A deviated nasal septum is a condition that occurs very often. In fact, a perfectly straight nasal septum is a big exception. But its deformations are not always regarded as a pathology and in most cases do not require treatment.

If the curvature of the nasal septum is severe enough, it can lead to a number of complications. In this case, they speak of the presence of a disease. Treatment with an otorhinolaryngologist (ENT doctor) is indicated.

According to statistics, a deviated nasal septum is practically never found in childhood. Peak detection occurs in adolescents aged 13–18 years, a period when rapid growth of the body is noted.

Anatomy of the nose

Nasal cavity– the initial section of the respiratory system. Entering the nasal cavity, the air then enters the nasopharynx, from there into the larynx, trachea, bronchial system, and finally into the pulmonary alveoli, where gas exchange occurs between air and blood.

Structure of the nose:

nostrils– inlets through which air enters the nasal cavity;
elementary section of the nasal cavity - a space that is divided into right and left halves by the vertical nasal septum;
nasal passages - located posterior to primary department nasal cavity, there are lower, middle and upper nasal passages, which are respectively limited by the upper, middle and lower nasal concha;
choanae – two openings through which the nasal cavity communicates with the nasopharynx.

Walls of the nasal cavity:

Anterosuperior wall formed by the bones of the skull (maxillary process, nasal bones) and nasal cartilage.
The lower wall is the bottom of the nasal cavity, - formed by the palatine processes of the upper jaws (hard, or bone, palate), as well as the soft palate.
Lateral walls of the nasal cavity formed mainly by the ethmoid bone.
Nasal septum, which divides the nasal cavity in half, is formed in the posterior part by the vomer, and in the anterior part by cartilage.

The inside of the nasal cavity is lined mucous membrane. It is abundantly supplied with blood and secretes a large number of mucus. In the area of the upper nasal passage in the mucous membrane there are many sensitive nerve receptors - this area is called the olfactory area.

Nasal turbinates- bone formations that are located in the back of the nasal cavity and divide it into three nasal passages - upper, middle and lower. The superior and middle turbinates are processes of the ethmoid bone. The inferior nasal concha is an independent small bone.

The nasal passages communicate with the paranasal sinuses:

Superior nasal passage communicates with the posterior sinuses of the ethmoid bone and the sinus located in the sphenoid bone.
Middle nasal passage communicates with the anterior and middle ethmoid sinuses, with the maxillary sinuses (sinuses located in the bodies of the maxillary bones).

The ethmoid bone contains many small cavities - sinuses, which are usually divided into three groups: posterior, middle and anterior.

The sphenoid bone is located at the base of the skull and is practically invisible from the outside. It has a body in the form of a cube, from which “wings” extend to the sides. Inside the body there is an air cavity - the sphenoid sinus.

Functions of the nasal cavity:

carrying air into the nasopharynx and larynx;
humidification of the air with the secretion of glands located in the mucous membrane;
warming the air flow - the venous plexus located under the mucosa is responsible for this function;
protection of the respiratory tract from mechanical irritants: hairs and mucus in the nose trap dust particles and bring them out;
protection against infection: nasal mucus retains pathogens and removes them from the nasal cavity, has bactericidal properties;
The olfactory region of the nasal cavity is responsible for the reception (perception) of odors.

The main function of the nasal septum is the correct distribution of air flows between the right and left halves of the nasal cavity. The significance of this mechanism was established through a series of studies using magnetic resonance imaging and computed tomography.

The nasal septum divides the inhaled air into two equal streams, which ensures their linear movement along the respiratory tract. Optimal conditions are achieved for the nasal cavity to perform its functions (warming, cleansing, humidifying the air). If the configuration of the nasal septum is disrupted, these functions are also disrupted.

In a newborn baby, the nasal septum is always straight and even. It is still difficult to distinguish between the bone and cartilaginous parts: almost all of it is cartilage, in which there are several foci of ossification. Gradually they turn into bones and grow together. Violation of this process leads to the occurrence of curvature of the nasal septum. The initial causes of violations that occur cannot always be accurately determined.

Causes of a deviated nasal septum

Classification of causes of deviated nasal septum

Physiological reasons: associated with heredity and impaired growth of the skull bones.	Traumatic causes	Compensatory reasons: the nasal septum is deformed due to the presence of other pathological formations in the nasal cavity.***
Uneven skull growth. The human skull consists of the facial and brain sections. The facial skull is formed from the upper and lower jaw, zygomatic, palatine bones, etc. The brain section of the skull is represented by the frontal, temporal, parietal, occipital, ethmoid, and sphenoid bones. If there is uneven growth of the facial and cerebral parts of the skull, then the size of the nasal cavity also changes. It becomes “tight” for the nasal septum. As a result, the latter has to bend.	According to statistics, a deviated nasal septum is more common in teenage boys and men. This is the population among which skull and facial injuries are most common. As a result strong blow displacement of the nasal bones occurs. It can lead to curvature of the nasal septum, even if it is minor. The most severe deformities are caused by improper fusion of the nasal bones after a fracture.	Hypertrophy(excessive development) of one of the nasal conchas. An enlarged concha puts pressure on the nasal septum and causes it to shift.
Uneven skull growth. The human skull consists of the facial and brain sections. The facial skull is formed from the upper and lower jaw, zygomatic, palatine bones, etc. The brain section of the skull is the frontal, temporal, parietal, occipital, ethmoid, and sphenoid bones. If there is uneven growth of the facial and cerebral parts of the skull, then the size of the nasal cavity also changes. It becomes “tight” for the nasal septum. As a result, the latter has to bend.		Polyps and tumors of the nasal mucosa. If they reach enough large sizes, then the breathing of one nostril is disrupted. By deforming, the nasal septum tries to compensate for this condition.
Excessive development of the Jacobson's organ rudiment. This cause of a deviated nasal septum is extremely rare. The Jacobson's organ is developed in reptiles, which with its help are able to literally “taste the air.” In humans, there is only a rudiment of it, represented by a cluster of nerve formations behind the olfactory region. If this rudiment is overdeveloped, then it limits the space for the growth of the nasal septum, and curvature occurs.		Constant stuffiness of one half of the nose. Deviation of the nasal septum in in this case– an attempt to adapt to breathing through one nostril, to make it more complete.

***In this case, it is often difficult to figure out whether impaired nasal breathing is the cause of a deviated nasal septum, or its consequence.

Disorders that occur when the nasal septum is deviated

Difficulty in nasal breathing

Pathological mechanisms that lead to difficulty in nasal breathing with a deviated nasal septum:

Narrowing of the nasal passage on the side of the convex septum. Reducing the volume of space on one side leads to difficulty in the passage of air flow, up to the complete inability to breathe through one nostril.
Disturbance of air dynamics inside the nasal cavity. Normally, during inhalation, the air in the nose rises and passes through the middle and partially upper nasal passage. During exhalation, it is directed into the lower nasal passage. When the nasal septum is deviated, disruption of air flow even through one nasal passage leads to difficulty breathing. Despite the fact that the other two nasal passages on the same side may have normal clearance.
Narrowing of the nasal passage and difficulty breathing on the side of the concavity of the deformed nasal septum. Often the symptoms here are even more pronounced than on the side of the convexity. As a result of the expansion of the nasal passage, compensatory hypertrophy (growth) of the nasal concha occurs. Over time, they become so large that they begin to make breathing difficult.
Reaction of nerve endings (receptors) of the nasal mucosa. Normally, the air flow in the nose is uniform. When the nasal septum is deviated, turbulence occurs in it. They irritate sensitive receptors located in the mucous membrane. A reflex occurs defensive reaction: the vessels of the mucous membrane dilate, swelling occurs, and a large amount of mucus is released.
Suction of the wing of the nose to the septum. This is often noted when the septum is deviated in the anterior part. The wing of the nose is constantly tightly adjacent to the septum, as a result, the passage of air is greatly hampered.

