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Deviated Nasal Septum

What is a Deviated Nasal Septum?

The nasal septum is the bone and cartilage that divides the nasal cavities into two separate chambers.  It is normally located at the midline, which makes the nostrils symmetrical. Deviated nasal septum is the improper alignment or displacement of the septum either to the left or right.  Slight deviation does not cause any problems and does not necessitate treatment. There is an estimate that 80% of the population have a deviated nasal septum. Most of them are going on with their lives without experiencing any inconveniences. It is only when there is too much deviation that certain health risks are involved. [1]

Deviated Nasal Septum Symptoms

A severe deviated nasal septum can obstruct one section of the nose and lessens the flow of air into that cavity. This would result to the most common symptoms of a deviated septum:

  • shortness of breath,
  • frequent nosebleeds,
  • nasal congestion,
  • headaches,
  • facial pain,
  • recurring postnasal drip and
  • recurrent sinus infections that would lead to sinusitis.[4]
  • Young children and infants with severe septum deviation may have noisy breathing while asleep.

Individuals with mild deviation would manifests symptoms of a deviated septum only when they are experiencing upper respiratory tract infections (common cold). The infection would cause inflammation of the nasal passages and briefly amplify minor airflow obstructions.

Deviated nasal septum snoring

Snoring is one of the most frequent consequences of a deviated septum. This is true because the obstruction of the nasal airflow causes individuals to breath through the mouth. When asleep, the body muscles relax, including the tongue, soft palate, uvula and the throat.  During respiration, the air movement causes these parts to vibrate resulting in loud noises or snoring.

Deviated nasal septum sleep apnea

Snoring, when is untreated and ignored for long, it can lead to one of the more serious symptoms of a deviated septum sleep apnea. [5] This is a chronic condition where an individual recurrently stops breathing for at least ten seconds during sleep. When this problem occurs thirty times or more in a 7-hour sleep period, it is considered as obstructive sleep apnea. Such frequent pauses can lead to mild to severe hypoxemia and lead to ischemic heart disease or other cardiovascular and cerebrovascular problems that may be fatal.

Deviated Nasal Septum Causes

A deviated septum can develop because of congenital malformation or a traumatic birth.  Most often it is due to postnatal trauma such as a direct blunt blow to the nose. That results in a fracture in thin bones in the nose.   Anything that can cause trauma to the nose can lead to septal deviation. This happens most often during  automobile accidents, rough play or playing any contact sports, or even shoveling snow with equipment that is too large for the child.

A deviated septum may also be connected to Marfan syndrome [6] and Ehlers Danlos Syndrome [7]. Both of these are congenital connective tissue tissue disorders.

Deviated Nasal Septum Pictures

Picture 1 : Deviated nasal septum

Image source : dyndns.org

Picture 2  : Image of Bony nasal septum deviation

Picture 3 : Deviated nasal septum midline

Picture 4 :  Deviated Nasal Septum Diagnosis

Image source : ent.com.hk

Deviated Nasal Septum Treatment

There are no known medications that can correct a deviated septum. Repair is based upon surgically correcting it.  Medical treatment is provided for managing symptoms of nasal congestion or post nasal drips.

The physicians would generally prescribe decongestants, antihistamines and nasal sprays to relieve these symptoms. In extreme pain caused by the inflammation of the sinuses, mild pain relievers may be given.

To prevent future complications and relieve the patient from recurring symptoms, permanent deviated septum repair is considered.  That means surgery.

Deviated Nasal Septum Surgery

Significant obstruction of the airway requires surgical intervention. Surgery for deviated septum is called septoplasty.

This is done by making a small incision on the internal portion of the nose where the mucous membrane lining the septum is removed from the bone and cartilage.The bone and cartilage are then shaped and repositioned.

In some cases, a portion of the cartilage or bone is removed in order to properly align and position the septum (rhinoplasty). Once this is done, the mucous lining is sewn back using absorbable sutures. [3]

It usually takes 30-90 minutes to complete deviated nasal septum surgery.  Septoplasty  is carried out under general anesthesia or sedation anesthesia. Following the surgical procedure the nose is quickly flushed with saline water  to remove blood clots and other debris. A nasal pack is then placed inside the nose to prevent post-operative hemorrhage and hold the tissues in position during the healing process.

Deviated Nasal Septum Surgery Costs

Deviated septum surgery cost varies.  Factors influencing the cost include:

  •  the skill of the surgeon,
  • where the procedure will be done and
  • how complex and severe the individual case would be.

A simple deviated septum surgery will probably cost around $1800-$2200  USD.  However,  if rhinoplasty (a cosmetic surgical procedure) is involved, then the operation charge would be greater.

Since the medical problem is related to breathing difficulties, deviated septum surgery cost is included in most insurance plans. Usually the accompanying rhinoplasty is not covered.

Deviated nasal septum surgery recovery

The rate of recovery depends on how complex the situation is for the patient.  A regular septoplasty usually requires five days to a week of recovery time before going back to work.  However, if more procedures were needed (rhinoplasty), then a longer time for rest is required.

During the healing process,the nasal packs placed inside should be changed as often as possible to avoid  infection. It is normal to have mild pain, minor inflammation and bleeding during the first few days following the surgery. Make sure that the nose is not rubbed or the nasal packs removed before schedule. That could cause further inflammation and bleeding.  Since the nose is packed, the patient needs to breath through the mouth. This is often quite inconvenient and difficult especially during meal times.

Deviated nasal septum surgery risks

Any surgical procedure has possible risks for bleeding and infection. Septoplasty also bears a slight risk of septal perforation. However this does not necessitate treatment unless an infection develops. Decreased sensation or numbness at the nose tip and the upper portion of the mouth, especially the front teeth, may also occur  temporarily. What is unusual is the impairment of the sense of smell.

It is your responsibility to gain a clear understanding of the overall procedure, recovery time, possible complications and risks as well as insurance and other costs. That way you can make your decision based on real information and your consent to proceed will be well informed.

References:

  1. http://www.entnet.org/HealthInformation/deviatedSeptum.cfm
  2. http://www.merckmanuals.com/home/sec19/ch221/ch221c.html
  3. http://www.urmc.rochester.edu/encyclopedia/content.cfm?pageid=P02062
  4. http://www.mayoclinic.com/print/acute-sinusitis/DS00170/DSECTION=all&METHOD=print
  5. http://care.american-rhinologic.org/snoring_nasal_congestion
  6. http://nlm.nih.gov/medlineplus/marfansyndrome.html
  7. http://nlm.nih.gov/medlineplus/ency/article/001468.htm



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