Exercise therapy for wedge-shaped nasal deformity. Deviated nasal septum - causes, types, symptoms, consequences, treatment methods

Deviation from the midline and violation of the relationship of the structures of the external nose. This pathology can not only disrupt the aesthetics of the face, but also interfere with healthy nasal breathing.

Kinds. Deformations can be congenital or acquired. Basic forms: C-shaped deviation; S-shaped curvature; crest; dislocation of the quadrangular cartilage; thickening (“bump”).

Typology by severity:

1st degree - slight deviation from the midline;

2nd degree - the protruding section of the septum is located approximately in the middle of the distance between the midline and the lateral wall of the nasal cavity;

3rd degree - the deformed septum is in contact with the lateral wall of the nasal cavity.

Typology by localization:

1. A small one-sided vertical ridge in the anterior sections of the nasal septum, which does not interfere with the function of nasal breathing.

2. A significantly pronounced vertical ridge in the same section of the nasal septum with a displacement of the anteroinferior edge of the quadrangular cartilage to the opposite side. Nasal breathing function is impaired.

3. One-sided vertical ridge in the deeper parts of the nasal cavity.

4. Two vertical ridges located one after the other on opposite surfaces of the nasal septum (S-shaped bend on a horizontal section).

5. One-sided, almost horizontal ascending ridge in the posterior parts of the septum, resembling a Turkish saber in shape.

6. Two almost horizontal ridges in the anterior and middle sections of the nasal septum on opposite surfaces with a characteristic groove on one side.

7. The so-called crumpled partition with multiple fracture lines, representing various combinations of the types listed above.

Causes and risk factors. There are three main factors in the development of acquired deviated nasal septum:

Physiological– one of the examples of growth disproportion during the development of a child. It occurs as a result of uneven growth of the septum itself and the bone frame into which it is inserted (the former grows faster). The deformity occurs after the age of 7 years - or at an earlier age.

Traumatic– pathology develops as a result of household, sports or road traffic injury. The development of pathology is caused by improper fusion of fragments, compensatory pressure on the nasal septum by an enlarged turbinate, polyps, and tumor.

Compensatory

Symptoms

Visible changes in the shape of the nose;

Difficulty breathing through the nose;

Discharge from the nose;

Dry throat

When ridges and spines are introduced into the nasal concha - the development of neurogenic diseases caused by reflex phenomena.

When the curved part of the septum comes into contact with the middle turbinate, there is a headache in the supraorbital region.

With prolonged disruption of nasal breathing - changes in the facial skeleton, a Gothic vault of the palate, an adenoid appearance of the face, abnormal development and arrangement of the upper teeth are noted, the voice changes (the resonator function of the nose is impaired).

With constant difficulty in nasal breathing - decreased gas exchange, oxygen starvation.

Diagnostics. Carried out on the basis of the general clinical picture, radiography of the nasal bones is also shown

Treatment. To eliminate deformities of the nasal bones, surgical treatment is performed: septoplasty, rhinoplasty, rhinoseptoplasty.

The most commonly observed lateral displacements of the external nose are accompanied by separation of the suture between the nasal bones and the frontal processes of the upper jaw or a fracture of the nasal bones (Fig. 2.34).

In clinical practice, the classification of external nasal deformities proposed by A.E. is used. Kitsera and A.A. Borisov (1993).

Rhinoscoliosis is a lateral displacement of the nose.

Rhinokyphosis is a deformation of the nose with the formation of a hump.

Rhinolordosis is a retraction of the nasal bridge (saddle nose).

Platyrinia - flattened nose.

Brachyriny is an excessively wide nose.

Leptoria - an excessively narrow (thin) nose.

Mollerinia - soft, pliable (lacking support) external nose.