Changes in the nasal mucosa

Normally, the mucous membrane of the nasal cavity produces a certain amount of mucus, which humidifies the air and performs protective functions. On the surface of epithelial cells there are cilia. They constantly make movements that remove dust and other small particles from the nose.

As a result of turbulence, the air in the nasal cavity constantly hits the mucous membrane in a certain place. Here it thickens, epithelial cells lose cilia. The protective functions and the process of cleansing the mucous membrane from foreign particles and mucus are disrupted. The secreted mucus dries, forming crusts.

The mucous membrane of the nasal cavity becomes more vulnerable to pathogens.
Rhinitis develops - runny nose, constant nasal congestion.

Oxygen starvation of organs and tissues

The supply of sufficient oxygen to the lungs and blood largely depends on how freely nasal breathing is. When the nasal septum is deviated, gas exchange in the pulmonary alveoli is disrupted. There is a general lack of oxygen in the body.

Mouth breathing

Nasal breathing is the only normal way for humans. When it is disrupted as a result of a deviated nasal septum, mouth breathing is activated. It is less complete in many ways.

Disadvantages of mouth breathing:

Air that is not humidified or warmed enters the lungs: as a result, gas exchange in the alveoli is not as efficient as with nasal breathing. Less oxygen enters the blood.
The protective properties of nasal mucus are disabled. The likelihood of developing a respiratory infection increases.
Mouth breathing can eventually lead to adenoiditis - inflammation of the pharyngeal tonsil.

Nervous disorders

When the nasal septum is deviated, constant irritation of the nasal mucosa occurs. This leads to complications that are reflexive in nature.

Reflex disorders due to a deviated nasal septum:

Bronchial asthma- there is a type of disease, main reason which is a neuropsychic imbalance.
Spasms of the larynx, manifested in the form of short attacks of suffocation.
Convulsive epileptic seizures.
Reflex sneezing and coughing.
Dysmenorrhea in women– violation of the frequency and duration of menstruation.
Disorders of the eyes, heart and other organs.

Violations from neighboring organs

Eustachian tube and middle ear disorders. The nasal cavity passes into the nasopharynx, on the mucous membrane of which there are pharyngeal openings of the auditory, or Eustachian, tubes on the right and left. The Eustachian tube connects the nasopharynx with the middle ear cavity (tympanic cavity, which contains the auditory bones: incus, stapes, malleus). A chronic inflammatory process as a result of a deviated nasal septum leads to the fact that mucus and infectious agents can enter the auditory tube and the tympanic cavity.
Inflammation of the paranasal sinuses - sinusitis. A direct connection has been proven between a deviated nasal septum and the development of inflammatory processes in paranasal sinuses nose Such patients often develop sinusitis (inflammation of the mucous membrane of the maxillary, or maxillary sinus) and frontal sinusitis (inflammation frontal sinus).
Inflammation of the tear ducts and lacrimal sac. Tears, which are produced by the lacrimal glands, normally flow into the nasal cavity through the nasolacrimal duct. It can serve as a route for spreading infection.

Types of deviated nasal septum:

actual curvature of the nasal septum
crest
a combination of two or three types of curvature

Varieties of the actual curvature of the nasal septum:

in a vertical or horizontal plane
in the front or back of the nasal septum
one-sided and two-sided
with the capture of the cartilaginous part of the septum (so-called dislocations of the cartilage occur, when it is torn from the bone), the vertical plate of the ethmoid bone (forms the anterior part of the bony nasal septum) or the vomer (forms the posterior part of the nasal septum)
S-shaped, C-shaped, in relation to the bony crest of the upper jaw.

Deviations of the nasal septum in the anterior part occur more often. The opener located behind is less often caught. The rear edge of the opener is almost always exactly vertical.

The ridges and spikes are usually located along the upper or lower edge of the opener. They can have different lengths and are directed in different directions. Sometimes they protrude into the mucous membrane on the opposite side. Most often, spines and ridges consist only of bone tissue. Sometimes their apices may be represented by cartilage.

But even a slight curvature of the septum in the front part can create air turbulence, which then intensifies and significantly disrupts nasal breathing.

Symptoms of a deviated nasal septum

Complaints that patients with a deviated nasal septum make when visiting a doctor:

Difficulty in nasal breathing. The symptom can vary in degree: from a slight disturbance to a complete inability to breathe through the nose (in this case, the patient breathes through the mouth). However, the absence of this complaint is not a sign that there is also no deviated nasal septum. If the deformation occurs at a young age, the body can compensate for it over time. The patient has no complaints of difficulty in nasal breathing. If the nasal cavity is large, then no difficulties arise either.
Chronic rhinitis - runny nose. Manifests itself in the form of nasal congestion and constant mucous discharge. Sometimes a patient does not see a doctor for a long time because he believes that he has frequent colds, and it's all about decreased immunity.
Allergic reactions. The changes that occur in the nasal cavity as a result of the curvature of the nasal septum are always accompanied over time by a violation of local protective mechanisms and immunity. This manifests itself not only in a decrease in resistance to infections, but also in the emergence allergic reactions. Allergic rhinitis is a common problem among people with a deviated septum. Chronic rhinitis is betrayed by asthma– a condition against which it often develops bronchial asthma. The patient complains to the doctor that nasal congestion and discharge occur mainly during contact with some allergen, for example, pollen from certain plants.
Headache. A spike, ridge, or deviated nasal septum may come into contact with the lining of the nose and put pressure on it. Constant irritation of nerve receptors leads to the development of reflex headaches.
Dry nose, discomfort and discomfort during nasal breathing. A symptom that develops as a result of prolonged irritation and inflammation in the nasal cavity.
Nosebleeds. They are also the result of irritation of the mucous membrane. On the side where there is a bulge on the nasal septum, the mucous membrane is very thin. Even with minor impact it is easily damaged.
Snoring at night as a result of impaired nasal breathing.
Increased fatigue, decreased performance, decreased resistance to physical activity. These symptoms are associated with impaired nasal breathing and insufficient oxygen supply to the blood from the lungs.
Frequent infections that occur with symptoms of acute respiratory infections (runny nose, cough, sneezing), increased body temperature.
Symptoms chronic inflammation pharynx and larynx: sore throat, dryness and pain, cough.
Symptoms of inflammation in the middle ear: pain, hearing loss.
Irregularity of the nose. This symptom characteristic of a deviated nasal septum of traumatic origin.
In severe cases, the patient and his relatives note periodic convulsive epileptic seizures, blurred vision, heart pain and increased blood pressure, shortness of breath and other symptoms. They can also be associated with deformations of the nasal septum.
Deterioration of memory, thinking, absent-mindedness. Schoolchildren with a deviated nasal septum experience decreased school performance over time.

Diagnosis of a deviated nasal septum

Diagnosis of a deviated nasal septum by an ENT doctor includes an external examination, rhinoscopy, - appointment additional tests and laboratory research.

Visual inspection

Evaluate appearance patient's nose. With a traumatic curvature of the nasal septum, it is changed.

Nasal breathing is assessed separately for the right and left nostrils. The patient is asked to close the left nostril with a finger, and a piece of cotton wool or thread is brought to the right. Look at its fluctuation during inhalation and exhalation. Then the manipulation is repeated for the left nostril.

To assess the sense of smell, one nostril is also clamped, and a piece of cotton wool soaked in a solution of an odorous substance is brought to the second. The patient is asked to inhale and name the smell. Usually, when the nasal septum is deviated, the sense of smell is reduced on one or both sides.

Rhinoscopy

Rhinoscopy– examination of the nasal cavity using special instruments.
There are anterior and posterior rhinoscopy. An anterior rhinoscopy is most often performed. Rear - according to indications.

