Deviated nasal septum (DNS) and nasal bones deformation
Congenital deformities of the nasal bridge, broad nose, large humped nose — cause psychological discomfort for the patient. Acquired traumatic deformity of the nose, often the result of domestic, sporting and traffic accidents. The violation of the aesthetic shape of the nose entails a violation of numerous functions of the nose. Important anatomical face formation — nose — and one of the components of the upper respiratory tract. The nose performs a number of functions such as air cleaning, warming and humidification. The right balance of anatomical structures of the nose provides a normal voice tone. An important function of the nose, providing the relationship of the organism with the external environment is the sense of smell.
Inspiratory resistance of the nasal cavity provides the creation of negative intrathoracic pressure during inspiration, which in turn enhances pulmonary ventilation and venous return to the lungs and heart. Therefore it is obvious that the violation of nasal breathing leads not only to chronic hypoxia, but is also a cause of lung, upper respiratory tract and the cardiovascular system diseases.
The nose performs aesthetic function, since it is the part on which is judged on its harmony. A person is considered to be harmonious when there is equality of the height of its three parts. Measure considered nose length, which is the height of the middle third of the face.
The nose on the one hand, gives the whole face aesthetic perfection, on the other hand - is involved in the implementation of a number of important features, main function is the nasal breathing. Congenital and acquired traumatic deformation of the nasal bridge is often not only disfigure the face, causing mental suffering, but also lead to functional impairment. The etiology of congenital and acquired deformities of the nasal septum (curvature comb, spike) has 3 main factors: physiological, traumatic and compensatory.
Deviated nasal septum is one example of the imbalances of growth in the period of development of the child; it is the result of uneven growth of the septum and bony framework within which it is inserted (the first is growing faster). According to some authors, its deformation occurs at the age of 7 years, according to others, at an earlier age. Indicates the possible hereditary nature of these changes. Traumatic deviation is caused by the improper fusion of the bone fragments, compensatory pressure on the nasal septum by enlarged turbinate, polyps or tumor.
Diagnosis and symptoms of deviated nasal septum (DNS) and nasal bones deformation
Marked difficulty breathing through the nose, hypersecretion, dry pharynx, and occasionally spasms of the glottis. The ridges and spikes may be sharp, easy to hurt, to infiltrate the turbinate to cause discomfort, contribute to the emergence of neurogenic diseases due to reflex phenomena.
The deviated part of the nasal septum are often in contact with the middle turbinate or pressuring her, causing headache (supraorbital region). Deformation of the nasal septum (deviated nasal septum) lead to functional and other changes. Prolonged violation of nasal breathing changes the facial skeleton, there are "gothic" arched palate, "adenoid-type" face, abnormal development and position of the upper teeth, changes the voice (disturbed sound function of the nose). Difficulty in nasal breathing leads to a decrease in gas exchange, oxygen starvation.
The nose performs respiratory, olfactory, protective, resonator and reflector functions. If the permeability of nose is disrupted, the breath is through the mouth with above mentioned functions. Difficulty in nasal breathing of a continuing nature is main symptom of a deviated nasal septum (DNS). A deviated nasal septum occur in congenital anomalies of development, domestic and sports injuries. Congenital and acquired post-traumatic deformation differ bizarre form of the nasal septum, the presence of sharp fracture lines, sometimes combined anteroinferior edge deviations and deformations of nasal pyramid. Differential diagnosis between these kinds of the nasal septum deformities should be based more on rhinoscopic picture than anamnesis.
It is not always possible to establish the fact of injury of the nose in early childhood. In addition, deformation of the nasal septum may cause a birth injury, it is for this reason in 5-15% of newborns are diagnosed with deviated nasal septum (DNS), mainly a shifting of its anteroinferior region. Yet the question of the etiological significance of generic and fetal injury is not completely resolved. We studied the relationship of deviated nasal septum (DNS) with the circumstances of childbirth, and, not finding significant differences on any of the analyzed criteria, the conclusion was made about the predominant etiological significance of trauma in the postnatal period. From the standpoint of phylo- and ontogenesis the formation of deviated nasal septum (DNS) is an inevitable condition and a result of human evolution. To the development of deviated nasal septum (DNS) lead the changes in the structure of the skull base in the process of evolution: autonomous growth of the cartilage of the septum, appearing in early mammals, changes in the ratio between the quadrangular cartilage and vomer that support the cartilage from the bottom, and regression maxillo-facial departments of skull and increased neurocranium.
Types of nasal septum deformation (deviated nasal septum)
In the severity of the deformation of the nasal septum is divided in the following way:
- 1 degree - slight deviation from the middle line
- 2 degree - extending septal part is located approximately midway between the midline and the lateral wall of the nasal cavity
- 3 degree - deformed septum in contact with the lateral wall of the nasal cavity
This classification of deformation of the nasal septum is not without drawbacks, as the contact ridge formed on the lateral wall of the nasal cavity does not depend on its severity and location. In addition, the size of the turbinates can vary greatly depending on the severity of an inflammatory or allergic process, in this case the turbinate can even communicate with a normal septum.
