I. Overview
When the nasal septum deviates from the midline and bends to one or both sides or forms a local protrusion that affects the physiological function of the nasal cavity, it is called nasal septal deviation. Based on clinical observation, Gray (1972) suggested that fetal head pressure due to fetal malposition in utero and fetal head pressure during natural delivery through the birth canal can lead to nasal septal deviation or dislocation. This is the theory of birth contouring. Improper holding of the forceps can also cause deviation and dislocation of the nasal septum due to pressure. It has also been suggested that the occurrence of deviated nasal septum is related to genetic factors. Acquired nasal septal deviation is mainly caused by trauma or compression factors, such as hypertrophy of the proliferator, due to nasal congestion since childhood and often open mouth whistling, resulting in high arching of the hard palate, nasal septum development space is restricted and cause deviation. The nasal septum can be deviated to the opposite side due to nasal tumor or foreign body’s pressure. According to clinical observation, there are very few adults with completely centered and straight nasal septum, and most of them have different degrees of deviation. If the degree of deviation is mild and does not cause nasal dysfunction or symptoms, it is a “physiological deviation” and should not be diagnosed or treated.
There are different types of nasal septal deviation, which can be divided into the following according to the shape of deviation
1.”C”-shaped deviation: The nasal septum is convex to one side, often limited to the cartilage, or the cartilage and the vertical plate of the sieve bone can be deviated to one side at the same time.
2.”S”-shaped deviation: The vertical plate of the sieve bone is deviated to one side, and the septal cartilage is deviated to the opposite side.
3.Crestal prominence: a long bulge on the nasal septum, which travels from anterior to posterior. It is mostly located on the upper edge of the maxillary nasal crest or plow bone. Some crestal prominences are caused by overlapping cartilage dislocation.
4.Spinous process (talus): it is a limited sharp protrusion, often located at the junction of septal cartilage and bone.
Indications for nasal septal deviation correction surgery
1. persistent nasal congestion or recurrent nasal bleeding caused by deviated nasal septum.
2, nasal septal deviation, momentum or crestal prominence affects the function of the eustachian tube, resulting in tinnitus, deafness or the occurrence of reflex headache.
3.Deviated nasal septum obstructs the middle nasal passage and hinders sinus ventilation and drainage.
4.The management of nasal septal deviation associated with external nasal deformity
5.The treatment of certain transnasal surgery of nasal septum anterior.
Preoperative preparation
(A) Nasal endoscopy
Nasal endoscopic examination makes the examination and diagnosis of nasal septal deviation more accurate. After surface anesthesia of the anterior nasal cavity, a 0° and 30° rigid nasal endoscope is used for observation. Then, the deep part of the nasal cavity was examined after adequate constriction of the nasal mucosa. The anatomical structure of the nasal septum in relation to the nasal cavity, nasal tract and turbinates and the effect on the ventilation and drainage of the nasal cavity and sinuses are observed.
(ii) Sinus CT scan
With reference to horizontal and coronal CT sinus scans, while understanding the morphology of the deviated nasal septum, the anatomical relationship between the septum and adjacent structures can be clearly observed, and the correlation between abnormal nasal septum morphology and sinus disease can be understood. The significance of sinus CT scan for the evaluation of deviated septum is.
1. correlation between deviated septum and sinusitis ;
2. It may affect the surgical operation under nasal endoscopy;
3, affect the postoperative nasal sinus ventilation and drainage or not;
4.The possibility of postoperative nasal adhesions;
5. Suggest the site and scope of surgical correction.
IV. Postoperative treatment
After surgery, patients with general anesthesia are placed in supine position and patients with local anesthesia are placed in semi-sitting position, cold compresses can be given to the nose, avoid sneezing and using nose blowing and coughing. After 24~48h of surgery, withdraw the hemostatic gauze and insist on daily or every other day drug change to prevent nasal septal hematoma or nasal adhesions, and follow up 1~2 months after discharge until complete epithelialization.
V. Common complications
1. Nasal septal perforation, mostly caused by inadvertent damage to both sides of the mucous cartilage membrane in the same area during surgery.
2.Nasal septal hematoma, mainly due to incomplete intraoperative hemostasis or too loose Vaseline gauze filled in the nasal cavity.
3.Nasal septal abscess, mostly caused by hematoma infection.
4.Nasal adhesions, caused by intraoperative damage to the mucous membrane of the lateral wall of the nasal cavity, and not separated in time after surgery.
5.Nasal deformity, often caused by removing too much cartilage from the anterior upper part of the nasal septum or secondary to nasal septal abscess.