How is anterior rhinoscopy performed?

Anterior rhinoscopy is performed using a special nasal dilator (see picture).
The doctor asks the patient to raise his head slightly, lifts the tip of his nose and inserts the instrument into the nostril. Using a button probe (see picture), the otolaryngologist can better examine the nasal cavity and assess the consistency of the formations inside.
Anterior rhinoscopy is performed separately for each nostril.

Diseases that can be distinguished from a deviated nasal septum during anterior rhinoscopy:

polyps mucous membrane
hematomas– hemorrhages under the mucous membrane, which, reaching large sizes, can impede nasal breathing
tumors in the nasal cavity
abscess- abscess.

If anterior rhinoscopy is difficult due to severe swelling of the nasal mucosa, the doctor first instills a 0.1% solution of adrenaline into the patient’s nostrils. It constricts the blood vessels and makes the nostrils free for inspection.

How is posterior rhinoscopy performed?

Posterior rhinoscopy is an examination of the nasopharynx and nasal cavity from the choanae. To do this, the doctor asks the patient to open his mouth, pushes the tongue away with a spatula and inserts a special mirror into the nasopharynx.

Additional instrumental studies for deviated nasal septum

Study	Indications
X-ray of the skull	assessment of the condition of the paranasal sinuses; identification of anomalies in the bones of the skull; identification of existing deformations after a nasal injury.
CT scan	Identification of ridges and spines that are located at the back of the nasal septum and are not visible during rhinoscopy.
Endoscopic examination of the nasal cavity It is carried out using a rhinoscope - a thin probe, at the end of which there is a miniature video camera. It is inserted into the nostril and moved a little deeper. Most patients tolerate the study well. Local anesthesia of the nasal mucosa is performed using anesthetic sprays.	Identification of formations in the nasal cavity that are inaccessible for inspection during anterior and posterior rhinoscopy.

Laboratory research methods for deviated nasal septum

Type of research	Purpose
General blood analysis	A general clinical routine study that allows you to identify signs of the inflammatory process.
Appointed only by special indications:
Bacteriological research nasal swabs and mucus discharge.	Identification of the infectious process and prescription of rational antibiotic therapy.
Cytological examination of smears and nasal mucus	Suspicion of an oncological process.
Allergy tests and immunological blood tests.	Deviation of the nasal septum, complicated by an allergic condition. Allergen identification.

Treatment of deviated nasal septum

Deviated nasal septum is treated surgically. The main type of operation that is performed in most cases is septoplasty.

Indications for surgery for deformities of the nasal septum:

Difficulty in nasal breathing on one or both sides. Surgical intervention is absolutely indicated provided that the difficulty in breathing is caused precisely by a deformation of the nasal septum.
Chronic rhinitis– inflammation of the nasal mucosa.
Otitis and eustachitis (inflammation of the middle ear and auditory, or Eustachian, tube), the initial cause of which is a violation of the shape of the nasal septum.
Inflammation of the paranasal sinuses (sinusitis): sinusitis, ethmoiditis (inflammation of the cells of the ethmoid bone). Surgery is indicated if these complications are caused by a deviated nasal septum.
Frequent, recurring headaches.
External cosmetic defects . Sometimes, in rare cases, after fractures, the bridge of the nose is straightened and septoplasty is performed.

Contraindications to septoplasty for deviated nasal septum:

Senile age. With age, breathing problems caused by a deviated nasal septum are partially compensated. Therefore, the symptoms of the disease become less pronounced. In older people, atrophy of the nasal mucosa occurs, so the operation is difficult and the risk of complications is high.
Blood clotting disorder. For example, septoplasty is contraindicated in people with hemophilia.
Serious illnesses of cardio-vascular system.
Diabetes.
Mental illness.
Malignant tumors.
Severe infections.
General serious condition of the patient.
Children and people over 48 years of age can undergo surgery, but the indications for it at this age are narrowed.

Preparation for septoplasty

The initial diagnosis of a deviated nasal septum is usually made by an otolaryngologist in a clinic. If the doctor believes that surgical intervention is necessary, he writes the patient a referral to the hospital.

In the emergency department, the patient is examined and a date for hospitalization is set. Before this, you must undergo a standard set of tests. This can be done at the clinic at your place of residence.

A couple of weeks before the upcoming operation, the patient should give up bad habits, avoid hypothermia and infections. It is necessary to cure diseased teeth and eliminate other sources of inflammation in the body.

During the operation, a large amount of blood may be lost due to the fact that the nasal mucosa is abundantly supplied with blood. For women, it is better to plan surgery 2 weeks after menstruation.

Before the operation in the hospital, additional examination may be prescribed. If the intervention is planned under general anesthesia, then on the day of the procedure you should not eat or drink in the morning. Within an hour, the patient is given premedication - medications are administered that help prepare the body for anesthesia.

Surgery for deviated nasal septum

Septoplasty(plasty of the nasal septum) can be performed under general or local anesthesia. In children, only general anesthesia is used. The patient is placed on the operating table in the supine position.

The surgical intervention does not involve incisions on the face - access is through the nostril. The surgeon dissects the mucous membrane, separates it from the nasal septum, performs plastic surgery and sutures.

After the operation, turundas (tampons) soaked in a solution of a hemostatic (hemostatic) drug are placed in the nose. The patient must wear them throughout the day.

Today, it is widely practiced to install silicone splints in the nose, which help the new septum maintain the desired shape.

A curvature of the nasal septum in some cases is combined with asymmetry of the ethmoid bone, changes in the shape and size of the nasal turbinates. These disturbances must also be corrected during surgery.

Endoscopic laser septoplasty

Modern methods of surgical correction of deviated nasal septum.

Advantages of laser septoplasty:

minimal tissue trauma;
blood loss during surgical intervention kept to a minimum;
the laser has antiseptic properties;
rehabilitation measures are minimized in postoperative period.

Postoperative period

For 1–2 days after surgery, the patient is forced to wear turundas in the nose. This causes discomfort, since during this time nasal breathing becomes impossible.

On days 2–4, nasal breathing is completely restored.

After the operation, the otolaryngologist regularly examines the patient, removes dry crusts from the nose, rinses with saline or sea salt solution, and performs a nasal shower.

If in the postoperative period the patient is bothered by pain, then analgesics (painkillers) are prescribed.

For prevention infectious complications antibiotic therapy is prescribed.

After the patient is discharged from the hospital, he is observed for a month by an ENT doctor in the clinic.

The most common complications after septoplasty surgery:

formation of large hematomas(hemorrhages) under the mucous membrane;
nosebleeds;
perforation of the nasal septum– formation of a hole or defect in it;
formation of an abscess under the mucous membrane– abscess;
purulent sinusitis;
nasal deformity– most often the back of the septum becomes retracted as a result of the surgeon resection of the septum too high.

Is it possible to treat a deviated nasal septum without surgery?

To combat the symptoms of complications of a deviated nasal septum, vasoconstrictor drops, antibiotics, sprays, and nasal rinses are used. These methods provide temporary relief, but they cannot eliminate the cause of the problem. It is possible to get rid of it completely and prevent further progression only through surgical intervention.

Is it possible to prevent deviated nasal septum?

The causes of impaired growth of the nasal septum and its deformation cannot always be identified. Therefore, at the moment there is no effective prevention of the disease.

How does a deviated nasal septum manifest in children? What are the treatments?

A deviated nasal septum is less common in children than in adults. However, this anatomical feature can seriously interfere with the child’s breathing, causing oxygen starvation and causing delays. physical development.

Causes of deviated nasal septum in children:

Injuries during childbirth;
A blow to one side of the nose;
Discrepancy between the growth rates of the bone and cartilaginous parts of the nose in adolescence.