Trying to merge the pathogenetic, morphological and clinical principles, it is proposed to allocate 7 types of the nasal septum deformities:
- A small unilateral vertical ridge in the anterior of the nasal septum that do not violate the function of nasal breathing.
- Significantly pronounced vertical ridge in the same part of the nasal septum with displacement of the anteroinferior edge of the quadrangular cartilage in the opposite direction. The function of nasal breathing is impaired.
- One-sided vertical ridge in the deeper parts of the nasal cavity.
- Two vertical, arranged one after the other ridge on the opposite surfaces of the nasal septum (S-shaped bend in the horizontal section).
- Single-sided, almost horizontal ridge upward in the posterior septum, resembling the turkish saber.
- Two almost horizontal ridge in the front and middle parts of the nasal septum on the opposite surfaces with a characteristic groove on one side.
- The so-called wrinkled septum lines with multiple fractures, representing different combinations of the above types.
Unnecessary details of various types of deformities of the nasal septum (nasal septum curvature) still does not allow you to fit in the scope of this classification many strains and most of the combinations of hits in the seventh type, which does not decrypt to a specific form of partitions. A further disadvantage of classification is that it doesn't include thickening of the skeleton of the partition and the options of deviations of the quadrangular cartilage with a special meaning in the choice of methods of surgical correction. Practically only 1-2 and 4 types involve more or less pronounced deformation of the cartilage of the division in the horizontal plane. Clinical experience shows that almost always bend quadrangular cartilage is not so much in horizontal as in a vertical plane and that the correction of this bending is difficult to obtain a good functional result of the operation.
Congenital and acquired deformities and the diversity of non-traumatic nasal septum deformities consists of five major types (components) or combinations thereof. Identifies the following types of the nasal septum deformities:
- C-shaped deviation
- S-shaped deviation
- dislocation of the quadrangular cartilage
- thickening ("hump")
Latest formation is usually on the border caudineural edge of the quadrangular cartilage and the perpendicular plate of the ethmoid bone and reaches a thickness of 5-6 mm, significantly disturbing the aeration of the upper parts of the nasal cavity. In this scheme do not fit the nasal septum deformation after multisplintered complex septal fractures, when fragments are at different angles, overlap each other. In the analysis of the shape of the nasal septum is of great importance degree of difficulty of nasal breathing. There is a violation of the secretory and absorptive functions of the nasal mucosa in patients with a deviated nasal septum.
It is well established that the deviated nasal septum, especially the ridges and spikes that are in contact with the nasal turbinates, causing a number of pathological reflexes, both local and general character.
There are no organs on which is not transferred the reflex from deviated nasal septum. Colds (acute rhinitis, acute respiratory infections) are more common in case of violation of nasal breathing. The presence of deformation of the nasal septum in patients with chronic tonsillitis, pharyngitis, laryngitis aggravates the course of these diseases. For this patient is indicated the operation on the nasal septum.
Well known septoplasties operation using maxillaria-premaxillary access to the nasal septum. During this operation the mucous membrane with the perichondrium peeled only on one side of the quadrangular cartilage for the convenience of its mobilization and fixation at the median position. For access to the middle sections of the walls reveal the bottom edge of the pear-shaped hole. Create a channel at the bottom of the nasal cavity, through which is resected deformed bony part of the septum.
The advantages of this method in the safety of the quadrangular cartilage. But this intervention has its drawbacks. These include: violation of vascularization and lymphatic drainage, disturbance of trophism of the mucous membrane of the septum and other structures of the nasal cavity due to damage to the palatal branches of the autonomic plexus in the floor of the nasal cavity. The violation of the trophic leads to the development of subatrophic rhinitis and septum perforation. Up to the present time in determining the indications for corrective operations on the nasal septum are still many unsolved and controversial issues.
Changes of the mucous membrane of the nose, caused by deformation of its walls, often have a negative impact on the function of the lacrimal canal. As a result, deformation of the nasal septum, the aerodynamics of the air flow during inhalation and exhalation is disturbed, which leads to impaired breathing through the nose, and it involves a whole chain of undesirable changes in the nasal cavity and paranasal sinuses.
Treatment of deviated nasal septum (DNS) and nasal bones deformation
Despite the fact that in recent years offered many different choices of operations on the septum of the nose, which are more physiological, but still today there is no universal method of its operation, as each version of the deformity of the nasal septum requires a creative approach to the choice of surgical treatment from ENT surgeons.
Septoplasty with its many options is a complex surgery and its effective implementation requires good theoretical and practical training, sufficient surgical skills. However, one of the most frequent complications is scarring, and atrophy. Quite often a complication produced by operations on the nasal septum is perforation. The occurrence of ruptures of the mucous membrane of the nasal septum depends on the degree of ENT physicians surgical training.
Currently, the most gentle and effective is laser septochondroplasty for the septal cartilage segment deformity and ultrasound septoplasty — effective for the septal cartilage and bone deformation. All operations are carried out in our clinic with a guaranteed restoration of nasal breathing and aesthetic appeal with full preservation of cartilage and bone basics of the nasal septum.