Nasal septum, Deviation and Septoplasty

The importance of nasal breathing and the inconvenience of nasal obstruction

The importance of 'effective' nasal breathing cannot be over emphasized. By the time inspired air passes through the nose and reaches the lungs, the air has been properly warmed, humidified and also cleaned. The  physiologic cleaning and filtering function which is important for proper pulmonary and overall health is emphasised simply because the continual or episodic absence of 'healthy' nasal breathing often is a reason to a host rise of medical problems and conditions.

Nasal airway obstruction is a very common problem, not just in United States, but throughout the world. There are multiple causes, both temporary and acute, for as well as chronic and persistent nasal obstruction. It can persist for weeks and months and sometimes even throughout ones lifetime.

The following is a list of some of the more important causes of chronic nasal airway obstruction: adenoid tonsil enlargement, chronic adenoiditis, chronic allergic rhinitis, chronic sinusitis, congenital choanal atresia (congenitally obstructed nasal passage), chronic vasomotor rhinitis, nasal polyposis, nasal valve collapse, nasoseptal deviation, refractory turbinate (nasal mucosa) enlargement, and outer nasal deformity due to trauma or surgery.


Nasal septum

The nasal septum separates the left and right airways in the nose. It is the large cartilage in nose that divides it into two cavities – lef and right nostril.
The nasal septum is composed of three structures: ethmoid bone, vomer bone and septal cartilage.
The nasal septum and nasal cavities are lined with mucosa, a thin membrane tissue. This tissue may get irritated due to bacteria, viruses and other irritants. Consequences may be the development of post nasal drip, nasal polyps, sinusitis, and if severe enough a septum deviation. Deviated septum may lead to impaired breathing due to the mucus collection, septum perforations, development of polyps. 

Septum deviation

Septum deviation is not often a problem, but sometimes the cartilage is too deformed that it bends and blocks one air passage, and nasal septum can depart from the centreline of the nose. Septum deviation may be caused by trauma, like an injury to the septum from a punch to the nose, excessive nose-picking or cocaine usage. However, there are two common causes for internal nasal obstruction due to nasoseptal deviation. People, suffering from some sort of injury or some other familiar nasal trauma have probably the most common cause for septal deviation. In the past several decades there has been an injury increase in nose trauma, nasal fracture and consequently a rise in nasoseptal deviation and crookedness. Reason for that is the rise of young adult  participants in sports such as skiing, snowboarding, skateboarding, bicycling and other contact sports.
Nose fractures, which are very common among this group may occur due to the trauma of each or a combination of the following three structures of nasal septum: ethmoid bone, vomer bone and septal cartilage. And since the bony parts of the nose the perpendicular plate of the ethmoid bone and the vomer are too thin, fractures are very common. The outer portion of the nose is connected with the nasal septum, so simple nasal trauma or nasal fractures can cause septum deviation.
Second most common group suffers from septum deviation because of cartilaginous growth abnormalities or unusual nasoseptal growth patterns. However, most often the deviation is caused by postnatal trauma (it can during a fist fight or even during delivery).

Symptoms of deviated nasal septum include:

• airway blockage
• sinus blockage
• nosebleeds
• headaches
• sleep apnea
• colds
• chronic sinusitis

Septoplasty

There is no other medicine or cure for a deformed nasal cartilage, septoplasty is the only effective treatment Septoplasty is a surgical procedure in which a deviate nasal septum is straightened. This results in both improved examination and breathing. Namely, when you have septum deviation, it is difficult to examine your sinuses and the your nose for polyps, tumors, epistaxis, thus in order to improve health problems, it is essential to undergo septoplasty.
The procedure takes about 30 minutes to be performed, but swelling and irritation may delay final improvement for about four to six weeks.
Septoplasty is generally performed on an outpatient basis with local or general anesthesia. The surgeon works through the nostrils, making an incision in the lining of the septum to reach the cartilage targeted in the operation. Bony spurs are trimmed or removed if they are present. The cartilage is morselized and straightened back to its original position. Bone is also manipulated to the center to achieve reasonable straightening and better nasal airflow.
Sometimes small splints are placed internally to support the septum, but they are removed in a few days time.
Nasal septoplasty is commonly performed with other procedures, such as reductive surgery for additional improvement in nasal breathing; endoscopic sinus surgery and reconstructive or cosmetic rhinoplasty.
After the procedure individual will go home the same day. There will be mild discomfort to the nasal area for one or two days afterward. In reducing postoperative discomfort oral pain medications are generally effective. Ice packs are also placed around the nose and cheek area for alleviation of the mild discomfort. Patient typically regain about 80% of their energy in one week after the surgery” patient is able to resume reasonable activities after three to four days and can go back to work after five to seven days. However, full recovery from the procedure is achieved after one month. During postoperative care frequent saline irrigations of the nasal cavities are continuously used until the healing process is complete.