Signs of pathology. Externally, changes may not be visible and both sides of the nose appear symmetrical. Upon examination, the doctor discovers that one side of the child’s nose is narrowed, and there is practically no air circulation in it. This is accompanied by swelling of the mucous membrane of the respiratory tract, which gradually loses its protective properties. Due to a decrease in local immunity, the child suffers from prolonged runny nose and otitis media.

Symptoms of a deviated nasal septum in children:

Breathing problems on the affected side. Parents note that periodically one nostril is completely blocked. In some cases, this causes the baby to sleep on only one side to optimize breathing.
Lingering or chronic runny nose . Frequent sinusitis and sinusitis are associated with increased susceptibility of the mucous membranes to infection. Hypertrophied (overgrown and thickened) mucosa is the basis for the formation of a polyp - a growth that blocks the nasal passage.
Frequent tonsils (adenoids), which can cause snoring and coughing.
Headache - a sign that the central nervous system is experiencing oxygen deficiency.
Impaired sense of smell. It develops gradually and is associated with damage to sensitive receptors on the nasal mucosa.

Treatment of deviated nasal septum in children. Not all children with a deviated nasal septum need treatment. Correction of the defect is necessary if the child’s breathing is significantly impaired, and there is evidence that the curvature leads to frequent otitis media and sinusitis.

Conservative therapy(treatment without surgery for a deviated nasal septum) is the main focus in children under 15 years of age. Its goal is to restore impaired breathing and the functions of the mucous membrane of the respiratory tract.

Intranasal glucocorticosteroids (Mometasone, Fluticasone, Beclomethasone) eliminate allergic rhinitis and medicinal rhinitis caused by prolonged use of vasoconstrictor drops. Use once a day better in the morning.
Cromony . Cromoglin - cromoglycic acid in the form of a spray is used to treat allergic rhinitis 4 times a day.
Antibacterial drugs (Isofra, Polydex, Bioparox) – local application Antibiotics stop the growth and reproduction of bacteria on the mucous membranes and sinuses.
Mucolytic sprays – (Sinuforte, Rinofluimucil) are used to thin mucus and facilitate its removal from the sinuses.
Moisturizing sprays – (Salin, Aqua-Maris) moisturize the mucous membrane, cleanse it of microorganisms, and help strengthen local immunity.
Vasoconstrictor drops and sprays – (Naphthyzin, Farmazolin, Noxprey). They constrict blood vessels, reducing swelling of the mucous membrane, and restore nasal breathing. Drops reduce swelling of the nasal tissues, increasing the lumen through which air passes.

Surgical treatment of deviated nasal septum in children. In childhood, they try to avoid surgery, fearing that it may affect the formation of the nose in the future. Doctors recommend postponing surgical intervention until 15-16 years of age. The earliest age of patients is 6 years. Surgery is resorted to when it is not possible to restore nasal breathing by other methods.

The operation is preceded by a thorough examination, blood and urine tests, x-rays or tomography, endoscopic examination, cardiography.

Choice of anesthesia depends on the age of the child and the extent of the operation. As a rule, children under 5 years of age require general anesthesia. For school-age children, the operation is performed under local anesthesia.

The essence of the operation. The surgeon makes an incision inside the nose. On one side, it separates the mucous membrane from the cartilage. The cartilage itself is then separated from the bone and adjusted. If necessary, bone defects are corrected: spines, growths, bone ridges, and space is created for the installation of cartilage. Finally, the surgeon returns the cartilage, perichondrium and mucosa to their place, after which the wound is sutured.

In some cases, when the cartilaginous part of the septum is thinned and is unable to maintain the shape of the nose, there is a risk of sagging of the nose or drooping of its tip. In this case, the cartilage fragments are attached to a special polydioxane mesh, which serves as a support for them. The mesh is not felt by the patient in any way and dissolves on its own after about a year. During this time, the cartilaginous septum restores its density and can independently maintain the shape of the nose.

The procedure itself lasts 30-45 minutes. It is quite unpleasant, but painless thanks to anesthesia. After the operation you will have to spend 1-2 days in the hospital. During this time, medical personnel must ensure that recovery is proceeding as planned and there is no risk of complications.

Treatment of deviated nasal septum with laser. Due to the fact that in children the curvature mainly occurs in the cartilaginous part, endoscopic laser operations are the best option. They are practically bloodless and low-traumatic. The laser heats the cartilage to a temperature of 70 degrees, after which the cartilage becomes plastic and is leveled. Special tampons are inserted into the nasal passages, which give the septum the correct shape. However, this treatment has only been practiced for a few years, so there is no data on how heating can affect the condition of the cartilage in the future.

Another option for laser plastic surgery is a traditional operation, which is performed using a laser scalpel. This allows you to reduce blood loss and minimize the risk of developing infectious complications. In addition, the laser instrument causes less damage to nerve fibers, so the child suffers less pain in the postoperative period.

Laser operations have a significant disadvantage - they are carried out only in large medical centers and their cost often exceeds $1000.

What is the cost of surgery for a deviated nasal septum?

Surgery to straighten the nasal septum can be done for free. To do this, you need to go to the clinic at your place of residence, where the doctor will give you a referral to the hospital. At the ENT department you will be put on a waiting list and after the examination they will perform the operation free of charge, as part of compulsory medical insurance (compulsory health insurance). However, even in this case, there may be costs for anesthesia and medications necessary for the operation. City and regional hospitals employ both surgeons with extensive experience and high qualifications, as well as novice doctors. This must be taken into account when choosing a specialist who will perform the operation, since the result of treatment largely depends on the work of the surgeon.

In private ENT clinics and medical centers where highly qualified specialists (surgeons of the highest category and professors) operate, the price of surgery for a deviated nasal septum depends on the qualifications of the doctor. Thus, the operation, together with a preliminary examination, anesthesia and stay in a 1-2-bed ward, will cost 300-700 USD.

Laser surgery price in private clinics it ranges from 500 to 2000 USD. Laser treatment for a deviated nasal septum is a bloodless and low-traumatic method, after which the patient can almost immediately return to their normal lifestyle. However, it has one significant drawback - laser septoplasty can only be used if the cause of breathing problems is a curvature of the cartilage of the nasal septum. This happens very rarely in adults. In 90% of cases, cartilage deformations are combined with bone growths, and in this case the laser will not be enough.

Cost of radio wave septoplasty reaches 1000 USD Instead of a scalpel, a high-frequency radio wave beam is used, which vaporizes soft tissue cells like a laser. The radio wave scalpel coagulates blood vessels, preventing bleeding and has a bactericidal effect. According to the technique, this intervention is no different from traditional surgery, and the same surgical instruments are used to correct cartilage and bone.

Aesthetic correction Deviated nasal septum (rhinoplasty) costs from 600 to 4000 USD, depending on the clinic and the scope of the operation. Plastic surgery are not included in the compulsory medical insurance list, so they are paid in all medical institutions.

How does it feel after surgery on a deviated nasal septum?

The patient’s sensations after surgery on a deviated nasal septum depend on the drugs used for anesthesia and the degree of intervention. Thus, a person who had the cartilaginous part of the septum corrected under local anesthesia will endure the postoperative period much easier than a patient who had to undergo surgery on the bone structures of the nose under anesthesia.

When to see a doctor:

rebleeding;
severe pain in the nose 5-7 days after surgery;
temperature increase;
purulent nasal discharge.

Inform your doctor about any health problems - this will help you take timely measures and prevent possible complications.

The nasal cavity is divided from the inside by a relatively flexible cartilaginous septum covered with mucous tissue. Normally, the structure of the nose is symmetrical, the septum has a straight shape without bending to the side. For various reasons, the shape of the septum may be far from ideal, deviating in one direction or another, up to complete blocking of the nasal passage on one side. The shape of the curvature can be “C” or “S”-shaped or more complex. The deformation can affect not only the cartilage, but also the bones of the face.