Hypogenesis - underdevelopment (median cleft of the nasal cavity, lateral cleft, aplasia of the halves, aplasia of the external nose). 4

Persistence - retained embryonic formation (dermoid cysts -> suppuration -> fistula). –Atresiahoan. The clinical picture depends on the degree of underdevelopment. Deformation of the external nose Congenital 2. Acquired (traumatic origin): - rhinoscoliosis rhinokyphosis rhinolordosis (saddle-shaped)

“platyrinia (flattened) - brachyrinia (wide) - leptorrhia (narrow) mollyrinia (deformed, soft nose). Indications for plastic surgery are the patient's wishes. Curvature of the nasal septum is the deviation of the nasal septum or its individual parts from the midline. In case of minor curvature, there are no medical indications for surgical intervention. In case of severe curvature, the patient is subject to surgery - resection of the septum.

7. Injuries of the nose and paranasal sinuses in children. Possible complications.

Injuries to the nose and paranasal sinuses are among the most common injuries not only to the ENT organs, but also to the entire body. This is due to the location of the nose and the fact that it protrudes above the surface of the facial skeleton. There are injuries of a military and domestic nature (industrial, sports, transport, etc.), as well as those that occurred during a seizure (for example, epilepsy).

Depending on the force and characteristics of the wounding object, its direction and depth of penetration, nasal injuries can be open - with damage to the skin or closed - without damage to the skin.

Closed injuries most often occur in the form of contusion, bruise in soft fabrics, abrasions, however, with a sufficiently large force, fractures of the nasal bones occur with or without displacement of the walls of the paranasal sinuses, orbit, zygomatic bone, cells of the ethmoidal labyrinth, etc. Often with facial injuries, hemorrhage appears in the chambers of the eye (hyphema), displacement of the eyeball (enophthalmos), compression of the extraocular muscles (diplopia), accompanied by decreased vision, up to its complete loss (amaurosis).

Open fractures may or may not penetrate the nasal cavity, which is determined by palpating the wound with a probe. Most common cause penetrating wounds are trauma to the nose with sharp-pointed objects. In this case, damage to the mucous membrane occurs, followed by nosebleeds, infection of the nasal cavity and paranasal sinuses, and the formation of hematomas of the nasal septum with abscess formation. Directing a penetrating object towards the upper wall of the nasal cavity can cause damage to the cribriform plate, accompanied by nasal liquorrhea.

Injuries in the area of ​​​​the projection of the frontal sinuses lead to a fracture of the anterior wall, which causes a cosmetic defect, retraction in this area and may be accompanied by a violation of the patency of the frontal sinus. The posterior wall of the frontal sinus is rarely damaged.

Damage to the ethmoid bone is usually accompanied by rupture of the lining mucosa and the appearance of subcutaneous emphysema on the face in the form of swelling and crepitus, which can spread to the forehead and neck. If the anterior ethmoidal artery is damaged, there can be dangerous bleeding into the orbital tissue.

Fractures in the area of ​​the anterior wall of the maxillary sinus can manifest as retraction and deformation in this area and be combined with damage to the orbital wall, eyeball, zygomatic bone and ethmoidal labyrinth.

A sphenoid fracture, essentially a fracture of the base of the skull, is rare and may be accompanied by damage to the optic nerve and the wall of the internal carotid artery with fatal bleeding or the formation of a post-traumatic aneurysm requiring the intervention of a neurosurgeon.

For Lefort type I fracture -

the fracture line runs along the bottom of the maxillary sinuses near the junction with the palatine bone and goes back along the tubercle of the maxilla, transitioning to the plates of the pterygoid process (transverse fracture of the maxilla). Lefort II fracture - the fracture line runs across the nasofrontal suture line down the medial wall of the orbit (paper crimoplasty

bones), across the floor of the orbit, near the infraorbital canal and around the cheekbone to the plates of the pterygoid process. Because of its triangular appearance, it is called a pyramidal fracture.

Lefort III fracture - the fracture line runs across the root of the nose, with a transition across the connecting suture of the frontal and ethmoid bones above the orbit, touching the frontozygomatic connecting suture, then passes through the base of the cheekbone and crosses the temporal fossa to the pterygomaxillary fossa. Fracture of the pterygoid plates usually occurs at the base of the skull. It is also called craniofacial separation or complete jaw avulsion.

