Septum deviation: when it is necessary to operate?

The nasal septum is a wall separating the nasal cavities . It is formed by cartilage in its anterior part and by bony tissue in the deepest part of the nose, and covered by mucosa. On each side of the nasal cavity we have structures that prepare the air to reach the lungs, functioning as a filter and humidifier of the external air. The nasal septum helps in this process and also works as a support for other structures of the nose.

What you would expect is that it divides the nostrils exactly in the middle, but in the vast majority of people, the septum is not completely straight. This is not a problem because cases where the deviation is accentuated to the point of causing obstruction of the nostrils are seen in a smaller percentage of people.

Septum deviation may be present from birth, or develop from infancy to even in adult life, from trauma, tumors or surgery. Nasal traumas, especially if they occur in childhood, may lead to a change in the pattern of septum cartilage growth, with marked deviations. A common complaint is nasal obstruction, which can manifest itself in varying degrees. The person can feel from a resistance to breathing to the sensation that one of the nostrils is completely blocked. In some cases the complaint of obstruction may be on both sides, and in this situation the septal deviation tends to be more accentuated and affects both sides, as in an "S" format.

Since the septal deviation hinders the flow normal air and secretions, the person may present bleeding and accumulation of secretions, generating pictures of sinusitis. Some people may be asymptomatic most of the time, and present symptoms only when they experience colds and sinusitis, which leads to a swelling of the nasal mucosa.

Allergic individuals may notice either a temporary nasal obstruction when in crisis, or a continuous obstruction in the case of more severe and chronic rhinitis. People who have a combination of septal deviation and rhinitis often complain of nasal obstruction and coryza very often.

In addition to nasal obstruction, rhinitis and sinusitis, septum deviation can lead the subject to breathe through the mouth , difficulty sleeping, snoring and facial pain.

Diagnosis

The diagnosis is made by physical examination performed by an otorhinolaryngologist who uses instruments that open the nostrils to visualize their contents. It is important to clarify if there are associated problems, such as rhinitis, sinusitis, and nasal tumors.

Nasopharyngoscopy is a very useful examination in clinical practice. It functions as a nasal endoscopy that allows visualization of the entire interior of the nasal cavity until its posterior part, including visualization of secretions, tumors and polyps.

When necessary, the otorhinolaryngologist requests tomography of the face as a complementary exam to evaluate sinusitis that may be associated. In young children, the difficulty of nasal breathing may indicate other problems, such as increased adenoid, and it is imperative to investigate as it has repercussions on the pattern of facial growth.

What is the treatment?

Not all deviations of the septum need be corrected by surgery only when it is considered obstructive. The person may have other illnesses, such as allergic rhinitis and sinusitis, which are causing the symptom of nasal obstruction. In these situations, drug treatment should be the first choice.

In cases where the deviation is considered obstructive, surgical correction is indicated. Septoplasty surgery is usually indicated in late adolescence, when nasal growth ends. However, if the septal deviation is accentuated to the point of hindering nasal breathing, surgery at an earlier age may be indicated, conservative only removing the deviated portion, and being aware that the septal deviation may recur in the future.

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