Nasal septal deviation

Curvature of the nasal septum (deviation of the nasal septum, deformation of the nasal septum, ridge of the nasal septum, spike of the nasal septum) is a change in its shape that occurs as a result of injury (fracture) or abnormal formation of its bone-cartilaginous skeleton, causing difficulty in nasal breathing or the development of changes or diseases of adjacent organs (nasal turbinates, paranasal sinuses, middle ear, etc.),

ICD-10 code

• M95.0 Acquired deformity of the nose.
• J34.2 Deviation of nasal septum.

Epidemiology of nasal septum deviation

An ideally straight nasal septum in an adult is extremely rare. In most cases, it has physiological bends and thickenings. Thickening of the nasal septum in the area of the articulation of the cartilage of the nasal septum with the anterior edge of the perpendicular plate of the ethmoid bone is considered normal. Another thickening is located in the basal sections - in the area of the junction of the lower part of the cartilage of the nasal septum with the upper edge of the vomer and premaxilla. Small smooth C- and S-shaped deviations are also not considered pathology.

The prevalence of nasal septum deviation as a nosological entity is difficult to determine because it depends not on the form and degree of deformation itself, but on the symptoms that this deformation causes. The presence of even a pronounced deformation may not manifest itself clinically if the width of both halves of the nasal cavity is equalized due to the adaptive capabilities of the surrounding structures, primarily the inferior and middle nasal conchae. These anatomical structures located on the lateral walls of the nasal cavity can change their shapes and sizes; the inferior nasal conchae - due to vicarious hypertrophy or, conversely, a decrease in the volume of cavernous tissue, the middle ones - due to pneumatization or a change in the shape of the bone skeleton.

Due to the lack of a clear definition of what exactly should be considered a curvature (deformation), statistical data on the prevalence of this disease vary widely. Thus, R. Mladina and L. Bastaic (1997), studying the prevalence of nasal septum curvature in the population, found it in almost 90% of adults. A. A. Vorobyov and V. M. Morenko (2007), when examining 2153 adults, found a curvature of the nasal septum in 58.5% of those examined (39.2% of women and 76.3% of men). This clearly refers to the simple presence of one or another form of deformation revealed by anterior rhinoscopy, and not the symptoms it causes. R. Mladina (1987) attempted to compare the prevalence of nasal septum curvatures and their variants in different ethnic groups. Based on a survey of 2,600 randomly selected people in different countries of the world, the author failed to identify differences in the prevalence of various types of nasal septum deformities in people belonging to different ethnic groups and living in different geographic areas. Of particular interest is the incidence of nasal septum deformities in various diseases. Thus, in chronic rhinosinusitis, clinically significant nasal septum deformities were found in 62.5% of the examined patients (A.S. Lopatin, 1989).

Screening for deviated septum

Performing anterior rhinoscopy in combination with active collection of patient complaints during preventive examinations is considered a completely reliable and sufficient method for detecting curvatures of the nasal septum.

Classification of nasal septum deviation

In the history of otolaryngology, several attempts have been made to classify various types of nasal septum deformations. The classic classification is M. Kottle's, which is based on the localization of the deformation. The author identifies five anatomical zones of the nasal septum and, accordingly, five types of deformation depending on its predominant localization. This classification has its pros and cons. The pros include the differentiation of some clinically important types of deformations that require technically different surgical approaches, in particular, deviation of the nasal septum in the anterior-superior sections (in the area of the nasal valve) and ridges in the posteroinferior sections (in the area of the suture between the upper edge of the vomer and the perpendicular plate of the ethmoid bone, into which the wedge-shaped process of the cartilage of the nasal septum is also introduced). The disadvantage of the classification is that it is difficult to use it to determine the nature of deformations covering all or several anatomical sections, in particular complex post-traumatic curvatures.

R. Mladina proposed another classification of nasal septum deformations, which identifies seven main types of deformations:

1. slight lateral displacement of the nasal septum in the area of the nasal valve, which does not impair its function;
2. slight lateral displacement of the nasal septum in the area of the nasal valve, which disrupts its function;
3. deviation of the nasal septum opposite the anterior end of the middle nasal concha;
4. combination of types 2 and 3 on opposite sides of the nasal septum;
5. the location of the ridge in the anterior-basal sections of the nasal septum on one side, the opposite side is straight;
6. the location of the ridge in the anterior-basal sections on one side, the “gorge” on the opposite side;
7. combinations of all the above types of deformations (usually the so-called collapsed nasal septum in post-traumatic deformations).

Since any classification in medicine not only systematizes the available information about a group of diseases, but also serves as a basis for choosing an adequate treatment method, it is advisable to use a working scheme that allows not only to distribute all curvatures of the nasal septum into certain groups, but also makes it possible to choose the most appropriate method of surgical correction of this deformation. Thus, it is necessary to distinguish between C-shaped deviation, S-shaped curvature and ridge or spike of the nasal septum, as well as their various combinations. However, another separate group is distinguished, including complex post-traumatic deformations of the nasal septum, which do not fit into any of the above categories.

Causes of a deviated nasal septum

According to the etiological principle, deformations of the nasal septum can be divided into the following main groups: post-traumatic and those resulting from anomalies in the formation of the bone-cartilaginous skeleton.

Deviated Nasal Septum - Causes and Pathogenesis

Symptoms of a deviated nasal septum

The main symptom of a deviated nasal septum is difficulty breathing through the nose, which can be unilateral or bilateral. With a pronounced shift of the nasal septum to the right or left (especially in the anterior sections), the patient complains of difficulty or lack of breathing through the corresponding half of the nose, but this is not at all necessary. Often, the subjective feeling of insufficient breathing through one or another half of the nasal cavity does not correspond to the shape of the nasal septum. More often, difficulty breathing through the nose is either constant, equally pronounced on both sides, or intermittent due to the nasal cycle.

Deviated Septum - Symptoms and Diagnosis

Treatment of deviated nasal septum

Restoration of nasal breathing

Surgical correction of curvatures is usually performed in a hospital.

Surgical treatment of deviated nasal septum

Depending on the identified type of deformation, an appropriate method of surgical correction is selected (for example, for a C-shaped deformation - laser septum septum or septoplasty using the principles of biomechanics; for isolated ridges/spikes in the posterior lower sections - endoscopic submucosal resection).

Deviated Nasal Septum - Treatment

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