A characteristic feature Lefort's fracture is a mobile palate. The doctor places one hand on the patient's forehead and with the other hand tries to move the palate and upper teeth. The presence of mobility of the palate indicates the presence of one of the types of Lefort fracture. In addition, a Lefort fracture is often indicated by facial swelling, ecchymosis and malocclusion. These patients may also have nosebleeds, displacement or mobility of the facial skeleton at the fracture site, lengthening or compression of the midface, and signs of liquorrhea.

Method of repositioning the nasal bones (reduction) for fractures.

Superficial application anesthesia is performed with a 2% dicaine solution, then infiltration anesthesia with an ultracaine solution, in children - 1% dicaine solution or general anesthesia. If there is a hematoma of the nasal septum, before repositioning the bone fragments, the blood accumulated under the mucosa and perichondrium is removed using a puncture. Palm right hand The doctor places it on the patient’s forehead and applies pressure with his thumb to the curved part of the external nose. In case of depressed fractures, the fragments are lifted using the elevator Yu.N. VOLKOV, introduced into the nasal cavity. Fixation is carried out using an X-shaped adhesive bandage, and anterior nasal tamponade is performed.

Contraindications for nasal repositioning are:

1) traumatic shock;

2) severe traumatic brain injury;

3) profuse nosebleeds;

4) liquorrhea.

After repositioning, X-ray control is necessary.

2. Defects and deformations of the external nose.

HOC is an unpaired organ that is the initial section of the respiratory tract and olfactory analyzer.

1. External nose. Structural features

There is a distinction between the external nose and the nasal cavity (internal nose).

The external nose is a formation of the facial skull protruding in the form of an irregular three-sided pyramid. The shape, length of the back, location of the root, direction of the base of the nose have individual and age-related characteristics.

In the root area, the external nose borders the forehead; the dorsum of the nose is located on the line connecting the root and tip of the nose; in the plane of the tip of the nose, at the lower border of the nose with the facial skeleton, there is the base of the nose. The lateral convex surfaces (wings of the nose) and the lower part of the septum are movable. The skeleton of the upper part of the nose, formed in part by the frontal and nasal bones, is laterally bordered by the frontal processes of the maxilla, and their lower edge forms the upper border of the pyriform opening. The bone formations of the outer nose continue into its cartilaginous frame.

Paired lateral cartilages (cartilagines nasi tat.) are triangular in shape, form the middle part of the nasal wall and in the area of ​​the nasal dorsum are connected to the cartilage of the nasal septum. Large cartilages of the wings of the nose (cartilagines alares majores) are also paired, consist of two plates, from which the lateral crus forms bottom part the upper lateral surface of the nose, and the medial crus borders on the cartilage of the same name on the opposite side and the nasal septum. Small cartilages of the wings of the nose (cartilagines alares minores) are located in the posterior sections of the wings of the nose. Accessory nasal cartilages are found between the lateral and major cartilages. The cartilage of the nasal septum with its posteroinferior edge is located in the groove of the vomer and nasal ridge of the upper jaw, and with its anterior superior edge it is attached to the nasal bone. The cartilaginous strips adjacent to the septum here are called nasal cartilages. The osteochondral structure of the nose is covered on the outside with skin closely connected to the muscles. Among them are the muscles that lift upper lip and wing of the nose; muscles that narrow the nasal opening and lower the wing of the nose; muscles that depress the septum.

2. Defects and deformations of the external nose

Developmental anomalies. Malformations of the external nose - duplication of the external nose, development of median fistulas, clefting of the tip of the nose, or "Dog nose", when both nostrils are separated by a groove - are quite rare. Defects of the nasal bones are somewhat more common. Malformations of the nasal concha (changes in their size and shape) are very rare.

Treatment is surgical.

The high position of the nose and the relative fragility of the skeleton contribute to frequent mechanical damage his. They are usually accompanied by bleeding, changes in the lumen of the nose, deformation of the entire external nose and, as a consequence, of the face are often observed. Injuries to the nose caused by blunt objects, as well as those caused by a fall, are in most cases closed and can be accompanied by fractures of the cartilage and bone skeleton without damaging the skin. Small fractures of the free edge of the nasal bones in such cases may not be accompanied by visible deformation and are determined only by palpation, sometimes based on crepitus, and more often by x-ray examination.

