deviated septum (the deviation, deformation) - a persistent deviation of its shape from the middle line, causing respiratory failure nose.In severe deformation occurs deterioration of cerebral blood flow, hampered the normal work of the heart and gastrointestinal tract.If
pathology manifests itself in early childhood, the child has formed a characteristic appearance (due to the reduction of oxygen in the body): open mouth, pale skin, adynamic constitution (due to the development of hypoxia and anemia).
Note that the nasal septum grows throughout life.Because it consists of several parts, which grow at different rates - with the age of the problems caused by its curvature, can appear more pronounced.
Ideal straight nasal septum in an adult is extremely rare due to numerous factors, injuries for life.More precisely - no straight walls, everyone there is any distortion, a partition ridge.However, operations are shown only in violation of the respiratory function.For example:
- Maybe a huge ridge on the partition, but does not prevent nasal breathing - operation is not necessary.
- In the case of having a small curvature (or a small but significant ridge) that blocks the narrow opening leading into the maxillary sinus, which is fraught with frequent sinusitis - it needs to be corrected.
What is the nasal septum
In the front part it is formed by a quadrangular cartilage and the back shows bone (vomer, ethmoid bone and upper jaw).Its deformation can develop in the bone, and cartilage, bone and cartilage sections.
- smell - the ability to perceive odors;
- purification of air inhaled - large dust particles are retained by a hair in the nostrils, and small deposited by an electrodynamic attraction to the mucosa.All foreign particles fall from the stomach mucus and, like the conveyor belt, excreted;
- warming and humidifying inhaled air - the air is warmed to body temperature, its humidity increases to 100%.Also during exhalation nasal retained moisture and heat from exhaled air, thus preventing the development of dehydration and hypothermia.
Causes of deformation
consequences of injuries
- In 50% of patients with septum deviation during the life of the nose revealed various injuries and facial skull.Especially dangerous traumatic situations during childhood and adolescence.
- deviated septum traumatic origin differ peculiar deformations, sharp kinks.
- This category includes also the birth trauma: describes cases where, because of rapid delivery, or improper tactics obstetrician, even in newborns detected pathology.
Wrong growth of facial bones of the skull
- This cause is relevant to 30% of patients examined.
- Very often the structure of the nose does not grow and develop in concert, causing a deviated septum.
Various diseases (compensatory deformation)
In 10% of patients may be due to pathology:
- nasal growths (polyps);
- hypertrophy of the nasal sinuses.
Modern research has proven that this pathology can be inherited and have the innate.
Jacobson organ hypertrophy
Also called the vomeronasal organ.It focused olfactory cells.In nature, it occurs in animals to mate, since perceives pheromones (specific odorous substances released male and female).In humans, Jacobson organ is atrophied.In rare cases, the vomeronasal organ may increase (hypertrophy), causing deformation of the nasal structures.
degree and kinds of distortions
- light - slightly deviates from the median axis;
- average - is deflected to the side about the middle of the sinuses;
- heavy - a deviated septum is almost in contact with the lateral nasal wall.
Classification distortions by Mladin:
- comb bending in front of the walls, small size, one-sided, does not disturb breathing nose.
- Severe comb-shaped deformation in the front of the nose, breaking the respiratory function.
- comb deviation, one-sided, in the rear partition department.
- partition S-deformation - the two comb-shaped curvature, located in the right and left sinuses.
- deviation of the type "Turkish saber" - comb-shaped, in the back of the nose.
- comb deformation in the horizontal plane in both nostrils.
- «Jamming" partition - a lot of distortion in different planes.
What type can receive the deformed partition (by Lopatin)
- C-shaped curvature;
- S-prominent deviation;
- dislocated cartilage 4-carbon and combinations thereof.
Almost every adult has little deviated septum, which do not impede the normal flow of air.But a significant defect appear complications which depends on the type and severity of the deformation.
