A septal deviation is colloquially recognized as the nasal bone
turning aside. Before answering the question what the deviation is, I think I
must address what the healthy nose structure is.

The nasal septum consists of cartilage and bone in the anterior
and posterior halves respectively. It extends from the midline between the two
separate nostrils to the pharynx, separating the nasal cavity into two airway
passages.

In a healthy nose, the anterior entrance to the airway passage
enlarges while extending posteriorly. The air taken into is warmed up,
humidified, and directed to the smelling regions in the roof of the nose.  Furthermore, the particles, with a size of
over 5 microns taken in from the air, are filtered through the mucous
secretions on the intranasal mucosa. This means that it always directs the air
to the lungs in constant quality and cleanliness. The health states of the
lower airways and lungs depend largely on the proper functioning of our nose.

In a deviated nose, this cartilage, which should be positioned
exactly on the midline, is more or less moved on the other side.  The intranasal septal deviation, which occurs
either in the entrance to or at the exit from the nose, causes an obstruction
and prevents air passage. The patient cannot breathe healthily from either one
side or both sides of the nose.

Deviated Septum Treatment Overview

A deviated septum is a common condition affecting the nasal
passages, where the nasal septum, the thin wall between the nostrils, is
off-center or crooked. This misalignment can be a result of an injury,
potentially during physical activities or accidents, and it often leads to
symptoms such as nasal congestion and difficulty breathing. As a consequence of
the obstruction caused by the deviated septum, individuals may experience
long-term health problems, including breathing difficulties and chronic nasal congestion.
In some cases, a deviated septum can impede proper airflow through the nose,
leading to the preference of breathing through the mouth. Such complications
can also have implications beyond the ear, nose, and throat domain, affecting
mental health due to the challenges faced while trying to breathe effectively.

Treatment methods for a deviated septum vary, with
reconstructive surgery being a common approach. During deviated septum surgery,
the nasal septum is repositioned to align it properly, restoring normal airflow
through the nasal passages. However, like any surgical procedure, there are
potential risks associated with deviated septum surgery, such as the risk of a
blood clot, particularly in the region near the carotid artery. It is crucial
to discuss the best course of action with a qualified ear, nose, and throat
specialist, considering individual health conditions and preferences.
Addressing a deviated septum through appropriate treatment can significantly
alleviate symptoms, improve breathing through the nose, and positively impact
overall physical and mental well-being.

What are the Causes of
Deviation?

A deviation may be congenital due to pronounced facial
asymmetries developing from hereditary causes, or it may occur as a result of
often external trauma subjected in childhood. The nonsignificant deviations
with 1 mm shifts as the result of childhood trauma to the nose leads to
significant deviations in adolescence as the development of the nose progresses
with increasing age. The nose usually continues to develop until 18 years of
age.

What are the Problems
Which can be Caused by the Septal Deviation?

The nasal obstruction caused by the septal deviation leads to a
loss primarily in the quality of life of the individuals. The incessantly
warmed up and humidified air is always sent to the lungs at a constant quality.
When the nose is obstructed, the patient starts breathing from the nose causing
the airways and lungs to be exposed to dry, cold, and polluted air directly. In
this situation; the throat, larynx, lower airways, and the lungs try to
climatize the air with failing attempts leading to severe irritation,
reactions, and diseases.  The patient
with severe nasal obstruction will have an increased tendency to snore at night
and will develop disturbances in her or his sleeping pattern and sleep quality
due to lack of full oxygenation of the body, leading to the development of
headaches in the mornings and low mental and physical performance during the
day. These may cause the individual to become more susceptible to weight gain,
diabetes, and cardiovascular diseases.

The negative aspects of
breathing from the mouth:

●
Dry mouth

●
A foul smell of breath

●
Gingival and dental health problems

●
Snoring

●
Low quality sleep, inability to rest

●
Irritability

●
Loss of appetite

●
Sneezing spells

●
A poor sense of smell

●
Getting up tired

●
Frequent infections and diseases of the lower respiratory
tract and lungs

The uncomfortable condition due to nasal obstruction costs
decreases in performance to the individual. The productivity of the individual
is reduced because of the irregular sleeping patterns. A general fatigue will
cause the patient to start failing to enjoy life sufficiently.

The following may occur
due to a septal deviation:

●      A general sense of fatigue

● Excessive weight gain and all diseases associated with
excessive body weight (Diabetes, cardiovascular disorders, hypertension, etc.).

●    Loss of capacity to enjoy life

●    Attention deficits

●    A tendency to fall asleep during the day

●    Career failures

Furthermore, sinusitis, sleep apnea, and diseases of the middle
ear can occur as well.

What are the Symptoms
of the Septal Deviation?