As a rule, the nasal bones are damaged, less often the frontal processes of the upper jaw. Sometimes there is only a divergence of the bone sutures. As a result of injuries to the nasal septum, it may be bent, dislocated, broken or fractured. Injuries to the cartilaginous part of the nose due to the elasticity of the cartilage lead to deformation of the nose less often. When hit from the front, a longitudinal fracture of the nasal bones occurs, the shape of the nose becomes flattened due to the retraction of the back in the bone and partly in the cartilaginous part, a significant deformation of the nasal septum is formed or it can be fractured with the formation of a hematoma and rupture of the mucous membrane.

The most common lateral displacement of the nose. On the side of the impact, the suture between the nasal bone and the frontal process of the upper jaw may separate, with a fracture of the frontal process on the opposite side. Fractures of the nasal septum and dislocation of the nasal bones from the frontal suture are also observed.

During the Great Patriotic War injuries to the nose and paranasal sinuses ranked first among gunshot wounds of the ENT organs. There are isolated gunshot wounds of the nose and its paranasal sinuses and combined ones, penetrating into the cranial cavity, orbit, pterygopalatine or infratemporal fossa, etc. Extensive destruction of the nose with separation of soft tissue and bone parts of the face is observed with shrapnel wounds. In such cases, it is often possible to tear off the entire external nose or its individual parts (tip, back) and damage the paranasal sinuses.

Damage to the nose is accompanied by pain up to shock, nosebleeds, swelling and hemorrhages in the nose and surrounding parts of the face, and sometimes the release of cerebrospinal fluid in the case of a crack in the upper wall of the nasal cavity. With rupture of the nasal mucosa and increased nose blowing, subcutaneous emphysema of the eyelids, face and neck may develop; swelling of the skin and nasal mucosa usually increases rapidly, making diagnosis difficult.

Deformities can be either congenital or acquired, resulting from various diseases.

A deviated nasal septum can be a malformation or form secondary, for example, with syphilis or tuberculosis, or after an injury. The curvature can be congenital, but most often it is the result of injury; in some cases (with the development of obstruction), surgical correction may be required, which is preferably performed when the child is 14-15 years old to avoid external deformation of the nose.

Deviations of the nasal septum can occur in all parts; the posterior bone part is much less commonly affected. The partition can be curved entirely in one direction or in an S-shape (Fig. 1).

Rice. 1. Schematic representation of the configuration of the nasal septum and nasal turbinates with deformations of the nasal septum (the nasal cavity is shown in black): 1 - slight curvature of the nasal septum; 2 - curvature of the nasal septum with hypertrophy of its mucous membrane; 3 - S-shaped curvature of the nasal septum; 4 - curvature of the nasal septum at an angle.

Sometimes top part bent at an angle relative to the bottom (curvature in the form of a fracture).

Thickenings of the nasal septum in the form of spikes and ridges usually occur on its convex part, mainly at the junction of the cartilage with the upper edge of the vomer; thickenings occur in both the posterior and anterior sections of the nasal septum, in some cases on the smooth straight part of it, in others (more often) they develop in the form of a separate thickening (ridge) along the entire length of the septum. Thickening of the nasal septum without its simultaneous curvature is rare. Much less common than deviated septum, swellings are observed at the anterior end of the middle concha (concha bullosa), which strongly protrude inward and push the nasal septum to the opposite side, making it difficult for air to pass through.

With a deviated septum, the main symptom is difficulty breathing through one or both halves of the nose. The diagnosis is made on the basis of anterior rhinoscopy and is usually not difficult.

Treatment for severe curvature of the nasal septum is surgical; it consists of partial or complete submucosal resection of it. Indications for surgery are such curvatures that are accompanied by functional disorders and difficulty breathing. Removal of the ridges and spines of the nasal septum usually coincides with surgery for a deviated nose. Blisters are removed using a loop or conchotome.

Various types of tumors also lead to deformation of the external nose.