Often invisible from the outside, a deviated nasal septum can cause unwanted symptoms in both adults and children. Depending on the severity of the pathology, children may experience:

1. Labored breathing through the nose due to narrowing or blocking of the nasal passage

Lack of oxygen leads to headaches, excessive fatigue, and decreased cognitive function
Heart problems due to impaired nasal breathing
In severe cases, oxygen deficiency due to impaired breathing leads to mental and mental delays. physical health baby

2. In children, pathology of the nasal septum not detected in time in some cases during the period of active growth provokes asymmetrical development of facial structures– both bones and muscles

3. Regular mucus production in a child from the nose (vasomotor rhinitis caused by disruption of the blood vessels of the nose). Vasomotor rhinitis in a child is easily confused with others pathological conditions, since it looks like a regular allergic or cold runny nose.

4. Chronic inflammatory process in the ear

5. Frequent nosebleeds

Reasons why a child's nasal septum may be deviated

The pathology of the formation of nasal bone tissue in the prenatal period provokes a septal defect in a newborn child. Also, in some cases, the pressure exerted on the baby’s facial bones as he passes through the birth canal leads to deformation of the soft cartilage.

Changes in the shape of the septum in a child’s nose are not always congenital. Sometimes the defect is acquired and can occur in the following cases:

If there is mechanical damage to the nose from a blow or fall, the septal cartilage can not only change shape, but also break. In this case, improper fusion of cartilage not only makes nasal breathing difficult, but also complicates the correction of the natural shape of the septum.
If there are neoplasms (tumors, polyps) in the nasal cavity that are not detected and removed in time, the septum may begin to strive to take a shape in which the pressure on surrounding tissues becomes minimal.
The uneven growth rate of nasal tissue during adolescence often leads to septal asymmetry.

Treatment of deviated nasal septum in children

Correction of a deviated septum in both children and adults is carried out surgically, mainly under local anesthesia. An operation aimed at correcting the shape of the septum in a child’s nose is called septoplasty.

External incisions are usually not required for the operation and therefore there are no scars left after surgery.

Content

A person who wages an endless struggle with rhinitis, suffers from colds or flu several times a year, suffers from insomnia and loss of smell, may not realize that the problem is not only in the immune system and nervous system. A deviated nasal septum is a diagnosis that is rarely made, but is present in the majority, although predominantly severe forms require urgent correction: a thorn, a ridge. Is treatment possible without surgery and why is this problem dangerous?

What is a deviated nasal septum?

A central, flat, thin plate that divides the air flow into equal parts, due to which it is processed and delivered harmoniously - this is the nasal septum, consisting of cartilage and bone tissue. If the air begins to flow unevenly, the doctor may say that there is a displacement of the nasal septum (its cartilaginous sections), or its deformation in the form of a spike or ridge in the bone area. Curvature occurs in 95% of people, but with varying degrees of severity, so you may not know about it until the end of your life.

Symptoms

A deviated nasal septum can make itself felt both externally and through internal changes in the body. If there is deformation of the cartilaginous tissues close to the front, or at the top of the bridge of the nose (bone section), it will be visible due to the loss of symmetry of the nose. Internal curvature is mainly expressed in:

frequent nosebleeds caused by thinning of the mucous membranes in the narrowed nostril;
difficulties with nasal breathing (feeling that air is not coming in at all);
snoring if a person sleeps on his back;
frequent overwork (due to hypoxia due to difficulty in nasal breathing);
decreased immunity, which entails acute respiratory infections, influenza, and other difficult to tolerate diseases;
chronic diseases ENT organs (mostly doctors focus on the appearance of chronic rhinitis in patients with a deviated septum).

Why is a deviated nasal septum dangerous?

If timely and complete air purification does not occur, a sufficient amount of oxygen does not enter the blood and brain, immunity and brain activity gradually decrease, and blood vessels suffer. Subsequently, a deviated septum leads to inflammation of the mucous membrane and chronic hypoxia, which can cause constant headaches and can cause male impotence.

Symptoms of the disease gradually develop into chronic disorders, and the result is:

nasal polyps;
problems with olfactory function;
hearing impairment;
emergence allergic rhinitis.

Types of curvatures

There are 2 classifications of deformation of the nasal septum - according to the prerequisites for its appearance and according to the type that the plate takes. Curvatures of the front opener are predominantly observed, and even if there is a defect in the rear, its edge remains smooth. The classification of deviated septum most commonly used by doctors is as follows:

Thorn– the appearance of a process from bone tissue, can be unilateral or bilateral. Depending on the length and direction, it can provoke irritation of the mucous membrane of the opposite wall and injure it.
Crest– local thickening of the nasal septum at the point of bending, associated with its deformation, can also injure the membrane of the nasal cavity, pushing into it.
Classic deviated nasal plate– C-shaped deformation, in which a slight deflection appears mainly in the central part. Such minor curvatures are very common, but a person is not always aware of their existence, since they may not manifest themselves in any way.
Combination of all 3 types- the most difficult variant of curvature, since it is not only responsible for breathing difficulties, but often its complete absence (if the deformation is bilateral, there is a displacement of the anterior and middle sections).

Causes of a deviated nasal septum

Doctors divide the entire list of prerequisites for deformation of the nasal septum into 3 categories:

Traumatic. Caused by blows to the facial area of the skull, this cause is predominantly found in males. Even with minor injuries, a bent nose is possible if the fusion of broken bones and cartilage tissue does not occur correctly.
Compensatory. They are a consequence of pathologies of the nasal cavities, including polyps, tumors and even persistent rhinitis, due to which a person, unnoticed by himself, due to congestion in one of the nasal passages, learns to breathe only freely and thereby provokes a curvature of the septum. Separately, there is compensatory hypertrophy, in which one of the nasal conchas, due to its increased size, puts pressure on the septum and can displace it. In compensatory curvatures, cause and effect often change: even a doctor cannot always say what occurred first - deformation of the plate or breathing problems due to an increase in bone formations that divide the nasal cavity into zones.
Physiological. Associated with congenital structural features of the skull - mainly uneven development of its bones. In rare cases, such a physiological curvature of the septum is observed, such as the development of a rudiment behind the olfactory zone, pressing on the nasal dividing plate. This deviation is rare.

The child has

The nasal septum in children under 10 years of age is predominantly a cartilaginous plate: more flexible than bone, and more vulnerable. Doctors mention cartilage fractures in children more often than in adults, and this often becomes the cause of septal deformation. If you do not pay attention to the violation in time correct breathing after an injury, the plate will ossify over time (as the child gets older), and the curvature will no longer be as easy to straighten as in childhood.

However, there are several more prerequisites for this problem in children:

birth injuries;
uneven growth of the skull bones (minor curvatures, corrected independently);
inflammation of cartilage tissue.

Diagnostics

An attempt to confirm or refute the diagnosis of a deviated septum begins with an examination of the patient by an otolaryngologist, who first evaluates the appearance of the facial part of the nose. If there are serious deformations of the nasal septum, they will be visible already at this stage. Afterwards, the breathing of each nostril is checked separately, the results are correlated: if there is no curvature of the nasal septum, the force of inhalation and exhalation is the same for the left and right sides. The last thing to do is test your sense of smell.

