Septal Deviation (Nasal Cartilage Deviation) in Istanbul, Turkey
Septal deviation is a condition that occurs when the cartilage and bone structure located in the midline of the nose abnormally shifts. This structural disorder leads to airway obstruction, causing breathing difficulties and aesthetic problems. Trauma, congenital anomalies, or structural imbalances in the nose are the main causes of septal deviation. The curvature can often be in the form of C, S, or I shapes. Surgical interventions like septoplasty or extracorporeal septoplasty are applied to correct nasal symmetry and improve breathing. Cartilage grafts are sometimes used to stabilize the septum.
What Is Septal Deviation?
Septal deviation is a disorder that arises when the nasal septum, composed of cartilage and bone dividing the nasal cavity into two, shifts to one side, causing the narrowing of one nasal passage. This condition can result from congenital factors, trauma to the nose, or structural changes occurring with aging. Mild deviations are present in most people and often go unnoticed. However, when there is a severe curvature, symptoms such as breathing difficulties, frequent nasal congestion, and recurrent nosebleeds may appear. This deviation can be corrected with a surgical procedure called septoplasty, which not only eases the patient’s breathing but also provides symmetry in the nasal structure.
What Are the Causes of Septal Deviation?
Septal deviation occurs due to the displacement of the cartilage and bone structure in the midline of the nose for various reasons. These reasons can range from congenital factors to trauma and can affect a person’s life both functionally and aesthetically.
The main causes of septal deviation are:
- Congenital structural abnormalities
- Fetal developmental disorders
- Trauma to the nose
- Sports injuries
- Accidents
- Injuries during birth
- Chronic sinusitis
- Nasal allergies
- Inflammatory diseases
- Syphilis
- Leprosy
- Genetic predisposition
- Cartilage weakening with aging
Septal deviation can become more pronounced over time, leading to various symptoms such as breathing difficulties, nasal congestion, and sleep problems. Sometimes this condition is entirely congenital, while at other times it worsens due to trauma or chronic diseases in later life. Especially as one ages, weakening of the cartilage structure in the septum can cause the septal deviation to become more severe. Additionally, genetic predisposition can play a significant role in the development of septal deviation. These structural problems often require surgical intervention and can significantly improve a person’s quality of life.
How Common Is Septal Deviation?
The prevalence of septal deviation varies greatly among populations and age groups. Research suggests that 80% to 90% of adults worldwide experience some degree of septal deviation. However, symptoms do not develop in every individual, and this condition does not always require medical intervention. Mild deviation cases can often be asymptomatic and may be considered a natural variation.
According to studies conducted on various populations, septal deviation has been observed more commonly in the following groups:
- Adults
- Middle-aged individuals (20-39 years)
- Slightly more in males than females
- Those who have experienced trauma due to physical activities and accidents
Septal deviation is less common in newborns and children. However, the rate may be higher in babies who have experienced nasal trauma during vaginal birth. The rates of deviation in children can increase with age, which is associated with developmental factors. Septal deviation during childhood is typically seen at a rate of 12% to 13%.
Septal deviation can become more noticeable with age and may cause symptoms such as nasal congestion and breathing difficulties, especially in individuals who have experienced trauma. In elderly individuals, deviations that were previously unnoticed may become apparent due to changes in the nasal structure over time. Therefore, septal deviation can occur with varying prevalence in different age groups and genders.
What Is the Formation Process of Septal Deviation?
The formation process of septal deviation is shaped by a combination of genetic, developmental, environmental, and traumatic factors. This process can begin during prenatal development or emerge in later stages of life. Septal deviation occurs particularly due to differences in the growth rates of the tissues surrounding the nasal septum and the facial bones. These imbalances during the growth process lead to the septum bending toward one side.
Developmental Factors:
- Uneven growth of facial bones
- Different growth rates of cartilage and bone tissues
- Genetic anatomical variations
Traumatic Factors:
- Pressure during birth
- Blows to the facial area
- Injuries from accidents
Environmental and Pathological Factors:
- Chronic infections
- Mucosal changes
- Post-surgical complications
Septal deviation can also significantly alter nasal airflow dynamics. Particularly, the concave side of the deviated septum is prone to mucosal thickening and inflammation issues. These changes can increase the risk of infection, paving the way for the development of chronic conditions like sinusitis and rhinitis. The convex side may experience mechanical pressure and may thin over time. All these effects of septal deviation can negatively impact a person’s respiratory functions and overall nasal health, reducing quality of life.
