Deviated nasal septum can cause headache, nasal obstruction, nasal bleeding, and snoring in sleep. The deviated septum presses on the inferior or middle turbinate, causing reflex migraine. The deviation of the nasal septum to one side narrows the nasal cavity on one side and widens the nasal cavity on the opposite side, resulting in compensatory hypertrophy of the inferior turbinate on the opposite side. The mucosa is thin and superficially vascularized at the projection of the deviated nasal septum, which is prone to rupture, and patients can show recurrent nasal bleeding. Another point that many patients do not know is that deviated septum is closely related to rhinitis. Many patients with allergic rhinitis have a combined deviated septum, and after septal correction is performed on these patients, the symptoms of allergic rhinitis are significantly reduced or even disappear. There are four reasons why the septum aggravates allergic rhinitis: First, the nasal mucosa on the convex side of the deviated septum is susceptible to airflow impact and erosion, with exposed nerve endings and high mucosal sensitivity, making it prone to allergic symptoms. Secondly, the depressed side is too wide before the inferior turbinate is compensated for hypertrophy, and allergens are inhaled and easily deposited on the mucosal surface to cause allergic reactions. Third, nasal ventilation is poor in patients with deviated septum, and mucosal swelling is more likely to appear or aggravate nasal blockage symptoms in allergic rhinitis. Fourthly, deviated septum is mostly combined with chronic rhinitis and high sensitivity of nasal mucosa, which makes it more likely to have allergic symptoms. Therefore, the correction of nasal septum has the following three benefits: First, it can remove the above four factors and reduce or eliminate the sensitivity of nasal mucosa. Second, septum correction deals more with compensatory hypertrophy of the inferior turbinate at the same time, and the surgical procedure itself reduces the mucosal nerve sensitivity of the septum and inferior turbinate, thus reducing the symptoms of allergic rhinitis. Thirdly, the nasal cavity is open after surgery, so that the nasal spray drugs for the treatment of allergic rhinitis can reach and evenly distribute in the nasal mucosa smoothly and improve the effect of drug treatment.
Deviated nasal septum is a deviation of the cartilage and bone that make up the nasal septum, and the only treatment method is surgery. The traditional surgical procedures are submucosal resection of the nasal septum and septal correction. Due to the use of nasal endoscopy, in recent years, rhinologists in a position to do so have preferred to perform endoscopic septoplasty. This procedure allows maximum preservation of the square cartilage of the nasal septum and the vertical plate of the septum in a minimally invasive manner. Based on a large number of nasal endoscopic septoplasty practices, the author has used different protocols according to the different characteristics of nasal septal deviation and achieved better results as follows: the procedure can be performed under either general or local anesthesia, with 1% bupivacaine/epinephrine cotton tablets to contract the bilateral nasal cavity, fully expose the septum, and infiltrate anesthesia with 1% lidocaine/epinephrine injection under the mucous cartilage of the anterior portion of the septum on the incision side . The mucous periosteum of the nasal septum was cut in an arc or L-shape 2 mm before the mucosal junction of the nasal septal skin on the side of the deviated septum, and the mucous periosteum and mucous membrane of the septum were separated under nasal endoscopy to fully expose the deviated square cartilage, the nasal crest of the maxilla, the plough bone and the vertical plate of the sieve bone. The septal vertical plate is straightened and placed in the midline. The lower edge of the square cartilage is freed from the upper edge of the maxillary nasal crest and the anterosuperior edge of the plow bone, and the mucoperiosteum is separated from the contralateral side. At this point, if the square cartilage is flat, it is pushed to the midline and the nasal septum is straightened. If the square cartilage is severely deviated, 2mm wide cartilage must be removed parallel to the base of the nose at the upper edge of the square cartilage projection, and 1mm wide cartilage perpendicular to the base of the nose 1-2mm after the incision, so that the deviated part of the square cartilage is free from the anterior, posterior, superior and inferior, and the mucosal tension is further reduced. If the square cartilage is centrally convex, the square cartilage can be straightened by removing the square cartilage at the most convex point in the shape of a “cross”. The incision is closed with one or two stitches to make a good mucosal alignment. Double nasal cavity filling is crucial for postoperative septal remodeling, and a ventilation tube is placed for 48 hours. This surgical approach maximizes correction of the septum and maximizes preservation of the septal cartilage and bony structures, which, together with the absence of separation of the contralateral mucous cartilage membrane, does not easily produce septal perforation.
If you have migraine, nasal congestion, snoring while sleeping or rhinitis that cannot be easily cured, it is best to go to the hospital to see a rhinologist for examination to see if there is a deviated septum, and if it is caused by a deviated septum, it is best to treat it early.