Benign tumors of the nose include papilloma, adenoma, fibroma, hemangioma, bleeding polyp, chondroma, neuroma, osteoma. Nasal fibroma has a lumpy surface, a wide base, a grayish-bluish color, elastic consistency, and grows slowly. Early clinical symptom tumors - difficulty in nasal breathing. With ulceration, mucopurulent discharge mixed with blood appears. Tumor growth can cause displacement of the nasal septum and deformation of the external nose.

Bleeding polyps of the cartilaginous part of the nasal septum have a round shape, a smooth surface, and a red color. The clinical picture is characterized by sudden heavy nosebleeds.

Treatment of benign tumors of the nose is mainly surgical, sometimes cryosurgery is used. The extent of surgical intervention is determined by the location and extent of the lesion, as well as the histological form of the tumor. During the operation, both endonasal and external approaches can be used.

Radiation therapy is used in combination with surgical treatment in cases of recurrent process, as well as in the preoperative period in order to reduce the size of the tumor.

Malignant tumors nose Among all malignant tumors they account for 0.5%. Squamous cell carcinoma is more common (80%), less common is glandular carcinoma, cystadenoid carcinoma, undifferentiated cancer (see Cancer) and non-epithelial malignant tumors - sarcoma, melanoma, esthesioneuroblastoma, etc. Malignant tumors are localized mainly on the lateral wall of the nasal cavity - in the area of ​​the middle nasal cavity passage or middle turbinate and usually quickly grow into the ethmoid labyrinth, maxillary sinus, and nasopharynx. They are distinguished by rare regional and distant metastasis, while lymph nodes are more often affected. bridles of the submandibular region (submandibular triangle, T.) and the upper third of the deep jugular chain, skeletal bones, brain. Due to the fact that patients often arrive for treatment with an advanced tumor process, difficulties arise in determining the initial location of the tumor.

The prevalence of the tumor process is classified according to stages: I - the tumor is limited to one anatomical part without spreading to adjacent areas and without destruction of the bone wall, regional metastases are not determined;

In II a, the tumor spreads to the other wall of the nasal cavity, causing destruction of bone tissue, but does not extend beyond the cavity, regional metastases are not detected;

II b - tumor of the same degree or less spread, but with a single metastasis on the affected side; IIIa - the tumor affects adjacent anatomical cavities, extends beyond the bone walls or spreads to the second half of the nasal cavity, regional metastases are not detected; IIIb - a tumor of the same or lesser extent as Ilia, but with multiple regional metastases - bilateral or on the affected side; IVa - the tumor grows into the base of the skull, the skin of the face, with extensive destruction of bones, without regional and distant metastases; IVb - a tumor of any degree of local spread with fixed regional or distant metastases.

Malignant tumors of the nasal cavity have the appearance of a bumpy, ulcerating infiltrate or resemble a polyp gray with a bluish tint. In the early stages, the disease is asymptomatic. Initial clinical manifestations resemble inflammatory processes, but with a more persistent dysfunction of the nose that cannot be treated. A gradually increasing unilateral nasal breathing disorder appears. The discharge from the nose becomes profuse, acquires a mucopurulent character, sometimes mixed with blood. Nosebleeds, lacrimation, and enlarged cervical lymph nodes occur less frequently.

Melanoma is rare, affects various parts of the nasal cavity and has the appearance of an exophytic tumor of a characteristic purplish-bluish or black color, sometimes with ulceration. The tumor metastasizes early to regional lymph nodes.

Bibliography

1. Big medical encyclopedia. In 30 volumes. T.17. – M.: BE, 1981.

2. Sviridov A.N. Human anatomy. – M.: Medicine, 1972.

3. Handbook of a practicing physician. In 2 hours. Part 2. - M.: Medicine, 1994.

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The nose is the most common object of plastic and reconstructive surgical interventions (in most cases, rhinoplasty) with the aim of correcting and changing its congenital and acquired deformities. Acquired deformities of the nose are primarily associated with the central location and its protrusion above the level of surrounding tissues, and therefore injuries to the nose in most cases are the most severe and have to be observed relatively more often than injuries to other parts of the face. At closed injuries Fractures and displacements of the nasal skeleton are observed. Deformation of the external nose occurs in 80% of the population Globe for a variety of reasons: birth trauma, production work, during sports games, as a result of transport accidents, in case of a fall during an epileptic attack, etc.