What Are the Symptoms of Septal Deviation?
Septal deviation is a condition that arises due to the curvature of the cartilage inside the nose and can manifest with various symptoms. The most common symptom is nasal congestion. This congestion can cause breathing difficulties, adversely affecting a person’s quality of life. The congestion is usually felt in one or both nostrils, and this condition can change over time.
- Nasal congestion
- Dry mouth
- Throat discomfort
- Snoring
- Mouth breathing during sleep
- Frequent recurrent sinus infections
- Nosebleeds
- Headaches
- Olfactory disturbances
- Facial pain or pressure sensation
In more severe septal deviations, sleep disorders like obstructive sleep apnea may also be encountered. This is a problem that arises due to restricted airflow and increases the risk of snoring. Deviation can also prevent the proper drainage of the sinuses, leading to frequent sinusitis attacks. In some patients, septal deviation can cause nasal irritation, triggering nosebleeds known as epistaxis. As the severity of the deviation increases, a decrease in the sense of smell and facial pain may also be observed. These symptoms vary depending on the degree of curvature and the area occupied inside the nose.
How Is Septal Deviation Diagnosed?
The diagnosis of septal deviation is made through both clinical examination and imaging methods. First, during a physical examination, the doctor examines the internal structure of the nose to assess the alignment of the septum and determine if there is any deviation. More precise results are obtained using methods like nasal endoscopy.
- Anterior rhinoscopy
- Nasal endoscopy
- NOSE (Nasal Obstruction Symptom Evaluation) scale
- Rhinomanometry
- Paranasal sinus computed tomography (CT)
- Cone-beam CT (CBCT)
Complaints of patients with septal deviation include nasal congestion, difficulty breathing, and sometimes a deterioration in nasal aesthetics. Imaging techniques play a critical role in examining the severity of the deviation and associated anatomical structures, aiding in the planning of surgical intervention. Surgeries like septoplasty can be applied to eliminate nasal congestion and improve the patient’s respiratory functions.
How Is Septal Deviation Treated?
When septal deviation does not improve with non-surgical methods, surgical treatment known as septoplasty becomes necessary. Septoplasty is an operation aimed at correcting the curvature in the cartilage and bone structure in the midline of the nose. In this procedure, the nasal septum is cut and repositioned, and if necessary, some sections are removed and reshaped. The goal is to eliminate nasal congestion and improve the patient’s quality of life. The necessity of performing septoplasty is determined by the severity of the deviation and the intensity of the person’s symptoms.
Other procedures that can be performed along with septoplasty:
- Turbinate reduction
- Rhinoplasty
During septoplasty, other structures in the nose are also evaluated. If the nasal turbinates, known as conchae, are enlarged and contribute to congestion, turbinate reduction can be performed simultaneously. Septoplasty is sometimes combined with rhinoplasty for patients with aesthetic concerns. Thus, both breathing problems are solved, and the external appearance of the nose is improved.
After surgery, most patients experience relief in breathing, reduced sinus problems, and an improved quality of life. The success rate of the surgery can vary depending on the patient’s condition, the degree of deviation, and other nasal disorders such as allergies. Additionally, although some patients are initially treated with non-surgical methods, it is known that about 30% may prefer surgery in the long term due to persistent symptoms. Therefore, septoplasty stands out as an effective option to address both functional and aesthetic concerns.
What Are the Complications of Septal Deviation?
Septal deviation can lead to many complications due to imbalances in the nasal airway. These complications can negatively affect the patient’s quality of life, causing both breathing problems and other side effects. Nasal congestion is the most common symptom of septal deviation, and this condition can turn into more serious problems over time.
- Nasal congestion
- Chronic headaches
- Snoring and sleep apnea
- Sinusitis
- Recurrent upper respiratory infections
- Dry mouth
Septal deviation can cause various discomforts in daily life in addition to respiratory functions. For example, snoring and sleep apnea can reduce sleep quality, leading to fatigue and concentration disorders during the day. Chronic sinusitis can occur as a result of airflow disturbances due to deviation, triggering inflammation in the sinuses.
