Curvature of septum of nose

The curvature of the septum of the nose (deviation of the septum of the nose, deformation of the septum of the nose, the crest of the septum of the nose, the spine of the septum of the nose) is a change in its shape resulting from a trauma (fracture) or abnormal formation of its bone-cartilaginous skeleton, causing difficulty in nasal breathing or development of changes or diseases neighboring organs (nasal conchae, paranasal sinuses, middle ear, etc.)

ICD-10 code

• M95.0 Acquired deformation of the nose.
• J34.2 Curvature of the septum of the nose.

Epidemiology of curvature of the septum of the nose

Ideally, a straight septum of the nose in an adult is extremely rare. In most cases, it has physiological curves and thickenings. Normal thickening of the septum of the nose in the articulation of the cartilage of the septum of the nose with the anterior edge of the perpendicular plate of the latticed bone is considered normal. Another thickening is located in the basal parts - in the area of the connection of the lower part of the cartilage of the septum of the nose with the upper edge of the opener and premaxilla. Small smooth C- and S-shaped deviations also do not consider pathology.

The prevalence of the curvature of the septum of the nose as a nosological form is difficult to determine, because it does not depend on the very form and degree of deformation, but on those symptoms that this deformation causes. The presence of even severe deformity may not manifest clinically if the width of both halves of the nasal cavity is equalized by the adaptive capabilities of the surrounding structures, primarily the lower and middle nasal concha. These anatomical formations located on the lateral walls of the nasal cavity can change their shape and size; lower nasal conchaes - due to vicar hypertrophy or, conversely, a decrease in the volume of cavernous tissue, medium due to pneumatization or changes in the shape of the bone skeleton.

In connection with the lack of a clear formulation of what exactly should be considered as a warp (deformation), statistical information about the prevalence of this disease varies on a very wide scale. Thus, R. Mladina and L. Bastaic (1997), examining the prevalence of the curvature of the septum of the nose in a population , revealed it in almost 90% of adults. A.A. Vorobiev and V.M. Morenko (2007), in a survey of 2,153 adults, revealed a curvature of the nasal septum in 58.5% of the examined (39.2% of women and 76.3% of men). It clearly refers to the mere presence of some form of deformity, revealed by anterior rhinoscopy, and not caused by symptoms. R. Mladina (1987) tried to compare the prevalence of curvature of the septum of the nose and their variants in different ethnic groups. Based on a survey of 2,600 randomly selected people around the world, the author was unable to identify differences in the prevalence of different types of nasal septal deformities in persons belonging to different ethnic groups and living in different geographical areas. There is some interest in the occurrence of curvatures of the septum of the nose for various diseases. Thus, in chronic rhinosinusitis, clinically significant deformities of the nasal septum were found in 62.5% of the examined patients (AS Lopatin, 1989).

Screening of the curvature of the septum of the nose

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

Classification of the curvature of the septum of the nose

In the history of otorhinolaryngology, several attempts have been made to classify various variants of deformities of the septum of the nose. The classification of M. Cottle, based on the localization of deformation, is considered a classical one. The author distinguishes five anatomical zones of the septum of the nose and, accordingly, five types of deformation, depending on its preferential localization. This classification has its pros and cons. The pluses include the differentiation of some clinically important types of deformities requiring technically different surgical approaches, in particular the deviation of the nasal septum in the anteroposterior parts (in the nasal valve region) and the crests in the posterior regions (in the region of the seam between the upper edge of the opener and the perpendicular plate of the trellis, in which also introduces the wedge-shaped process of the cartilage of the septum of the nose). The disadvantage of classification is that with its help it is difficult to determine the nature of deformations that cover all or several anatomical divisions, in particular complex posttraumatic distortions.

R. Mladin suggested another classification of deformations of the septum of the nose, in which seven basic types of deformations are distinguished:

1. slight lateral displacement of the septum of the nose in the region of the nose valve, which does not violate its function;
2. slight lateral displacement of the septum of the nose in the region of the nose valve, which violates its function;
3. deviation of the septum of the nose opposite the front end of the middle nasal conch;
4. Combination of types 2 and 3 on opposite sides of the septum of the nose;
5. the location of the crest in the anterior-basal part of the septum of the nose on one side, the opposite side is straight;
6. the location of the crest in the anterior-basal regions on the one hand, the "gorge" on the opposite side;
7. a combination of all the types of deformities listed above (usually the so-called crumpled nasal septum for posttraumatic deformities).

Since any classification in medicine not only systematizes the available information about any group of diseases, but also on its basis the choice of an adequate method of treatment is based, it is advisable to use a working scheme that allows not only to distribute all curvatures of the septum of the nose to certain groups, but also to give an opportunity choose the most appropriate method of surgical correction of this deformation. Thus, C-shaped deviation, S-shaped curvature and the crest or thorn of the septum of the nose, as well as their various combinations should be distinguished. However, another separate group is isolated, including complex posttraumatic deformities of the nasal septum, which do not fit into any of the above categories.

The causes of curvature of the septum of the nose

According to the etiological principle of deformation of the septum of the nose, the main groups can be divided at the bottom: post-traumatic and resulting from anomalies in the formation of the osteochondral skeleton.

Curvature of the septum of the nose - Causes and pathogenesis

Symptoms of curvature of the septum of the nose

The main symptom of the curvature of the septum of the nose is the difficulty of nasal breathing, which can be one-sided or two-sided. If there is a pronounced displacement of the septum to the right or to the left (especially in the anterior regions), the patient complains of difficulty or lack of breathing through the corresponding half of the nose, but this is absolutely not necessary. Often the subjective feeling of insufficiency of breathing through this or that half of the nasal cavity does not correspond to the shape of the septum of the nose. More often the difficulty of nasal breathing is either constant, equally pronounced on both sides, or alternating due to the nasal cycle.

Curvature of the septum of the nose - Symptoms and Diagnosis

Treatment of curvature of the septum of the nose

Restoration of nasal breathing

Surgical correction of curvature, as a rule, is carried out in a hospital.

Surgical treatment of curvature of the septum of the nose

Depending on the identified variant of deformation, the corresponding method of surgical correction is selected (for example, for C-shaped deformation, laser septum of the mastic or septoplasty using the principles of biomechanics, for isolated ridges / thorns in the posterior sections - endoscopic submucosal resection).

Curvature of nasal septum - Treatment

[1], [2], [3], [4], [5], [6], [7]