In clinical practice, lateral displacement of the nose (rhinoscoliosis) is most common. Another type of post-traumatic deformation of the external nose is rhinokyphosis, in which the formation of a hump is noted. The treatment for these diseases is rhinoplasty.

Often, old nasal fractures lead to deformation of the nasal septum as a result of thickening and displacement, less often of the bone and more often of the cartilaginous parts, as well as curvature of the external shape of the nose relative to the midline. Deviations of the bony part of the septum can be in the form of a unilateral hump, a unilateral clivus depression, a bilateral clivus curvature, and a curvature of the nasal root. The curvature of the cartilaginous part of the septum is caused by displacement of the quadrangular cartilage relative to the anterior nasal bone of the upper jaw. Thus, G.S. Protasevich notes three degrees of severity of deformation of the nasal septum, and Mladina in her classification lists seven types of deformation. A.S. Lopatin, rightly considering their classifications to be insufficiently convenient and accurate, identifies five types of deformations of the nasal septum, while emphasizing that post-traumatic deformations of the nasal septum, due to the bizarre form of fusion of comminuted fractures with sharp angles and fracture lines, do not fit for systematization into the types described by him.

Deformations of the nasal septum are divided into:

1) deformations of the middle and posterior sections,

2) anterior section,

H) the entire department (C-shaped and S-shaped).

Saddle nose deformity- deformation of the external nose with the presence of a depression in the middle part of the back; observed with underdevelopment or destruction (for example, with syphilis) of the cartilage of the nose or nasal bones.

Thickening of the nasal septum is expressed in the formation of spines and ridges, usually at the junction of the cartilage with the upper edge of the vomer. Sometimes they form in the anterior, and sometimes in the posterior sections of the nasal septum, but more often - along its entire length, narrowing or completely blocking the nasal passages, making it difficult to breathe through the nose.

It has been established that deformations of the nose and intranasal structures, first of all, lead to disruption of aerodynamics and, consequently, disruption of its main functions - respiratory and olfactory. The sense of smell affects behavior, memory and emotions, and many autonomic functions of the nervous system that are not controlled by consciousness.

Content

A person who wages an endless struggle with rhinitis, suffers from colds or flu several times a year, suffers from insomnia and loss of smell, may not realize that the problem is not only in the immune system and nervous system. A deviated nasal septum is a diagnosis that is rarely made, but is present in the majority, although predominantly severe forms require urgent correction: thorn, ridge. Is treatment possible without surgery and why is this problem dangerous?

What is a deviated nasal septum?

A central, flat, thin plate that divides the air flow into equal parts, due to which it is processed and delivered harmoniously - this is nasal septum, consisting of cartilage and bone tissue. If the air begins to flow unevenly, the doctor may say that there is a displacement of the nasal septum (its cartilaginous sections), or its deformation in the form of a spike or ridge in the bone area. Curvature occurs in 95% of people, but with varying degrees of severity, so you may not know about it until the end of your life.

Symptoms

A deviated nasal septum can make itself felt both externally and through internal changes in the body. If there is deformation of the cartilaginous tissues close to the front, or at the top of the bridge of the nose (bone section), it will be visible due to the loss of symmetry of the nose. Internal curvature is mainly expressed in:

• frequent nosebleeds caused by thinning of the mucous membranes in the narrowed nostril;
• difficulties with nasal breathing (feeling that air is not coming in at all);
• snoring if a person sleeps on his back;
• frequent overwork (due to hypoxia due to difficulty in nasal breathing);
• decreased immunity, which entails acute respiratory infections, influenza, and other difficult to tolerate diseases;
• chronic diseases of the ENT organs (mostly doctors focus on the appearance of chronic rhinitis in patients with a deviated septum).

Why is a deviated nasal septum dangerous?