- more often in front of the deformation, with even a slight bending may cause air turbulence, significantly violated nasal breath.
- The ridges and spikes, typically located along the lower or bottom edge of the vomer and consist of bone (apex of cartilage) have different lengths, may be directed in different directions or to go into the mucosa on the opposite side.
main symptoms, complaints
Current statistics show: 90% of adults in the survey revealed this pathology.However, not all of it causes complaints.In many cases, for her symptoms.The main complaints of the disease include:
Rhinitis and Sinusitis
In this disease the patient is much more likely to develop sinusitis (sinusitis, ethmoiditis, sinusitis, sphenoiditis), the penetration of infection in the paranasal sinuses than a person without such a defect.A 3% in the case of developing an allergic rhinosinusopathy, 15% vasomotor rhinitis.
According to some authors of most of the patients (with the nasal septum deformity requiring surgery) have comorbidities, namely chronic sinusitis (47% of cases), which is accompanied by:
- nasal congestion;
- secretions of mucus or muco-purulent character;
- watery eyes and sneezing;
- nasal voice.
Snoring, sleep apnea phenomenon
- Often, patients with this disease complain about the presence of snoring (Statistics men in 2 times more often than women).
- However, snoring is not only a hindrance to the dream of people around.In these patients during sleep occur short-term episodes of cessation of breathing - apnea (see reasons for snoring and treatment.).
- Patients often complain of daytime sleepiness, headache, underachievement in school and at work, increased blood pressure (due to circulatory disorders of the heart and brain).
Difficult nasal breathing
This feature can be expressed in varying degrees, from mild disturbances of nasal breathing to complete his absence, when a person is forced to breathe through the mouth.It often happens that nasal breathing is difficult, not because of the curvature of the nasal septum, and in the presence of nasal turbinate hypertrophy.Thus there is a growth of tissue inferior turbinates, and as a result, narrowing the lumen, there is a slight nasal breathing.Man turns to Laura and he diagnoses curve of the nasal septum (as it is in most curved).After surgery, the nose is still not breathing.In such cases, the excess portion of tissue to be removed by laser.
- Reduced smell - impaired ability to perceive odors, up to the total absence of the sense of smell.
- Bleeding from the nose - deformation causes thinning of the mucosa, especially in the lower part, where the focus vascular plexus.Consequently, any injury, even banal picking your nose can cause excessive bleeding.
- frequent sore throats and bronchopulmonary diseases - when gasping breath is not cleaned from dust and germs, which allows them to get into the lungs and trigger frequent SARS, as well as asthma.
- Dry nasal mucosa - the cause of the dryness in the nose is as follows: with a strong curvature of nasal septum mucous membranes are in contact with each other, disrupting cilia and cells that produce mucus.
- Recurrent headaches - are reflexive in nature, associated with mucosal irritation.
- congestion and noise in the ears, decreased hearing - due to the spread of the inflammatory process in the middle ear through the eustachian tube.In advanced conditions may develop hearing loss.
- Dry mouth - if a person is forced to breathe through the mouth (with a pronounced deformation), the moisture evaporates from the mucous membrane, and appears dry mouth.
- Cosmetic defects - in children due to disease, develops adenoid type of person - open mouth, overbite, nasal voice.Cosmetic nose defects are also possible after injuries and bruises.
How to identify pathology
|Radiography nose|| |
assess the state of the paranasal sinuses, the possible presence of abnormalities of the skull bones or septum deformation detected.
is carried out in four standard positions:
|Computed tomography|| |
This study is particularly important to identify spikes and ridges located in the posterior and turbinate hypertrophy.
also helps to identify co-morbidities (chronic sinusitis, sinus cysts), which may be treated simultaneously with a partition.