If suspicions that the nasal septum is deviated grow stronger, the doctor may prescribe:

Rhinoscopy– consists of examining the nasal cavity (left and right) using a special instrument that widens the nostrils. Next, it is introduced into the lumen thin probe to palpate the mucous membrane, evaluate neoplasms (if any): these are polyps, tumors, ulcers. Additionally, hypertrophy of the posterior ends of the turbinates can be detected when examining the curvature through the oral cavity.
Endoscopy– a more informative examination, which should be performed with local anesthesia of the nasal mucosa. Her condition is assessed through a probe with a “video camera”. Thanks to the endoscopic method, the lower shell, where mucus accumulates, is clearly visible.
X-ray of the skull– an image is needed to say whether there are formations in the paranasal sinuses, to confirm or refute the presence of traumatic deformation, congenital bone anomalies of the skull, which could provoke a curvature.
Computed tomography– helps to examine in detail the back of the nasal cavity, determine the presence or absence of spines and ridges on the septum.

Treatment

A crooked nasal septum is an anatomical problem, so it is impossible to straighten the plate with medication. If, as a result of its deformations, breathing and hearing disturbances are noted, a disorder of smell develops, the middle concha is additionally enlarged, or hypertrophy of the lower one is observed, we will definitely talk about surgical interventions, mainly traditional ones - septoplasty or endoscopic surgery. In rare cases, a deviated septum can be corrected with a laser.

Treatment without surgery

Conservative therapy can be aimed at eliminating the chronic inflammatory process, polyps, adenoids (a consequence of a deviated septum), helping to alleviate the condition of allergic diseases, restoring breathing and strengthening the immune system. However, correcting a crooked septum is impossible, so doctors question the effectiveness of such treatment. Mostly experts can advise:

removal of adenoids, polyps;
osteopathy (manual therapy);
a long course of drugs to eliminate swelling.

Operation

The doctor may recommend surgical correction of the curvature in case of serious deviations in the development of the cranial bones, which provoke a large number of complications: among them, concha hypertrophy, persistent sinusitis, and the inability to breathe through a narrowed nostril. Surgery is performed only on persons over 16 years of age (exceptions are possible). Resection of the nasal concha can be performed with an endoscope, which is less painful. In case of severe injuries, rhinoplasty is performed simultaneously with classical surgery.

Laser chondroseptoplasty

Classic septoplasty is performed only in cases of severe forms of curvature, and for minor deformities the doctor may suggest laser treatment. This method is used only if it is necessary to straighten the cartilage tissue - the laser will not perform resection of spines and correct the bending of bone tissue, nor will it help with traumatic curvature. According to reviews, the procedure is painless, but it is not recommended for children and elderly people.

Rehabilitation after surgery

If it was necessary to perform surgical correction of a curved nasal plate, after it tampons are inserted into the patient’s nostrils, and silicone retainers must be installed. The next day they are removed, if there is no heavy bleeding, the patient returns home, but he may remain in the hospital for 4 days. However, completely normal breathing is restored only 3 weeks after straightening the septum. During rehabilitation you need:

during the first week, have your nasal passages cleaned daily by an ENT doctor to remove crusts and prevent the appearance of pathogenic microorganisms;
do breathing exercises that will prevent adhesions from forming;
use wound healing agents for external use (they must be prescribed by a doctor).

Possible complications after surgery

According to doctors, doing septoplasty is relatively safe (even from an aesthetic point of view - photos of people who have undergone it prove that there are no scars): blood loss is minimal, and trauma is also minimal. However, any operation is accompanied by risk, so after septoplasty you may:

ulcers and hematomas form;
prolonged nosebleeds appear during the rehabilitation period;
fusion of cavities and narrowing of the lower passage are observed;
develop purulent sinusitis, perichondritis.

Treatment at home

If the nasal septum is not so curved that the doctor insists on surgery (resection of the ridges, removal of spines, correction of the consequences of the fracture is not required), but causes problems, you can independently do procedures to make breathing easier and expel mucus, but this will only relieve symptoms. Home therapy may include:

Corticosteroids.
Silver preparations.
Antiseptics.
Compositions for rinsing the nasal passages (combat a common symptom of a crooked septum - rhinitis).

Prevention

You can protect yourself from deformation of the central nasal plate only if it is initially smooth or the curvature is slight. For this it is recommended:

avoid activities that are accompanied by fractures of the skull bones (traumatic sports, etc.);
do not allow ENT diseases to develop into polyps and adenoids;
strengthen the immune system.

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Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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Why is a deviated nasal septum dangerous? Causes, treatment and rehabilitation

Catad_tema Diseases of the ENT organs - articles

Displaced nasal septum in children. Clinical recommendations.

Displaced nasal septum in children

ICD 10: J34.2

Year of approval (revision frequency): 2016 (reviewed every 3 years)

ID: KR308

Professional associations:

National Medical Association of Otolaryngologists

Approved

Chief freelance specialist otorhinolaryngologist of the Ministry of Health of Russia, Doctor of Medical Sciences, Professor N.A. Daikhes President of the National Medical Association of Otorhinolaryngologists Honored Doctor of Russia, Corresponding Member of the Russian Academy of Sciences Professor Yu.K. Yanov

Agreed

Scientific Council of the Ministry of Health of the Russian Federation__ __________201_

deformation of the nasal septum

Terms and Definitions

Nasal septum- an anatomical structure that divides the nasal cavity in half, formed in the posterior part by the vomer, and in the anterior part by cartilage.

Deviated nasal septum- deviation of the nasal septum in both or one direction from the midline.

1. Brief information

1.1 Definition of disease

Deformations of the nasal septum are defined as anatomical changes in the position and structure of the nasal septum, expressed by curvatures, thickenings in the form of spikes and ridges, and various combinations of these changes, causing persistent impairment of nasal function.

Synonyms– deviation of the nasal septum, deformation.

1.2. Etiology and pathogenesis

The main cause of deformation of the nasal septum (87%) is its traumatic dislocations and fractures, including as a result of intrauterine and birth trauma, since the nasal septum at this age consists of several immature cartilaginous and unfused sections that are easily injured. As the facial skeleton grows and forms, as a result of the discrepancy between the growth of the osteochondral skeleton of the nasal septum and the bone frame that frames it, i.e., the vault and bottom of the nasal cavity, the deformation of the nasal septum becomes more pronounced, causing persistent functional disorders and deformation of the external nose.

Deformation of the nasal septum can also be caused by a violation of the embryogenesis of the maxillofacial rudiments, for example, with congenital cleft palate or anomalies in the development of the lateral wall of the nasal cavity. Vacant deformities of the nasal septum as a result of polyposis and tumors of the nasal cavity are observed much less frequently in childhood.

Based on an analysis of the circumstances of the injury, we can identify 5 typical mechanisms of action of the traumatic agent, which determine the characteristic types of nasal septum fractures in children.

When a traumatic agent acts from the front on the tip of the nose (9.3% of cases), a vertical fracture of the quadrangular cartilage in the caudal region most often occurs, accompanied by its dislocation from the bone bed in the area of the nasal spine. In this case, the nasal septum is deformed in the cartilaginous part like a spike, narrowing the nasal valve. The bony skeleton of the external nose is not damaged during such an injury, but with the growth of the facial skeleton, a deformation of the external nose is formed in the form of deviation of its tip to the side.

In the case of a complete fracture of the cartilage with the growth of the facial skeleton, the cartilage fragment in the caudal region lags behind in development, and the posterior sections of the cartilage grow intensively in the anterior-superior direction. The so-called double cartilage is formed, which is a common intraoperative finding during septoplasty performed on adolescents.

A strong blow to the tip of the nose often leads to rupture of the mucous membrane in the area of the nasolabial fold with the release of the caudal part of the quadrangular cartilage into the vestibule of the nose, and the formation of vestibulo-nasal fistulous tracts, abscesses of the septum and the bottom of the nasal cavity is possible.

