Curvature of the nasal septum (ICB code 10) is a natural or acquired persistent displacement of bone or cartilaginous structures, the nasal septum, accompanied by a violation of nasal breathing.
The nasal septum is made up of cartilage and bone structures that divide the nasal cavity into two relatively equal halves and determine the direction of airflow in the nose. This leads to the normal formation of free nasal breathing, the inhaled air is warmed and humidified, other protective functions of the nose work normally and the sense of smell is formed.
Curvature can appear both as a result of direct trauma to the nose, and appear gradually in the process of human growth. Many attribute significant curvature to nasal injuries in early childhood - falls, birth injuries, but this seems unlikely given the long developmental time.
Violation of nasal breathing can have a very negative effect on the human body. Lack of nasal breathing and even just constant breathing through the mouth leads to hypoxia (lack of oxygen) and not only affects well-being, but contributes to the development of a number of pathological changes.
The nervous and cardiovascular, hematopoietic system reacts most strongly to a lack of oxygen, a significant impact on the human endocrine system is possible. Patients with chronic lung disease can be very sensitive to air quality, which is determined by proper nasal breathing. After all, our nose not only breathes, but also cleans, warms, and humidifies the air so it doesn't irritate a person's airways and lungs. Growing organisms of children, patients with chronic diseases of the lungs and cardiovascular system, people with heavy physical exertion, constant stress and intense mental activity are very sensitive to oxygen starvation.
Surgery to correct the nasal septum
Correction of the nasal septum deviation is only possible through surgery. The operations are called septoplasty or submucosal resection of the nasal septum. Septoplasty - what is it? Sometimes this type of surgery is combined with correction of the external nose and is part of rhinoseptoplasty. A better understanding of what a nasal septoplasty looks like will help before and after the photo.
It is important to understand that operations are performed to eliminate functionally significant disorders, that is, to lead to the development of pathologies that cause the patient discomfort or hidden problems in his body. A slight curvature of the nasal septum, which does not cause nasal breathing disorders, does not contribute to the development of other pathologies and is usually not subject to surgical correction.
The aim and course of the operation is to isolate the curved bone and cartilage structures of the nasal septum, to partially remove them and to straighten the remaining part as much as possible, while preserving, leaving intact or restoring the mucous membrane covering the nasal septumsupporting parts of the nasal septum. Access is through the patient's nostrils. No incisions are made from the outside, so the operation leaves no visible scars and scars. Septoplasty of the nasal septum does not change the external shape of the nose, so this procedure is invisible to others.
A "cold" instrument (scalpel, etc. ) is mainly used for the operation. Popularized among the masses, laser and radio frequency technologies are tools.
They are mainly used to correct turbinates, sometimes cuts in the nasal septum, or work with cartilage to stop bleeding. In most cases, full correction of the nasal septum requires work on bone structures where lasers or other destructive coagulation techniques are of no benefit. Nevertheless, one often encounters patients who insist on laser correction of the nasal septum with full confidence that this is the only modern method and that a cold instrument is "from the last century". Unfortunately, this is not the case, one could even say the oppositeThe laser possesses excellent hemostatic (hemostatic) properties due to exposure to high temperatures, burns or "welds" tissue, and yet cannot approach a well-sharpened scalpel in terms of cutting cleanliness and healing time. The world's leading clinics "still" use classic instruments when working on the nasal septum, and their standards do not include the mandatory use of a laser for nasal septum operations. But in defense of the laser, we can say that due to the hemostatic effect, it is very convenient forSurgery on the nasal conchae is, although there are many other methods that are not inferior in efficiency, such as electrical and thermal exposure (including cryocoagulation, which is popular in our country), the use of ultrasound, radiofrequency surgical methods.
There are operations on the nasal septum using a special video camera - an endoscope, which is also an option rather than a necessity.
The choice of additional equipment during the operation (endoscope, laser, high-frequency coagulator) is entirely on the shoulders of the specialist, not the patient. An incorrectly or improperly used tool not only does not help, but also complicates the operation.Only the surgeon knows how much this or that tool will help him in the operation.
Almost always, an operation on the nasal septum (before and after the photo) is combined with the simultaneous correction of other intranasal structures - the nasal conchae.