|MRI||survey administered in cases of suspected tumor or polyp in the nose or in the middle ear.|
|Rinoendoskopiya||Methods shown for better inspection of posterior regions of the nasal sinuses.Held necessarily using anesthesia fibroelastichnym endoscope.|
|rinoskopii||study allows to inspect the eve of the nasal cavity and deeper divisions partitions.For detailed pictures of patients before rhinoscopy bury vasoconstrictor drops (0.1% xylometazoline solution).|
|rhinometry||Acoustic rhinometry allows to reveal the extent and location of obstructions the stream of inhaled air, that is, the degree of nasal congestion.Based on the measurement of air flow at the nose.|
When the operation is necessary when a deviated septum
not difficult to guess that the treatment of curvature of the nasal septum is possible only surgically.The indication for surgery is not the fact of the curvature of the nasal septum, and the operation is necessary if the curvature of the expressed and leads to the appearance of the patient's nasal breathing difficulty, discomfort, comorbidities.To change the nasal septum should be approached very seriously:
- breathing or not breathing nose - that is, whether the function of the nose
- stored weigh ratio of risk or benefit in each case
- take into account the patient's age.
doctors came to the conclusion that the operation carried out before the children of 4-5 years is inappropriate in recent years.A child older than 5 years of surgery performed only if there are complaints.The operation for the reconstruction of the nasal septum called rhinoseptoplasty.
Modern correction surgery deviated septum is much more forgiving than a similar operation 20-30 years ago.Today, to be removed only a small ridge interfering in the wall and the whole partition, no one removes, as it did before.
How to prepare for rhinoseptoplasty?
rhinoseptoplasty does not require special training.During the 2 weeks before surgery should abandon bad habits, minimize the risk of infection and hypothermia.It is also advisable to visit your dentist and treat patients teeth, eliminate other possible foci of inflammation in the body.Before the surgery, the patient is recommended to conduct a standard investigation:
- clinical blood;
- study of the hemostatic system (coagulation);
- study of HIV and syphilis;
- consulting physician and anesthesiologist.
Since the operation can be significant blood loss, women are more appropriate to conduct it in the middle of the cycle (2 weeks after menstruation).The patient is usually prescribed a cleansing enema at night, asking him not to eat after 18.00 the day before the operation.An hour before the intervention the patient makes premedication - administration of drugs to help prepare the body to anesthesia.
Are there any contraindications to rhinoseptoplasty?
absolute contraindications for surgery exists.For relative include:
- elderly (over 65) age (patients carrying heavy anesthesia);
- pregnancy, lactation;
- decrease blood clotting (as the high risk of bleeding);
- malignant neoplasms (cancer, sarcoma);
- high blood pressure (risk of heart attack and stroke);
- acute respiratory infections (operation not earlier available than a month after recovery);
- during flowering herbs (during an exacerbation of allergic rhinitis).
The operation is performed under general endotracheal anesthesia (introduction of the endotracheal tube into the trachea and the supply of anesthetic gas) and local anesthesia (injection of local anesthetics - novocaine, lidocaine).There are several types rhinoseptoplasty:
This operation is indicated in patients with non-traumatic curvatures.Using fibroscopy to prevent complications such as the development of bleeding and bruising.
operation is bloodless and safe for patients.It based on the fact that the cartilage under the influence of laser radiation can change its shape.The operation is performed on an outpatient basis and does not require hospitalization in ENT department.Its advantages:
- minimal blood loss
- minimal tissue trauma
- rehabilitation and post-operative period is much softer
- laser has antiseptic properties
disadvantage of laser - not all of the nasal septum deformation it is able to adjust, especially the bony part.
resection technique, reimplantation
curved portions of the cartilage and bone are cut, then straightened on a special splyuschivatele and implanted back under the mucosa.The advantage of surgery is that your own tissue is usually well prizhivlyayutsya and restore barrier, preventing the development of perforations.
Classical submucosal resection for Killian
operation is quite old, the essence of it is to remove the curved osteochondral septum formation.This resection has many side effects:
- partition becomes mobile and can vibrate during breathing;
- nose can sink, taking the saddle shape;