If timely and complete air purification does not occur, a sufficient amount of oxygen does not enter the blood and brain, immunity and brain activity gradually decrease, and blood vessels suffer. Subsequently, a deviated septum leads to inflammation of the mucous membrane and chronic hypoxia, which can cause constant headaches and can cause male impotence.

Symptoms of the disease gradually develop into chronic disorders, and the result is:

• nasal polyps;
• problems with olfactory function;
• hearing impairment;
• the occurrence of allergic rhinitis.

Types of curvatures

There are 2 classifications of deformation of the nasal septum - according to the prerequisites for its appearance and according to the type that the plate takes. Curvatures of the front opener are predominantly observed, and even if there is a defect in the rear, its edge remains smooth. The classification of deviated septum most commonly used by doctors is as follows:

• Thorn– the appearance of a process from bone tissue, can be unilateral or bilateral. Depending on the length and direction, it can provoke irritation of the mucous membrane of the opposite wall and injure it.
• Crest– local thickening of the nasal septum at the point of bending, associated with its deformation, can also injure the membrane of the nasal cavity, pushing into it.
• Classic deviated nasal plate– C-shaped deformation, in which a slight deflection appears mainly in the central part. Such minor curvatures are very common, but a person is not always aware of their existence, since they may not manifest themselves in any way.
• Combination of all 3 types- most difficult option curvature, since it is not just responsible for breathing difficulties, but often its complete absence (if the deformation is bilateral, a displacement of the anterior and middle sections is observed).

Causes of a deviated nasal septum

Doctors divide the entire list of prerequisites for deformation of the nasal septum into 3 categories:

• Traumatic. Caused by blows to the facial area of ​​the skull, this cause is predominantly found in males. Even with minor injuries, a bent nose is possible if the fusion of broken bones and cartilage tissue does not occur correctly.
• Compensatory. They are a consequence of pathologies of the nasal cavities, including polyps, tumors and even persistent rhinitis, due to which a person, unnoticed by himself, due to congestion in one of the nasal passages, learns to breathe only freely and thereby provokes a curvature of the septum. Separately, there is compensatory hypertrophy, in which one of the nasal conchas, due to its increased size, puts pressure on the septum and can displace it. In compensatory curvatures, cause and effect often change: even a doctor cannot always say what occurred first - deformation of the plate or breathing problems due to an increase in bone formations that divide the nasal cavity into zones.
• Physiological. Associated with congenital structural features of the skull - mainly uneven development of its bones. In rare cases, such a physiological curvature of the septum is observed, such as the development of a rudiment behind the olfactory zone, pressing on the nasal dividing plate. This deviation is rare.

The child has

The nasal septum in children under 10 years of age is predominantly a cartilaginous plate: more flexible than bone, and more vulnerable. Doctors mention cartilage fractures in children more often than in adults, and this often becomes the cause of septal deformation. If you do not pay attention to the disruption of proper breathing after an injury in time, the plate will ossify over time (as the child gets older), and the curvature will no longer be as easy to straighten as in childhood.

However, there are several more prerequisites for this problem in children:

• birth injuries;
• uneven growth of the skull bones (minor curvatures, corrected independently);
• inflammation of cartilage tissue.

Diagnostics

An attempt to confirm or refute the diagnosis of “deviated septum” begins with an examination of the patient by an otolaryngologist, who first evaluates appearance facial part of the nose. If there are serious deformations of the nasal septum, they will be visible already at this stage. Afterwards, the breathing of each nostril is checked separately, the results are correlated: if there is no curvature of the nasal septum, the force of inhalation and exhalation is the same for the left and right sides. The last thing to do is test your sense of smell.

If suspicions that the nasal septum is deviated grow stronger, the doctor may prescribe:

• Rhinoscopy– consists of examining the nasal cavity (left and right) using a special instrument that widens the nostrils. Next, a thin probe is inserted into the lumen to palpate the mucous membrane and evaluate neoplasms (if any): these are polyps, tumors, and ulcers. Additionally, hypertrophy of the posterior ends of the turbinates can be detected when examining the curvature through the oral cavity.
• Endoscopy– a more informative examination, which should be performed with local anesthesia of the nasal mucosa. Her condition is assessed through a probe with a “video camera”. Thanks to the endoscopic method, the lower shell, where mucus accumulates, is clearly visible.
• X-ray of the skull– an image is needed to say whether there are formations in the paranasal sinuses, to confirm or refute the presence of traumatic deformation, congenital bone anomalies of the skull, which could provoke a curvature.
• Computed tomography– helps to examine in detail the back of the nasal cavity, determine the presence or absence of spines and ridges on the septum.