These formations of the nasal cavity greatly impair nasal breathing, and their malfunction can lead to the development of the pathology "vasomotor rhinitis". With a curved nasal septum, the turbinates often take the shape of their curvature, become asymmetrical. In this case, even with normal functioning without correction, it is difficult to achieve good nasal breathing just because of an operation on the nasal septum. Since the one-time correction of the nasal conchae and the nasal septum is ubiquitous, doctors often speak of the correction of the nasal septum and mean a one-off correction of these structures. In some institutions, work with the nasal conchae is immediately included in the cost of the operation, in others it can be a separate item. Nevertheless, it is inextricably linked to the operation on the nasal septum to restore good nasal breathing.
types of anesthesia
The operation is performed only under general anesthesia - anesthesia
- This type of anesthesia is gentler on the patient's mental state(the patient is asleep, feels nothing and has good dreams,if you fell asleep with good thoughts - therefore, a positive attitude before the operation and full trust in specialists are very important)
- offers better performance
- reduces blood loss during surgery
Local anesthesia in modern medicine is not used for a full-fledged operation and can only be used for minor corrections (corrections).
By eliminating pain, such anesthesia does not eliminate the discomfort when working in the nose (a different type of receptors on which anesthesia does not act is responsible for this) and is very negatively perceived by the patient during long-term or large-scale interventions ( Dentistsprefer to work with the patient for no more than 30-40 minutes for the same reasons - a person gets tired of unpleasant sensations, and interventions in the nasal cavity are considered by many to be much more unpleasant than in the oral cavity). Anesthesia allows the surgeon to focus directly on the operation without having to be distracted by talking to the patient (which often plays an important role in calming the patient down). Blood pressure control, which is mandatory during anesthesia, allows you to control and reduce bleeding during the operation, which, due to minimal blood loss, has a positive effect on both the surgeon's work result and the patient's well-being after the operation.
Indications for an operation:
The main indications for which septoplasty is performed are:
- persistent (persistent) difficulty breathing through the nose.The human body has an enormous potential to adapt to adverse conditions, including partial adaptation to a deviated nasal septum. Many people are not aware of the problem as long as their body can withstand this stress, is young and not burdened with other chronic diseases. Most often, the problem appears gradually, and the person does not immediately pay attention to it. Only after he often begins to breathe through his mouth, even in a dream, wakes up with a sore throat or a dry throat, sleeps poorly, snores, constantly uses vasoconstrictor drops, or often gets sick, does he begin to look for a problem and turnspecialists. Timely restoration of nasal breathing will help a person's recovery or reduce his discomfort. It creates an opportunity to restore the body - not only improves the functioning of the systems directly connected to the nose (throat, lungs), but also affects the nervous and cardiovascular systems.
- chronic diseases of the paranasal sinuses.A correction of the nasal septum can also be carried out in patients with chronic inflammatory diseases (sinusitis) who do not notice any significant difficulties in nasal breathing. "Incorrect" Due to the curvature of the nasal septum, the redistribution of air flows can lead to constant irritation of the mucous membrane, infection or impaired ventilation of the paranasal sinuses and the appearance of problems in them.
- Benign formations of the paranasal sinuses (polyps, cysts, mucocele, pyocele, etc. ).Violations of ventilation of the paranasal sinuses, the direction of air flow in the nasal cavity, caused by a significant curvature of the nasal septum, contribute not only to the occurrence of chronic inflammation of the mucous membrane of the nasal cavity and paranasal sinuses, but also to the appearance of benign formations such as cystsor polyps.
- massive operations on the paranasal sinuses (polyps of the nasal cavity and paranasal sinuses) or the base of the skull (pituitary adenoma).A slightly crooked nasal septum can also become an obstacle when the surgeon is working in the deep structures of the nasal cavity and paranasal sinuses. Septoplasty is often performed in major surgeries, including neurosurgical procedures, such as removing a pituitary adenoma.
- Headache of unknown cause.Constant contact of the protruding parts of the nasal septum (ridge, spine) with the mucous membrane of the side walls of the nasal cavity, nasal conchae can lead to irritation of the nerve endings and the appearance of reflex pain in the head. This connection is often difficult to recognize, both for the patient and for the specialist. Often this group of patients begins treatment with a neurologist and comes to an ENT surgeon only after the exclusion of other causes and the ineffectiveness of conservative treatment. Elimination of irritating factors in the form of protrusions of the nasal septum in contact with the mucous membrane of the side walls can reduce or even eliminate the patient's pain.
