A “crooked nose” as it is sometimes called is not just a cosmetic problem. The middle cartilage that separates the nasal cavity into a right and left side may be misaligned and this can lead to a host of symptoms. It can affect breathing, sleep and even daily functioning. Therefore severe cases require surgery to correct the deviation when the symptoms cannot be controlled with medication alone. However, many people with a deviation do not experience any problem and surgery may therefore not be necessary.
What is a deviated septum?
A deviated septum is where the cartilage that divides the nasal cavity in two is off-center or crooked. As a result the flow of air through one side is greater than the other. However, in most cases this difference is minor and does not significantly affect breathing. In fact most people may have some degree of misalignment of the septum but are not aware of it. Contrary to popular belief it is not easily visible on the surface of the nose.
Another common misconception is that a deviated septum is only present from birth or can occur only in early childhood. However, this is untrue. It can occur at any time in life with trauma. On its own a deviated septum is not a problem but it can lead to problems like nasal congestion which in turn results in difficulty breathing through the nose. This congestion can be treated medically but ultimately solution is to surgically repair the deviation.
Read more on nasal congestion.
Causes of a Deviated Septum
Some studies have shown that as many as 1 out of 4 people who experience ongoing nasal obstruction have a deviated septum. It is estimated that some degree of displacement of the septum may affect as many as 80% of the population but in the vast majority of cases there is little to no symptoms, such as nasal drying and congestion. Therefore it remains undiagnosed.
A deviated septum may be congenital or acquired. Congenital means that the deviation developed in the fetal stage of life and was therefore present from the time of birth. Sometimes it may not be noticed or be a problem. Acquired refers to deviation that arises during the course of life and is often associated with an injury to the nose. Sometimes the problem may not be immediately obvious until years later as age results in changes that worsens the deviation.
The septum is very flexible and can withstand significant amounts of force. However, there is a limit. A blow to the nose like with a forceful punch or high impact injury like in a car accident when the nose strikes the steering wheel can easily lead to a deviated septum. The septal cartilage can also fracture horizontally or vertically. The direction of the force is also an important factor that plays a role in deviations and fractures of the nasal septum.
Signs and Symptoms
As mentioned, a minor deviation does not present with significant symptoms if any at all. A moderate to severe deviation means that airflow through one side is significantly greater. It causes the nasal passage on that side to dry faster, for tissue to become swollen and increases the risk of nasal infections. When nasal congestion affects one side of the nose in severe cases, the narrowing on the other side makes it difficult for sufficient airflow through the nose.
Collectively these effects lead to a host of signs and symptoms such as:
- Difficult nasal breathing
- Post nasal drip
- Noisy breathing
- Sleep apnea
- Facial pain
There are other symptoms that may arise as a result of mouth breathing to compensate in severe septal deviation. Dry mouth, impaired taste and excessive fluid intake may be present due to the mouth breathing.
Diagnosis of Deviated Septum
Although a deviated septum can be diagnosed by physical examination of the nose, a computed tomography (CT) scan may also be conducted when other problems are suspected. This is useful for assessing the extent of trauma to the head and the state of the paranasal sinuses. However, CT scans are not necessary if there is other problem suspected apart from the deviation of the septum.
Treatment of Deviated Septum
A deviated septum does not always require treatment. If there are little to no symptoms, then the deviation should not be corrected. When treatment is necessary, it is initially targeted at the symptoms such as nasal congestion. This may be managed with medication. However, in severe cases or where a patient desires a long term solution, surgery is then considered.
The following drugs are commonly prescribed for treating the symptoms of a deviated septum.
- Antihistamines reduce mucus production.
- Decongestants help to relieve the congestion.
- Corticosteroids (nasal spray) ease inflammation.
Surgical correction of a deviated septum is known as a septoplasty. At times it may be done in conjunction with a “nose job” (rhinoplasty) for cosmetic reasons and is collectively referred to as a septorhinoplasty.Depending on the presence of sinus complications, surgery may also be performed on the paranasal sinuses as the same time as the septoplasty.
The procedure take about 60 to 90 minutes and can be done under local or general anesthetic. In a septoplasty the bone is straightened and then repositioned. The bone and cartilage may also be modified further if a rhinoplasty is being performed at the same time.
Surgical Complications and Prognosis
There is always the risk of complications with any surgery. When it comes to a septoplasty or septorhinoplasty there is a risk of:
- CSF leak
- Perforation of the septum
- Post-operative bleeding
- Nasal deformity
- Anosmia (complete loss of smell)
A rare but very important complication is where pooling of blood can lead to the blood supply to the septum being cut off. This can lead to death of a portion of the cartilage tissue and a perforation. Overall the prognosis is good in the majority of cases. It can even lead to total resolution of the nasal obstruction. It is important that a septoplasty is done by an experienced otorhinolaryngologist (ENT surgeon).