When a traumatic agent acts from the front on the dorsum of the nose (32.6% of cases), most often a horizontal fracture of the quadrangular cartilage occurs in the antero-inferior section with the formation of a crest-type deformity. The initial shape of the nasal septum largely determines the types of deformation that occur as a result of injury. If the nasal septum previously had a C-shaped bend, then when hit from the front or from above, it breaks towards the bend. If it was in a strictly central position, then dislocation of the cartilage occurs from the bone bed of the premaxilla and vomer. The bony part of the nasal septum is usually not damaged. With such an injury, a fracture of the nasal bones is possible without significant displacement of the fragments and without deformation of the external nose.

When a traumatic agent acts from above on the dorsum of the nose (6.2% of cases), horizontal fractures are primarily formed in the posterior parts of the bony part of the nasal septum. Bone fragments of the perpendicular plate of the ethmoid bone and the vomer overlap each other; injury to the cribriform plate of the ethmoid bone is possible, causing nasal liquorrhea. The quadrangular cartilage, depending on its original shape, can break, continuing the fracture line of the bone part, or bend and dislocate from the bone bed at the bottom of the nasal cavity and slide off the vomer. A combined osteochondral deformity of the nasal septum in the form of a ridge or a deformation of the bony part of the nasal septum in the form of lateral displacement is formed, which significantly impairs the respiratory function of the nose.

With such an injury, a fracture of the nasal bones always occurs, often comminuted, with the fragments displaced inward. Deformation of the external nose occurs in the form of retraction and flattening of the back. If the fragments are not repositioned in a timely manner, then over time a saddle-shaped deformity of the nose is formed, which can be eliminated with rhinoplasty.

The action of a traumatic agent on the side of the nose is noted in 16.3% of cases, and occurs in the vast majority of boys after a blow to the nose with a fist during a fight. In this case, a fracture of the nasal bones and frontal processes of the upper jaw is observed with the formation of deformation of the external nose in the form of retraction of one slope (usually the left) or lateral displacement of the entire nasal dorsum to the side, which can be eliminated by reposition.

In some cases, a combined fracture of the ethmoid bone cells and the medial wall of the orbit occurs. Radiologically, hemorrhages are detected in the cavity of the ethmoid bone, less often - in the orbit. Clinically, in such cases, subcutaneous emphysema in the area of the medial corner of the eye and lower eyelid can be detected.

With this mechanism of injury, a horizontal fracture of the nasal septum occurs in upper sections, more often without displacement, less often - with the formation of angular deformation of the bone part. Since these deformations are located in the upper parts of the nasal cavity, they do not cause serious disturbances in the respiratory function of the nose, but in some cases the sense of smell is impaired. The quadrangular cartilage, as a rule, does not break, but only bends in an S- or C-shape.

Traumatic injuries that occur when the face hits a hard surface (6.2% of cases) occur as a result of a car injury or a fall from a height; they are distinguished by a variety of clinical combinations and the severity of the general condition of the victim, because accompanied by concomitant injuries to other parts of the body.

Damage to the septum is characterized by multiple multidirectional fractures, which determine complex combined deformations of the osteochondral part. The most typical type of injury is a complex combined deformity (the so-called “crushed” septum), caused by multiple vertically directed fractures.

With this mechanism of injury, fractures of the bones and nasal septum are often combined with fractures of the walls of the frontal and maxillary sinuses, hemorrhages in them, with facial wounds and damage to intranasal structures, fractures of the base of the skull and intracranial hematomas.

Thus, despite the numerous clinical variants of traumatic deformities of the nasal septum, there are certain patterns of displacement of fragments depending on the mechanism of injury, which can be clarified in 75.2% of cases. Knowledge of these features helps to plan the use of certain operational and technical methods of surgical treatment.

1.3. Epidemiology

Deformations of the nasal septum of varying severity are observed in 42.5% of the child population and constitute on average 2% of the total number of patients treated in a children's otorhinolaryngological hospital. More common in boys (81%) 14-15 years of age (46.4%).

1.4 Coding according to ICD 10

J34.2 - Deviation of the nasal septum

1.5 Classification

Due to the morphological diversity of variants of deformation of the nasal septum, they are classified according to their shape and anatomical location.

Deformations of the cartilage department:
- C - shaped;
  
  S - shaped.
Bone deformities:
- arcuate.
Combined osteochondral deformities.

The most common clinical variant of the deformity is a combined deformity of the osteochondral region in the form of a ridge (37.6%).

2. Diagnostics

2.1.Complaints and anamnesis

The main complaints of patients with a deformed nasal septum are impaired nasal breathing (usually unilateral - 76.6%), sense of smell (anosmia - in 18.6% of cases) and mucociliary clearance (37.5%); closed nasality (43.3%); snoring (41.3%); conductive hearing loss (48.0%); deformation of the external nose (29.4%).

From common symptoms, caused by chronic hypoxia of the growing organism, it should be noted increased fatigue, attacks of headaches, lag in psychophysical development, frequent acute respiratory diseases, and the severity of this symptom complex is directly dependent on the duration of the deformation of the nasal septum.

Most patients have a history of nasal trauma.

2.2 Physical examination

Comments:The shape of the external nose can be changed due to deviation of the axis of the nose, deviation of the tip of the nose or retraction of the nasal slopes.

Comments:When performing rhinoscopy, the patient may have a deformation of the nasal septum in the cartilaginous, osteochondral or osseous region. Nasal breathing is difficult when the nasal septum is deformed. It is also necessary to evaluate the condition of the inferior turbinates in children with a deformed nasal septum. In older patients age group there is hypertrophy of the inferior nasal conchas, congestion in them.

2.3 Laboratory diagnostics

clinical blood test;

biochemical blood test: level of blood glucose, total protein, aspartate aminotransferase, alanine aminotransferase, creatinine;

blood test for syphilis;

a blood test for infection caused by the human immunodeficiency virus (HIV);

blood test for hepatitis B and C.

2.4 Instrumental diagnostics

Comments:The study makes it possible to evaluate in detail changes in the architectonics of the nasal cavity, the localization of deformation of the nasal septum, and the condition of the nasopharynx. Diseases associated with deformation of the nasal septum in children are: vasomotor rhinitis (67.8%, of which the allergic form is 16.6%), chronic adenoiditis (51.6%), recurrent rhinosinusitis (32.6%).

Comments: When diagnosing an inflammatory process in the paranasal sinuses or adenoid vegetations, as well as in the presence of hypertrophy of adenoid vegetations, the first step is to carry out sanitation of foci of infection (treatment of rhinosinusitis and adenoiditis, adenoidectomy) in order to avoid purulent-septic complications of septoplasty.

2.5 Other diagnostics

Comments:This technique allows you to assess the degree of respiratory dysfunction in children with deformed nasal septum in the pre- and postoperative period.

Comments: Most often, nasal injuries are combined with traumatic head injuries. With such trauma, the child needs to consult a neurosurgeon and a neurologist to rule out a concussion and skull injuries.

3. Treatment

Indications for hospitalization

The presence of a deformed nasal septum in a child with impaired nasal function is an indication for hospitalization for surgical treatment.

3.1 Conservative treatment

Comments: Treatment of deformed nasal septum is only surgical. Indications for septoplasty are a significant impairment of the respiratory function of the nose and the presence concomitant diseases.

3.2. Surgery

Comments: The purpose of surgery is to restore nasal function, primarily respiratory function.

Comments:From the point of view of relation to the tissues of the nasal septum, methods of septoplasty in children can be systematized in the following groups: tissue-preserving operations; resection and tissue-saving operations using non-free autoplasty techniques; resection and tissue-replenishing operations using free plastic techniques with various grafts. An important point in nasal septum surgery in children younger age is the principle of a gentle attitude towards its structures, when it is enough to correctly form the nasal valve without moving the entire nasal septum to the middle position. A well-functioning nasal valve with age eliminates nasal breathing disorders associated with minor curvatures of the nasal septum in the posterior sections, due to reflex stimulation of the blood supply to the mucous membrane of the nasal turbinates by the inhaled air stream. The use of tissue-preserving surgical methods allows septoplasty to be successfully performed in children aged 4-5 years with good long-term results.

