What is Nasal Bone Curvature (Septum Deviation)?
The anatomical structure that separates the two airway tunnels in the nose at the midline and contains cartilage on the anterior side and a thin bone on the posterior side is called the septum. For different reasons, this structure may be curved to the right or left of the midline or in both directions, and this deformity is called nasal bone curvature (septum deviation).
Why is Septum Deviation Important?
Deviated septum or nasal bone curvature prevents nasal breathing unilaterally or bilaterally, decreasing physical performance, impairing the health of the upper respiratory tract, reducing sleep and quality of life. Since the dynamics of the air taken through the nose is disrupted, it can cause drying of the nasal mucosa and nosebleeds, block the sinuses opening into the nose and cause recurrent sinusitis attacks.
On the other hand, deviated septum can also distort the external appearance of the nose and cause aesthetic problems as well as health problems.
What are the Causes of Septum Deviation?
The cause of deviated septum cannot usually be determined. It can be in the form of congenital deformation of the facial bones, or deviation may develop as a result of trauma to the nose during normal delivery. It is usually caused by
- Infancy and childhood,
- Playing sports,
- Playing in the playground,
- Trauma to the nasal area, such as a traffic accident, can cause a deviated septum. Most of the time, patients do not remember a specific trauma history.
What are the Symptoms of Deviation?
- Difficulty breathing through the nose unilaterally or bilaterally,
- Frequent nosebleeds,
- Frequent attacks of sinusitis,
- Headache
- Nasal discharge
- Sleeping with the mouth open at night and associated dryness in the mouth and throat,
- Babies and children breathing loudly through their nose while sleeping,
- Deviation should also be suspected in people who prefer to lie on one side because they breathe more easily through their nose.
While people with mild nasal bone curvature do not have significant respiratory distress under normal conditions, the nasal mucosa swells in the slightest cold or upper respiratory tract infection and breathing difficulty begins immediately. When the infection passes, the breathing problem also passes.
On the other hand, normal noses without a deviated septum cannot breathe from both nostrils at the same time with the same comfort. While breathing is more comfortable from one side of the nose for a while, breathing is more comfortable from the other side after a while. This situation changes constantly during the day and is completely physiologic and should not be confused with deviation.
Respiratory problems observed due to swelling of the nasal mucosa due to allergic causes should not be confused with deviation. Sometimes both deviation and allergy may be present together. In such cases, both causes should be treated separately.
How is Septum Deviation Diagnosed?
Deviation is diagnosed by examining the inside of the nose with the naked eye and fiberoptic camera systems. Computed tomography, known as Paranasal Sinus Tomography, is an extremely useful diagnostic tool in terms of showing both the intranasal structures and the condition of the sinuses around the nose. Pathological conditions that cannot be detected by visual examination are more easily recognized in this way and the operation plan is made more accurately.
Should Every Septum Deviation Be Operated?
Mild septum deviations that do not disrupt the quality of daily life and do not cause health problems do not require surgical treatment. However, if the previously mentioned complaints do not go away despite medical treatments, surgery should be considered.
What is the Age of Septum Deviation Surgery?
The growth and development process of the nasal and mid-face bones continues until the ages of 18-20 in men and 16-18 in women. Surgical interventions to the growth centers in the nose before these ages have a risk of adversely affecting the growth and development of the nose and therefore surgery is not recommended before these ages unless it is very compulsory.
On the other hand, there are some conditions that require immediate nasal intervention. These are cancers, abscess or blood collection (hematoma) in the septum, severe nasal trauma (traffic accident, falling from a height, etc.), cleft lip deformity or worsening deformity of the nose.
How is Nasal Bone Curvature (Septum Deviation) Surgery Performed?
Septum Deviation surgery must be performed in a full-fledged operating room environment. The use of blood thinners and food should be discontinued beforehand and necessary blood tests should be performed. The surgery is performed under intravenous sedation and local anesthesia or general anesthesia depending on the degree of septum deviation and the size of the surgical procedure to be performed.
In order to eliminate the existing deviation, some of the cartilages with curvature are removed, and the cartilages that support the nose are corrected and brought to the midline. Deviation surgery is not a standard surgery, it can be a very limited intervention depending on the condition of the existing anatomical deformation, or it can be a comprehensive surgical procedure in which all nasal cartilage and bone structures are corrected.
The surgeon who will perform the surgery determines the size of the deviation and the treatment plan in the preoperative interviews and informs the patient. Sometimes, in addition to correcting the deviation, additional procedures for the sinuses such as reducing the growths in the nasal flesh (turbinate hypertrophy) and widening the mouths of the sinuses opening into the nose are also performed.
Should Septum Deviation and Aesthetic Surgery be Performed Together?
If the external appearance of the nose needs to be changed aesthetically in addition to the elimination of deviation, it is best to perform deviation and aesthetic surgery in the same session. Because the cartilage tissues removed during deviation surgery are the most important natural support structures used in shaping the nose.
In people who have previously undergone deviation surgery, aesthetic nose surgery may be more difficult because the cartilages to be used for support may have been discarded. It may be necessary to take cartilage from other parts of the body such as ears, ribs or use some synthetic materials for support.
Recovery Process After Nasal Bone Curvature (Septum Deviation) Surgery
Depending on the anesthesia administered and the size of the surgical procedure performed in deviation surgery, the patient can go home the same day after surgery or spend the night of the day of surgery in the hospital. It is very important to lie in a semi-sitting position to reduce blood leakage from the nose after surgery.
For the same reason, excessive straining, bending forward, carrying heavy things, talking and walking should be avoided. In the postoperative period, it is very important to stay calm, not to get excited, to apply cold, to take enough fluids and food.
Generally, the person gradually returns to his/her daily life within the first week after surgery. Depending on the additional procedures performed, it may take an average of 6 weeks to correct factors such as swelling and crust formation due to surgery in the nose.