- Ear diseases (chronic otitis media, adherent otitis media).In chronic problems with the middle ear and eardrum, the first stage is also recommended to eliminate significant curvature of the nasal septum. The middle ear cavity, located behind the eardrum, receives air from the nasal cavity through the ear canal. Deviations in the nasal septum can make it difficult to properly ventilate this cavity. Chronic changes gradually develop in the form of a perforation (hole) in the eardrum, chronic inflammation appears, scars or cholesteatoma in the middle ear with gradual hearing loss. Ignoring this issue can render ear surgery ineffective. After ear surgery, normal ventilation of the middle ear space is particularly important and directly affects the effectiveness of the treatment. Normally, the nasal septum correction is performed as the first step of an ear operation 2-6 months before the main operation. It is not recommended to combine operations on the nose and ear, since nasal breathing is not restored immediately after one operation on the nose.
Contraindications to the operation
- acute diseases (ARVI, bronchitis, herpes infection, etc. ).The operation is not an emergency, so there are no additional risks due to colds or other acute illnesses. If you are ill, contact the surgeon and reschedule the surgery. You can usually postpone the operation for 2 weeks until you are completely better.
- violation of the blood coagulation system,Not only blood diseases can lead to a violation of blood coagulation, but also the constant intake of drugs based on aspirin (acetylsalicylic acid).
- It is not recommended for women to perform the operation during menstruation.This can lead to impaired blood clotting and increase blood loss during surgery.
- chronic diseases in the acute stage (gastric ulcer, cholecystitis, etc. ) and decompensation of chronic diseases (diabetes mellitus, coronary artery disease, hypertension). A specialist doctor's license is required, possibly pre-training.
- high age.In connection with the violation of the healing processes and recovery of the body, surgery is not recommended in old age. This indicator is considered separately depending on the presence of concomitant diseases. The decision to have surgery in people over the age of 70 is made on an individual basis.
- Childhood.During the growth of the child, the nasal septum is involved in the formation of the external nose, which is most active during puberty. But due to the same growth, the child experiences an increased need for normal nasal breathing. Stress from a heavy workload at school, emotional experiences also have a negative effect on the body. Oxygen starvation, caused by a significant violation of nasal breathing, can spoil this period. Operations under the age of 16 are performed only after careful consideration by a doctor of the possible positive and negative consequences for the child. Most often, correction is carried out only with significant difficulties in nasal breathing and severe curvature. For a doctor, the principle of gentle correction is important - if the goal is not an "absolutely even" nasal septum, but an improvement in nasal breathing to "acceptable". In some situations, additional correction of the nasal septum is possible after the child has stopped growing (20-25 years).
How to prepare for the operation
- For 2 weeks, stop taking drugs that affect blood clotting - anticoagulants.Before the abolition of anticoagulants, it is necessary to consult the attending physician.If it is not possible to stop taking the medication, inform the surgeon about it, talk to your doctor about a possible change in therapy.
- In the presence of concomitant diseases (CHD, hypertension, bronchial asthma, peptic ulcer, etc. ), consult your doctor about the possibility of surgery and the need for preoperative preparation.
- 2 weeks before the operation it is advisable to stop smoking and not to consume alcohol
- for women - stop taking hormonal contraceptives 1 month before the operation or consult a gynecologist. This is especially important if you have varicose veins.
- If you have severe dryness in the nose, you should consult the operating ENT doctor 2-4 weeks before the operation.Dryness of the mucous membrane, significant crusts can interfere with the operation and the postoperative period.
How is the hospital stay
Operation is only in the stationary state, the "Done and Going Home" approach with complete correction of the nasal septum is eliminated. The total hospital stay is 5-6 days, including 1 day of admission, 1 day of surgery, 2 days of tamponing and 1-2 days of follow-up after tampon removal.
