A crooked nasal septum is referred to as a deviated septum. The nasal septum deviates from the normal central position in the nose. The entire nasal septum can be crooked, or just parts of it, e.g. a so-called septal spur.
Such a crooked nasal septum can be congenital or caused by trauma to the nose.
A crooked nasal septum is a common malformation of the human face. Among the anatomical nasal variants, deviated septum is the most common.
60 to 80 percent of all people show a deviated septum on clinical examination of the nose.
However, only 25 to 50 percent of people feel impaired by their crooked nasal septum. This is the difficulty in interpreting the diagnosis "crooked nasal septum". It is therefore essential to select patients critically and carefully to ensure that both the patient and the surgeon have identical expectations for the operation.
With a deviated septum, the nasal septum is crooked and can lead to breathing problems © Alessandro Grandini | AdobeStock
The main symptom of a deviated septum is a blocked nose. This is caused by the obstructed passage of the air we breathe. It is not only the narrowing of the nose, but also the associated turbulence of the air flow in the nose that leads to the symptoms that occur.
This is why some patients with an "empty nose", e.g. as a consequence of excessive endonasal resection of the septum and/or turbinates, also complain about the feeling of a blocked nose. Permanently obstructed nasal breathing can also lead to drying out of the nasal mucosa with increased nosebleeds. This is due to the acceleration of the air flow (Venturi effect).
If the ventilation of the paranasal sinuses is impaired, repeated sinusitis can occur.
Headaches, on the other hand, are rarely the result of a crooked nasal septum. They mainly occur when the curvature is in contact with the middle turbinate or lateral nasal wall. If the crooked nasal septum restricts access to the olfactory cleft in the nose, this can impair the ability to smell.
However, a runny nose is not a typical symptom of a deviated septum.
Careful clinical examination of the nose is an essential prerequisite for further treatment of a deviated septum.
Optical aids, i.e. a microscope or endoscope, help to discover findings that would not be visible to the naked eye. Changes in the nasopharynx can also be excluded or diagnosed.
The functional diagnosis of nasal breathing, rhinomanometry, should also not be missed. There are various ways of measuring and quantifying the air flow passing through the nose. However, the measured values obtained should not be regarded as absolute indicators, but only as one component in the overall diagnostic complex. The reason for this is that the measured values often do not correspond to the subjective symptoms. An abnormal value therefore does not necessarily indicate a nasal obstruction requiring treatment.
In the course of diagnostics, other causes of obstructed nasal breathing, e.g.
- allergies,
- excessive use of decongestant nasal drops,
- chronic sinusitis (inflammation of the paranasal sinuses) with or without polyps, etc.
can be determined and ruled out.
X-rays of the nose and paranasal sinuses complete the diagnosis of a crooked nasal septum. This allows a concomitant disease of the paranasal sinuses to be detected or ruled out.
The treatment of obstructed nasal breathing caused by a deviated septum consists of surgical straightening of the nasal septum. The procedure is also called plastic septal correction or septoplasty.
In otorhinolaryngology, septoplasty is one of the most frequently performed operations. It involves straightening the bent or displaced parts of the septum in the nose and removing excess tissue.
In the early days of nasal surgery, large sections of the septum were removed for this purpose. This destructive surgical technique is no longer used today. Modern surgical techniques limit the removal of parts of the nasal septum to what is absolutely necessary.
In addition, the removed tissue is reinserted into the nose for reconstruction after it has been straightened. This has minimized the complications that used to be typical of the operation. These complications included the so-called "empty flutter septum" with endonasal breathing-dependent displacement and corresponding nasal breathing obstruction.
Nevertheless, plastic septal correction also involves risks, which are generally rare but cannot be completely avoided. For example, a defect in the nasal septum and an unsatisfactory functional result may occur postoperatively.
Very rarely, the body breaks down nasal cartilage after the operation, which can lead to a change in the external shape of the nose.
Approximately 80 percent of patients who have undergone surgery benefit from the operation and report lasting and significant relief from their symptoms.
Experience has shown that a recovery period of around 14 days can be expected after surgery.
As a rule, tampons are inserted into the nose after the operation. They are usually removed two days after the operation. During this time, a breathing tube attached to the tamponade can make it easier to breathe through the nose.
Without tamponades, there is a risk of frequent secondary bleeding. Postoperative tamponade is therefore recommended due to the risk of secondary bleeding and for internal splinting of the nasal skeleton.
Careful nasal care with nasal rinsing and nasal ointment is recommended after the operation.
The nose heals completely about four weeks after the operation. This will also show whether the procedure was successful and whether the patient's symptoms have been alleviated.
You should refrain from sporting activities for 14 days after the operation. Contact sports with the risk of injury to the newly operated nose are not recommended for four to six weeks.
