstructed, and the person describes it as “first one nostril is blocked, then the other.” Therefore, the complaint of intermittent congestion does not contradict the diagnosis, but confirms it.
Examination: what is needed and what is not
- Расспрос: с какой стороны и как давно нарушено дыхание, есть ли связь с сезоном, пылью, животными, применяются ли капли и как долго.
- Передняя риноскопия — базовый осмотр, показывает передние отделы перегородки и раковины.
- Эндоскопия полости носа — тонкий эндоскоп позволяет увидеть глубокие отделы, задние концы раковин, соустья пазух и носоглотку; это ключевое исследование, без которого картина неполная.
- Проба с сосудосуживающим средством: если после него дыхание полностью восстанавливается, значит, main вклад вносит отёк слизистой, а не сама перегородка, и начинать нужно с лечения ринита.
- Компьютерная томография околоносовых пазух — при подозрении на хронический синусит, полипы или перед планированием операции.
- Аллергологическое обследование при подозрении на аллергический ринит: у значительной части пациентов заложенность связана с аллергией, а не только с анатомией.
- Исследование сна — при выраженном храпе с остановками дыхания.
Septoplasty and rhinoplasty are different operations
These two interventions are constantly confused, and the confusion creates inflated expectations. The difference between them is fundamental and concerns the goal, scope and result.
- Septoplasty is an operation inside the nose: the surgeon straightens or partially removes curved sections of cartilage and bone of the septum. The external shape of the nose does not change, there are no incisions on the skin, and no scars remain. The goal is to restore breathing
- Rhinoplasty is an operation on the outer frame of the nose: the back, tip, wings, shape and size are changed. The purpose is aesthetic
- Rhinoseptoplasty is a combination of both tasks in one intervention; performed when there is both external deformation and breathing problems, which is typical after injuries
- Conchotomy or vasotomy of the inferior turbinates is an auxiliary step that reduces the volume of enlarged turbinates; often performed in conjunction with septoplasty
- Septoplasty is usually not performed until the growth of the facial skeleton has finished, approximately until 16-18 years of age, except in cases of severe respiratory impairment and consequences of injury.
From this difference follows the answer to the most common question before surgery: will the shape of the nose change after septoplasty. No, it won’t change - the work is done under the mucous membrane, nothing is touched on the outside. If a person wants to simultaneously correct their breathing and change their appearance, this needs to be discussed in advance, since this is a different operation, with different preparation, different recovery and different expectations. Planning aesthetic correction “later, if anything” is less profitable: repeated intervention in scar tissue is always more difficult.
How is recovery going?
Modern septoplasty is performed endoscopically, through access inside the nose, often under general anesthesia, and lasts on average from 40 minutes to an hour and a half. Hospitalization is usually short. The most unpleasant part of the recovery is not the pain, but the temporary inability to breathe through the nose in the first days.
- Первые 1-2 суток в носу находятся тампоны или силиконовые сплинты, поэтому дышать приходится ртом; современные материалы имеют внутренние трубочки, частично сохраняющие дыхание.
- Извлечение тампонов — самый тревожащий пациентов момент; при использовании силиконовых сплинтов и гелевых материалов он переносится значительно легче, чем при классической марлевой тампонаде.
- Первые 7-10 дней сохраняются отёк, заложенность и корки в носу — это ожидаемо и не означает, что операция не удалась.
- Промывание носа солевыми растворами по схеме врача — основа ухода в первые недели; корки нельзя удалять самостоятельно пальцем.
- Нельзя сморкаться примерно 2 недели, поднимать тяжести, посещать баню и сауну, заниматься спортом — ориентировочно 3-4 недели.
- Полноценное носовое дыхание устанавливается не сразу: заметное улучшение наступает через 2-3 недели, а окончательный результат оценивают через 2-3 месяца, когда полностью уходит отёк слизистой.
- Плановый осмотр у оперировавшего врача обязателен — он удаляет корки и контролирует заживление, от чего во многом зависит итоговый результат.
Drops that create a separate disease
People with difficulty breathing through their nose almost always have a history of exposure to vasoconstrictor drops. They give a quick and convincing effect, so the bottle appears in your pocket, in the car and on the nightstand. The problem is that when used for longer than 5-7 days, the vessels of the mucous membrane cease to respond adequately: between instillations, the swelling returns stronger than before, the intervals are reduced, and the dose increases. Drug-induced rhinitis is formed - a condition in which the nose does not breathe because of the drops themselves, and not because of the original cause.
- A sign of addiction is the need to instill drops more often than indicated, waking up at night for drops, the inability to do without a bottle
- With prolonged use, the mucous membrane becomes thinner, becomes dry and brittle, and nosebleeds become more frequent.
- Withdrawal always occurs after a few difficult days of complete congestion - this is an expected stage, and not a worsening of the disease
- The doctor helps you go through withdrawal: hormonal sprays, saline solutions and a gradual reduction in frequency are used.
- Hormonal sprays for allergic rhinitis are not addictive and act differently - their effect develops over several days and accumulates
- Rinsing with saline and humidifying the air is a safe base that can be used for as long as you like
As for exercises, massage of the bridge of the nose, breathing exercises and warming up as a way to correct the septum, they do not work for a simple mechanical reason: cartilage and bone do not change shape from external influences. All that can be achieved with these methods is a temporary reduction in swelling of the mucous membrane, which subjectively makes breathing easier for a short time. This is not bad in itself, but it is incorrect to pass off the relief of edema as correction of the septum, and you should not count on it as an alternative to surgery in case of significant deformity.