The patient is hospitalized about a day before the operation, spends the night in the ward assigned to him. The next day, the operation is performed according to the operation plan. Immediately before the operation, the patient is given an anesthetic and falls asleep. During the operation and for some time afterwards, the patient sleeps (under anesthesia). Immediately after the operation and until 8 a. m. the next day, the patient is in the intensive care unit, where he is constantly monitored by the nurse on duty, the doctor on duty visits him and his condition is monitored. You can't leave this room. But from the next day he will be transferred to a ward of the department, where he will stay another 3-4 days until discharge from the hospital, during which time he will be cared for and the procedures necessary for a good recovery will be carried out. Usually tampons from the nasal cavity installed during the operation are removed on the second day, and after another 1-2 days the patient is discharged home.
conditions of incapacity
Regular disability periods are 14-15 days. Nasal breathing can fully develop a little later, 2-6 weeks after the operation.
In 2 weeks, the main stage of healing of the nasal septum occurs. But you must understand that it is very likely that during this period you will not be able to fully get the comfort of a new breath, and the final nasal breathing will begin to form 3-6 weeks after the operation. Complete healing of the nasal mucosa is required for free breathing and comfort. In addition, the timing of this healing is significantly influenced not directly by the operation on the nasal septum, but by the intervention on the inferior turbinates performed at the same time as the correction of the nasal septum. It is work with these structures that to a greater extent affects the presence of crusts in the nose after surgery and the time of full recovery of the patient.
Postoperative care and monitoring
- in the hospital, postoperative care primarily includes treatment and observation of the healing process by the doctor. The patient does not perform any actions of his own without the recommendation of the surgeon.
- After discharge from the hospital, the patient spends the first week at home. It is recommended to adhere to the home regime, avoid increased physical exertion and crowded places and follow the recommendations. Nasal rinsing with large amounts of saline solution, up to 1 liter, is often prescribed.
- After work, the patient must gradually return to the natural rhythm of life, slowly increasing physical activity to the usual level. It is recommended to postpone significant, strenuous loads, visits to swimming pools, baths, saunas, exercises in the gym, flights, business trips for 1 month after the operation for normal body recovery. Often the surgeon schedules a follow-up visit 2-4 weeks after surgery to monitor the recovery process.
Possible negative consequences
Surgery to correct the nasal septum is considered safe, complications or negative phenomena are very rare. Choosing an experienced surgeon, proper preoperative preparation, and following postoperative instructions can minimize the risk of complications.
In medicine, unfortunately, it is not yet possible to completely avoid complications. During healing and restoration of nasal breathing, a person is more prone to colds, nosebleeds, headaches, severe swelling of the nasal septum may appear. Compliance with the scheme and the surgeon's instructions minimizes the risks of these manifestations. In the period before the nasal mucosa is restored, there may be a feeling of mucus in the throat, but it will gradually disappear on its own as it recovers. Sometimes there are repeated difficulties in nasal breathing a short time after the operation - this can be due to the restoration of the cartilage in its curved shape after the operation (in the case of incomplete resection), the displacement of grafts (recovered parts of the nasal septum) or incomplete eliminationthe curvature. Such changes are subject to future corrections. Rarely, there may be a perforation (hole) of the nasal septum or a change in the shape of the outer nose (saddle nose deformity), such changes may be due to the complexity of the operations, nasal injuries before or after the operation. These complications often do not occur immediately, but 3-4 months after the operation and are initially not noticed by either the patient or the surgeon. Correcting such unfavorable results is the most difficult and time consuming for the surgeon. But the appearance of difficulties in nasal breathing a long time after the operation - a year, two or ten years - are not complications of the operation and are associated with the manifestation of another disease of the nasal cavity, more precisely with its return - vasomotor rhinitis.
CH
Based on the order of the Ministry of Health, the attending doctor of the polyclinic issues a referral for this surgical intervention to a medical organization that provides this type of medical care in the field of compulsory health insurance (KHI) within the framework of the territorial program of compulsory health insurance (ina city hospital).
VHI
If you have VHI insurance, you only have to contact your insurance company, which will organize the treatment in the clinic of your choice in full.
cost of treatment
The complex costs of treating a deviated nasal septum mainly depend on the comfort of the ward and the length of the hospital stay.
It must be understood that the final price does not consist of the cost of the operation itself., but from the prices for all the services provided as part of the treatment: operations on the nasal septum and turbinates, anesthesia, hospital stays, medical and nursing treatments. If there is a concomitant pathology, such asB. Chronic sinusitis (sinusitis), neoplasms of the paranasal sinuses (cysts, polyps), the cost increases when eliminating this pathology.