HEAD AND NECK

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Nasal septum deviation or scoliosis is one of the most common causes of breathing difficulties through the nose. Very often it is due to malformations during the development of the face, a process that begins from early childhood. Sometimes there is also an inherited predisposition and more rarely it can occur after face serious injuries.

The patient visits the doctor complaining about deficient nasal breathing. His/ her medical history may go back to adolescence, nevertheless he/ she may also have noticed a more recent aggravation of symptoms. Although septum remains firm during all adulthood, as people grow old, aggravating factors are added. Firstly, the extra weight we put on with age plays a very important role; secondly, hypertrophy of the lower nasal conchae (or turbinates), which are normal formations of the nose, a situation which occurs gradually. Loosening of the nose skin with age, may also worsen the symptoms. As time goes by, symptoms may get worse, however, when they are the result of septum scoliosis they do not show any fluctuations. Less or more intense symptoms depending on season, temperature and environmental humidity changes or on the contact with allergic substances show parallel presence of allergic or vasomotor rhinitis, a fact that reveals sensitivity of the nasal mucosa.

At first, the doctor has to find out the precise cause of breathing difficulty. Apart from deviation of the septum and the coexisting hypertrophy of the lower nasal conchae, other causes may also be involved or have the exclusive responsibility for the symptom. Thus, polyps, tumors of the nose and the nasopharynx, residual hypertrophy of the adenoids (adenoids vegetation), congenital atresia of one of the choanae or functional deficiency of the nose entrance, may coexist with scoliosis of the septum or they may be the exclusive cause of nasal breathing difficulties. Moreover, a sinus with chronic alterations or disorders of the lower respiratory tract, of the lungs, may also cause a feeling of breathing difficulty while the nose is functioning properly in every other aspect.

Clinical examination helps to distinguish among the possible causes of deficient nasal breathing. Today, the clinical examination with endoscope allows us to perform a detailed examination of the nasal cavity. Hence, we are able to recognize the precise cause of the nasal breathing difficulty, by detecting polyps or other lesions or even by detecting the collapsing of the nasal walls during the inhalation phase. Moreover, by showing the video to the patient we can help him / her understand in general the nature of the problem and also the fact that the nose is not only the visible part we can see on our face but also a large cavity at the centre of the head that presents a rather complicated anatomy.

Other types of examination such as rhinomanometry, that is the measurement of air flow, may also help determine the problem and do the reference measurement in order to be able to compare it with the postoperative result. If the patient reports a sinusitis medical history, it is then necessary to perform a simple x-ray of the sinus, and in case of further findings, to proceed to a CT (computer tomography).

If the final diagnosis is indeed scoliosis of the septum, then a sincere conversation with the patient must be done. First of all, not every case of deviated septum is an indication for surgical intervention. Our goal is not to straighten the septum but to improve patient’s breathing ability. Moreover, attributing all our problems to a cause that involves an easy solution is human and easily understood. However, a thirty minutes surgery cannot change our lives by making us different people. When the patient is complaining about snoring, headaches, frequent sinusitis or increased nasal catarrh, we must explain to him / her that a septum straighten surgery may improve these symptoms to some extent but it cannot eliminate them completely. Otherwise, we may perform a successful operation but in the end our patient may remain disappointed.

Experienced colleagues may perform the operation under local anesthesia. Our team prefers the general anesthesia if the patient’s overall health condition allows it, since this method allows better handling of the particular case, and sometimes in controlled environment, it may be safer than local anaesthesia. Surgery lasts from 30 up to 45 minutes and due to our technique, it is not necessary to place gauzes inside the nose. The patient remains in hospital for 24 hours and his / her postoperative course is almost totally painless. Nevertheless, for a period of two up to three weeks, the nose will continue to be congested as a result of the surgery.

Along with the septum straightening procedure we also try to reduce the lower nasal conchae. The most effective technique, especially in relapsing cases is powered inferior turbinoplasty.

There is no doubt that if our patient also seeks an aesthetic change in the appearance of the nose, we can combine septum and rhinoplasty surgeries. In certain cases, when the nose external tissues loosen and slide downwards, aesthetic intervention will also improve the functional result outcome. However, in these cases, the character of the surgery changes considerably.