Comments: In the development of the nasal septum in children, several periods of intensive growth are distinguished. At 5 years of age, compared to younger children, the horizontal and vertical size of the nasal septum intensively increases with a simultaneous increase in its total area. The next stage of intensive growth of the nasal septum is observed at 7 years of age. The third period occurs at 14-15 years of age, when the septum grows more rapidly in height and there is a significant increase in its total area. Based on these data, in children aged 8-13 years, septoplasty should be performed with minimum volume resection, try to completely reimplant the restored and modeled areas of the nasal septum, because at this age, the growth of the septum's own tissues is minimal. During periods of intensive growth of the nasal septum (5-7 years and 14-15 years), compensation of its curved areas may be less economical.

Comments: In childhood, the question of choosing anesthesia when performing septoplasty should be decided in favor of endotracheal anesthesia. Local anesthesia during this operation, it is used as a method of hydropreparation of mucoperichondrium and mucoperiosteum from the osteochondral skeleton of the nasal septum.

Comments: When performing operations on the nasal septum, a wide visual overview and free instrumental access to the area of deformation are required when the anatomical dimensions of the nasal cavity are small in childhood. These requirements are fully met by surgical access through the separation of the mucoperichondrium and mucoperiosteum under the control of rod-lens endoscopic optics, always on both sides of the nasal septum from the bottom of the nasal cavity on the side of the incision, which provides a wide view and free instrumental access to all its parts.

Comments: Each type of nasal septum deformity requires a specific approach and scope of surgical intervention. In case of severe deformations of the nasal septum, when it is not possible to preserve the quadrangular cartilage in existing form, use the resection-reimplantation method. The mobilized cartilage is removed entirely. Modeling of cartilage is carried out by cutting off scarred areas, thinning thickened areas and perforating. Reimplantation is performed with 180° chondroinversion. Having placed the cartilage in the sagittal plane close between the dorsum of the nose and the premaxilla, it is fixed with catgut sutures.

Comments: If the deformation of the septum is accompanied by deformation of the external nose in the form of deviation of its tip, then the strip of quadrangular cartilage remaining on top is first mobilized, separated from the triangular cartilages, and modeled by incising vertically in several places. In these cases, after surgery, external fixation of the corrected shape of the nose is used using a thermoplastic orgoplast plate.. In cases of drooping of the nasal tip due to retraction of the columella or saddle-shaped deformation of the nose, the volume of one’s own cartilage is not enough to restore the full skeleton of the nasal septum; its reimplantation is supplemented with autotransplantation of auricular cartilage.

Comments: A tampon is inserted on the side of the incision and deformation of the nasal septum and is removed on the 3-5th day after surgery. The other half of the nose is loosely tamponed with a latex tampon, changing it daily for endoscopic monitoring of the position of the nasal septum and the condition of the mucoperichondrium, toileting the nasal cavity and local treatment.

3.3. Other treatment

Comments: Within 5 days after surgery, it is preferable to use broad-spectrum antibacterial drugs parenterally to prevent purulent-septic complications.

Comments: Of particular importance in the postoperative management of patients are therapeutic measures aimed at optimizing regeneration processes in the tissues of the nasal septum: the prescription of anti-inflammatory and decongestant therapy, calcium supplements; local use of antiseptic, vasoconstrictor, secretolytic and wound-healing drugs in the form of drops, ointments, sprays and gels.

4. Rehabilitation

Recommended after surgical interventions for deformation of the nasal septum: under the supervision of an otolaryngologist for a year, with a mandatory examination 1 month after surgery, 3 months, 6 months, one year.

5. Prevention and clinical observation

To prevent deformation of the nasal septum in childhood, it is recommended to carry out a general set of social measures to prevent injuries, as well as educational work with parents.

Comments:The general complex of social measures for the prevention of injuries includes the organization of safe leisure time for children and adolescents, the organization of safe road traffic, etc. Parents need to be explained about the possibility of developing concomitant diseases and the need for timely surgical treatment of deformed nasal septum in children.

6. Additional information affecting the course and outcome of the disease

The functional results of septoplasty are objectively assessed using acoustic rhinometry. A good result in children is considered to be an increase in the minimum cross-sectional area of the nasal cavity in the area of deformation by more than 2.5 times. The effectiveness of treatment of nasal septum deformity is also assessed by the dynamics of reverse development general symptoms and the course of concomitant diseases and restoration of nasal functions.

Criteria for assessing the quality of medical care

	Quality criteria	Level of evidence
1.	Examination by an otorhinolaryngologist was performed no later than 12 hours from the moment of admission to the hospital
2.	A detailed general (clinical) blood test was performed
3.	A general therapeutic biochemical blood test was performed (level of blood glucose, total protein, aspartate aminotransferase, alanine aminotransferase, creatinine)
4.	Septoplasty or rhinoseptoplasty performed
5.	Anesthesia performed
6.	Treatment with antibacterial drugs was carried out in the postoperative period (in the absence of medical contraindications)
7.	Rhinometry was performed before discharge from the hospital
8.	No complications during hospitalization

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Appendix A1. Composition of the working group

Yunusov A.S., Doctor of Medical Sciences, Professor, Honored Doctor of the Russian Federation, is a member of the professional association.
Molchanova E.B., Ph.D. is not a member of a professional association.

There is no conflict of interest.

FSBI " Scientific and clinical center otorhinolaryngology, FMBA of Russia". Director: Professor, Doctor of Medical Sciences N.A. Daikhes.

doctors general practice(family doctors);

otorhinolaryngologists;

audiologists-otorhinolaryngologists;

pediatricians;

city (district) pediatricians;

local pediatricians;

emergency doctors medical care;

senior doctors of emergency medical care stations (departments);

general practitioners;

adolescent therapists;

local therapists;

local general practitioners of shop medical districts;

infectious disease doctors;

ship doctors.

Table P1. Levels of evidence used

Table P2. Recommendation strength levels used

Scale	Strength of evidence	Relevant types of research
	Evidence is Convincing: There is strong evidence for the proposed claim.	High-quality systematic review, meta-analysis. Large randomized clinical researches with a low probability of errors and clear results.
	Relative strength of evidence: there is sufficient evidence to recommend the proposal	Small randomized clinical trials with mixed results and moderate to high error rates. Large prospective comparative but non-randomized studies. Qualitative retrospective studies on large samples of patients with carefully selected comparison groups.
	Insufficient evidence: The available evidence is insufficient to make a recommendation, but recommendations may be made based on other circumstances	Retrospective comparative studies. Studies on a limited number of patients or on individual patients without a control group. Personal unformalized experience of developers.

Appendix A3. Related documents

The procedure for providing medical care in the field of otorhinolaryngology: Order of the Ministry of Health of the Russian Federation dated November 12, 2012 N 905n “On approval of the Procedure for providing medical care to the population in the field of otorhinolaryngology.”

Appendix B. Patient management algorithms

Appendix B: Patient Information

If patients have long-term nasal breathing impairment, then they need to consult an otolaryngologist. One of the most common causes of difficulty in nasal breathing is deformation of the nasal septum.

Not every deformity of the nasal septum is subject to surgical correction, but only those that impair the functions of the nose.

Untimely surgical treatment for deformation of the nasal septum leads to disruption of the functioning of all systems and organs. Chronic inflammatory processes occur in the nasal cavity and paranasal sinuses. The functioning of the hearing organ is disrupted (catarrhal otitis occurs, exudative otitis, chronic otitis media, hearing loss).

The bronchopulmonary system suffers, and there is insufficient oxygen supply to the brain. Patients with impaired nasal breathing experience constant physical fatigue and weakness. An active lifestyle is disrupted.