Individuals with septal deviation often develop a habit of breathing through the mouth. This brings problems such as dry mouth and throat irritation, especially throughout the night. This condition, which affects the person’s immune system, can lead to frequent infections like colds.
When Can Septal Deviation Treatment Be Performed?
Treatment for septal deviation should be considered when patients experience severe breathing problems. Especially nasal congestion, snoring, and sleep apnea are among the most common reasons for septoplasty. In some cases, recurrent sinus infections, headaches, or nosebleeds may reveal the necessity for treatment.
- Difficulty breathing during sleep
- Snoring
- Sleep apnea
- Recurrent sinus infections
- Chronic headaches
- Nosebleeds
When non-surgical treatments do not yield sufficient results, septoplasty is recommended to improve the patient’s quality of life. Additionally, septal deviation can cause aesthetic concerns by leading to the collapse of the nasal valve. In some patients, deviation can increase the risk of sinusitis and trigger bronchial hyperreactivity. Therefore, the decision for treatment should be made considering the patient’s overall health, the severity of symptoms, and individual expectations.
When Should Septal Deviation Treatment Not Be Performed?
Treatment of septal deviation, especially surgical intervention like septoplasty, cannot be performed in some situations. In such cases, surgery may be risky or may not be a suitable option for the patient. The main situations where surgery should not be performed are:
- Active infections
- Bleeding disorders
- Severe cardiopulmonary disorders
- Uncontrolled diabetes
- Inappropriate surgery expectations
- Immunosuppression
- Ongoing nasal development (children)
- Pregnancy
Such contraindications can increase the risks of surgery and negatively affect the recovery process. Especially in the presence of infections, serious complications may occur after surgery. Additionally, patients with bleeding disorders or those receiving anticoagulant therapy have a higher risk of bleeding and should be carefully evaluated. Surgical procedures are also not recommended for patients with low tolerance to anesthesia or those with cardiopulmonary problems.
In some patients, nasal congestion may occur without septal deviation. In such cases, performing septoplasty can lead to unnecessary risks. Similarly, if the patient’s cosmetic expectations do not align with surgical results or if psychological disorders are present, surgery may be contraindicated.
In the treatment of septal deviation, a careful evaluation should be made considering the patient’s general health status and postoperative recovery process. During this process, the doctor thoroughly considers the patient-specific risks and treatment options to determine the most appropriate treatment plan.
What Is the Recovery Process of Septal Deviation?
The recovery process after septoplasty requires careful care and patience. The first days are especially sensitive, and patients are advised to rest and keep their heads elevated. There are specific stages during the recovery process, each requiring different attention.
First 24 hours: Rest and keep the head elevated
- First week: Mild bleeding, nasal congestion
- Use of saline spray
- Reduction of swelling and bruising
- Second week: Improvement in breathing
- 6-12 weeks: Full recovery
Nasal congestion and swelling are normal in the first week of healing, but swelling may take weeks to completely subside. It may take months for the nose to reach its final shape, so patience is important. Regular doctor check-ups after surgery play a critical role in ensuring that healing is progressing properly.
How Is Septal Deviation Prevented?
To prevent septal deviation, it is essential to avoid nasal and facial traumas. Simple precautions taken especially during sports or driving can prevent nasal fractures and septal displacement. Although septal deviation can also result from genetic causes, environmental factors can worsen this condition. Here are some important precautions to take:
- Use of protective equipment
- Wearing seat belts
- Avoiding risky sports
- Early treatment in injuries
- Attention to congenital risks
Protecting against nasal traumas is the most critical step in preventing septal deviation. Protective equipment such as helmets and face guards should be used during contact sports, and seat belts must be worn to prevent injuries in traffic accidents. Additionally, it is crucial for individuals who have experienced nasal or facial trauma to seek medical help promptly. Delayed treatment increases the likelihood of bones healing improperly or the septum becoming permanently curved. Young individuals, in particular, should be informed and made aware of this issue.
Apart from this, congenital septal deviation cannot be prevented, but preventing traumas protects against effects that could worsen this condition. Since the nasal bone and cartilage structure are especially sensitive during childhood, precautions taken at early ages can lead to more lasting results. To maintain a healthy nasal structure, one should be careful during physical activities and not hesitate to seek surgical intervention when necessary.