A septal deviation can be observed from outside by the unaided
eye roughly as the nasal bone moving aside or it may develop as a hidden
structure within the nasal cavity. There are several general symptoms
associated with the disease. If the patient experiences one or more of the
following symptoms, the patients must see an Ear Nose Throat specialist
(otorhinolaryngologist):

●   Nasal obstruction (on one side or on both
sides)

●   Breathing from the mouth or sleeping as the
mouth is open (causes a continuous inflammation in the pharynx, chronic
pharyngitis, dryness in the throat).

●   Snoring and sleep apnea

●   Always getting up tired and poor performance
during the day

●    Repeating sinus infections with increasing
frequency

●  Pain in the nose, in the middle region of the
face, and in the sinuses (sometimes misdiagnosed as migraine spells).

●   The decision-making process for the septal
deviation surgery

The nose is composed of bone, cartilage, and soft tissues. As I
always refer, inside and outside of the nose is a whole and cannot be handled
separately. A patient with a septal deviation should have a careful examination
of his or her nose both inside and outside before the surgery as it is
critically important to determine whether the intranasal deviation causes a
deformation visible outside as it will require performing both aesthetic
surgery and a septal deviation surgery simultaneously.

In most cases, it is not possible to resolve an intranasal
septal deviation visible outside by only performing an intranasal septal
deviation surgery. Furthermore, in cases of only intranasal septal deviation
surgery in patients with extranasal cosmetic disturbances, the intranasal
cartilaginous structures, which constitute an important part for the extranasal
aesthetic surgery of the nose, are either lost or injured in the nasal surgery.
When the patient demands an extranasal aesthetic surgery in the coming years,
these missing or injured non-existent intranasal cartilaginous structures cause
remarkable troubles for the aesthetic nasal surgery.  Similar to the revision surgeries,
cartilaginous tissue should be taken from the ear or from the ribs in order to
restore the nose.  This increases the
cost, duration, and the complexity of the surgery. After intra and extranasal
structures are thoroughly evaluated before the septoplasty, it should be
thoroughly discussed whether the patient would like to undergo a nasal
aesthetic surgery along with the septal deviation operation in the same
session. The patient’s opinions about this issue should be carefully
noted. 

How is a Septal
Deviation Surgery (septoplasty) Performed?

Surgery to treat a deviated septum can be performed under either
local or general anesthesia. I prefer performing all kind of surgeries under
general anesthesia to maintain my patients’ comfort.

First, the nasal cartilage is accessed via an incision performed
on the nose of the patient under general anesthesia. Then, the nasal cartilage
membrane is elevated and the deviated parts are excised. During these steps,
utmost care should be attended to protect the cartilages strutting and bracing
the nose. It is extremely important not to harm the connection points between
the nasal septum and the nasal bone. Above, the image on the left demonstrates
a narrow nasal airway passage. The image on the right shows that this airway
passage has become patent.

A deviated septum surgery lasts for 1.5 to 2 hours in my hands.
If the surgery includes a rhinoplasty, the duration will vary from 4 to 5
hours. The important point is not the duration of completing the surgery but
allowing the patient to finally have a healthy and breathing nose.

The Period After the
Septoplasty

After the surgery, breathing difficulties may occur due to the
intranasal silicon plaques, intranasal edema, accumulated blood or clots. The
patients must consume liquid and soft diets in the first days following the
surgery. Drinking lukewarm water and moisturizing the lips will help during
this period.

In the recovery period, the patients should use only the
medications which I will recommend. Blood-thinning medications should not be
used although they were received in the period before deciding the surgery.

The patients’ heads must be supported by at least two pillows to
keep the head elevated. Although it is normal to have a mild bloody discharge
at the tip of the nose for a few days, the doctor should definitely be
contacted in the case of an increased bleeding.

Silicone plaques are usually removed in the postoperative 5-7
days. The patients can breathe from their noses comfortably after this step.

During this period, it is very important to prevent the nose
from blows. One should definitely not poke with and around the insides of the
nose. Wearing glasses should be avoided as they will exert some force on the
nose. A toothbrush with soft bristles should be preferred.  Moisture should be added inside the nose to
avoid any intranasal crusting or dryness which can occur later in the process.

Blood pressure increasing activities should be avoided
approximately for a duration of 2 weeks. During this period exposure to sun
should be avoided, too. The nose should be protected from direct sunlight and
sunscreen creams should be used if required.

It is normal to experience some degree of numbness in the nose
and in the upper lip.  This numbness is
temporary. It will be useful to avoid rubbing the nose strongly, blowing
through the nose or sneezing as much as possible during this period.

If you consider having rhinoplasty surgery, contact
us right away to get a free consultancy service from Prof. Dr. Selçuk İnanlı.