Treatment

A crooked nasal septum is an anatomical problem, so it is impossible to straighten the plate with medication. If, as a result of its deformations, breathing and hearing disturbances are noted, a disorder of smell develops, the middle concha is additionally enlarged, or hypertrophy of the lower one is observed, we will definitely talk about surgical interventions, mainly traditional ones - septoplasty or endoscopic surgery. In rare cases, a deviated septum can be corrected with a laser.

Treatment without surgery

Conservative therapy can be aimed at eliminating chronic inflammation, polyps, adenoids (a consequence of a deviated septum), helping to alleviate the condition of allergic diseases, restoring breathing and strengthening the immune system. However, correcting a crooked septum is impossible, so doctors question the effectiveness of such treatment. Mostly experts can advise:

• removal of adenoids, polyps;
• osteopathy (manual therapy);
• a long course of drugs to eliminate swelling.

Operation

The doctor may recommend surgical correction of the curvature in case of serious deviations in the development of the cranial bones that provoke a large number of complications: among them are shell hypertrophy, persistent sinusitis, and the inability to breathe through a narrowed nostril. Surgery is performed only on persons over 16 years of age (exceptions are possible). Resection of the nasal concha can be performed with an endoscope, which is less painful. In case of severe injuries, simultaneously with classical surgical intervention rhinoplasty is performed.

Laser chondroseptoplasty

Classic septoplasty is performed only in cases of severe forms of curvature, and for minor deformities the doctor may suggest laser treatment. This method is used only if you need to level cartilage tissue– the laser will not perform resection of spines and correct the bending of bone tissue, nor will it help with traumatic curvature. According to reviews, the procedure is painless, but it is not recommended for children and elderly people.

Rehabilitation after surgery

If it was necessary to perform surgical correction of a curved nasal plate, after it tampons are inserted into the patient’s nostrils, and silicone retainers must be installed. The next day they are removed, if there is no heavy bleeding, the patient returns home, but he may remain in the hospital for 4 days. However, completely normal breathing is restored only 3 weeks after straightening the septum. During rehabilitation you need:

• during the first week, have your nasal passages cleaned daily by an ENT doctor to remove crusts and prevent the appearance of pathogenic microorganisms;
• do breathing exercises that will prevent adhesions from forming;
• use wound healing agents for external use (they must be prescribed by a doctor).

Possible complications after surgery

According to doctors, doing septoplasty is relatively safe (even from an aesthetic point of view - photos of people who have undergone it prove that there are no scars): blood loss is minimal, and trauma is also minimal. However, any operation is accompanied by risk, so after septoplasty you may:

• ulcers and hematomas form;
• Prolonged nosebleeds appear in rehabilitation period;
• fusion of cavities and narrowing of the lower passage are observed;
• develop purulent sinusitis, perichondritis.

Treatment at home

If the nasal septum is not so curved that the doctor insists on surgery (resection of the ridges, removal of spines, correction of the consequences of the fracture is not required), but causes problems, you can independently do procedures to make breathing easier and expel mucus, but this will only relieve symptoms. Home therapy may include:

• Corticosteroids.
• Silver preparations.
• Antiseptics.
• Compositions for rinsing the nasal passages (combat a common symptom of a crooked septum - rhinitis).

Prevention

You can protect yourself from deformation of the central nasal plate only if it is initially smooth or the curvature is slight. For this it is recommended:

• avoid activities that are accompanied by fractures of the skull bones (traumatic sports, etc.);
• do not allow ENT diseases to develop into polyps and adenoids;
• strengthen the immune system.

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Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and make treatment recommendations based on individual characteristics specific patient.