Septal deviation is the most common structural cause of nasal obstruction, a prevalent symptom for which patients seek otolaryngologic consultation. Surgical correction of septal deviations (septoplasty) is the third most frequently performed surgery by head and neck surgeons and is usually aimed at improving the patient’s quality of life. However, only about 25% of patients with septal deviations present with symptoms.
Anatomy and function:
The nasal septum constitutes the medial wall of the nasal passages and is formed by a bony part (perpendicular plate of the ethmoid and vomer), a cartilaginous part (quadrangular cartilage) and a membranous part (the most anterior and smallest part consisting mainly of skin).
The main function of the septum is to provide support to the nasal tip, separate both nasal passages favoring laminar flow and also helps absorb the impacts of the anterior cranial fossa by forming part of its floor.
The main function of the septum is to provide support to the nasal tip, separate both nasal passages favoring laminar flow and also helps absorb the impacts of the anterior cranial fossa by forming part of its floor.
Etiology of Septal Deviation:
Septal deviations can occur without prior nasal trauma. Severe deviations may develop as early as the fetal period; microfractures in the last trimester of pregnancy or during childbirth can weaken the injured septal cartilage, leading to asymmetrical curvature toward the weaker side.
Direct trauma-induced deviations can occur in childhood or adulthood. Depending on the direction and force of nasal trauma, the septal cartilage can fracture horizontally or vertically, along single or multiple fracture lines, and may involve fractures of the nasal bones and/or the perpendicular plate of the ethmoid. Additionally, the septal cartilage may become displaced from its caudal attachment, with the osteocartilaginous junction being the most commonly affected area in trauma cases.
Symptoms of Septal Deviation:
Patients typically report nasal obstruction, which may be unilateral or bilateral, and does not improve with vasoconstrictors or topical corticosteroids. Other reported symptoms may include a history of nasal trauma, prior nasal surgery, or sinusitis.
Diagnosis:
Diagnosis is made through physical examination using anterior rhinoscopy and nasal endoscopy. These methods allow for a comprehensive view of the entire bony and cartilaginous septum.
Different types of deviations can be observed based on their shape, such as:
C-shaped deviation S-shaped deformity Nasal spur
Treatment of Septal Deviations:
The treatment for septal deviations is surgical when indicated. The procedure, known as septoplasty, is generally recommended for patients with visible septal deformity and/or respiratory insufficiency not attributable to other identifiable causes such as nasal polyps, turbinate hypertrophy, or allergic rhinitis.
Other indications for this surgery include:
- Nasal bleeding or epistaxis,
- Obstruction of the sinus drainage pathways,
- Or as part of a surgical approach, such as in cases of pituitary tumors.