Why there is nasal curvaturebulkheads, операция, лечение

Update: December 2018

Искривление носовой bulkheads (девиация, деформация) – это
persistent deviation of its shape from the middle line, causing a violation
nose breathing. With severe deformation, deterioration occurs.
blood supply to the brain, making it difficult for normal work
heart and gastrointestinal tract.

If the pathology manifests itself in early childhood, the child
a characteristic appearance is formed (due to a decrease in
oxygen into the body): open mouth, pale skin, asthenic
the constitution (due to the development of hypoxia and anemia).

It should be borne in mind that the nasal septum grows throughout
of life. Since it consists of several parts that grow with
different speeds – with age, the problems caused by its curvature,
may manifest more pronounced.

Ideal straight nasal septum in an adult
is extremely rare due to numerous factors, injuries in
течение of life. More precisely – no direct partitions, each
существует какое-либо искривление, какой-либо гребень partitions.
However, operations are shown only in violation of the respiratory function. TO
for example:

  • There may be a huge comb on the septum, but not at all
    interfering with nasal breathing – surgery is not needed.
  • В case же наличия маленького искривления (или небольшого, но
    significant ridge) overlying a narrow opening leading into
    maxillary sinus, which is fraught with frequent sinusitis – it is necessary
    to correct.

What is the nasal septum

In front of its part, it is formed by quadrangular cartilage, and
the back is represented by bone tissue (opener, ethmoid bone and
upper jaw). Its deformation can develop in the bone and in
bone and cartilaginous, and in the cartilaginous divisions.

Nose functions

  • Smell – the ability to perceive odors;
  • purification of inhaled air – large dust particles
    are held up by the hairs in the nostrils, while the small ones are deposited behind
    by electrodynamic attraction to the mucous membrane. Everything
    alien particles with mucus enter the stomach and, like
    conveyor belt excreted from the body;
  • warming and moistening of inhaled air – the air is warming
    to body temperature, its humidity rises to 100%. Also at
    exhalation in the nasal cavity is kept moisture and heat from exhaled
    air, thus preventing the development of dehydration and
    hypothermia.

Causes of deformation

 Consequences of injury

  • У 50% пациентов с девиацией bulkheads в течение жизни
    various injuries of a nose and facial skull come to light. Especially dangerous
    traumatic situations in childhood and adolescence.
  • Искривления bulkheads посттравматического происхождения
    different peculiar deformations, sharp kinks.
  • TO данной категории относятся также и родовые травмы: описаны
    cases where due to rapid delivery or incorrect
    tactics of an obstetrician-gynecologist, even in newborns revealed
    pathology.

Wrong growth of the bones of the facial skull

  • This reason is relevant in 30% of the examined patients.
  • Very often the structures of the nose grow and develop
    согласованно, вызывая искривление partitions.

Various diseases (compensatory deformation)

In 10% of patients, pathology may occur due to:

  • nasal neoplasms (polyps);
  • гипертрофии носовых sinuses

Hereditary predisposition

Modern studies have proven that this pathology can
be inherited and innate.

Jacobson’s organ hypertrophy

It also has the name of the coulomus-nasal organ. In him
olfactory cells are concentrated. In nature, found in animals
for mating, as it takes pheromones (specific
odorous substances secreted by male and female). In humans, the body
Jacobson is atrophied. In rare cases
the nasal organ may increase (hypertrophic),
causing deformation of the nasal structures.

The severity and types of curvature

  • light – slightly deviates from the median axis;
  • average – deviates towards about the middle
    sinuses;
  • heavy – curved partition almost in contact with
    боковой стенкой the nose.

TOлассификация искривлений по Младину:

  • Гребневидное искривление в передней части bulkheads,
    small size, one-sided, not disturbing breathing
    nose.
  • Pronounced crest-like deformity in the anterior nose,
    impaired respiratory function.
  • Combustion deviation, one-sided, in the posterior section
    partitions.
  • S-деформация bulkheads – два гребневидных искривления,
    расположенные в правой и левой пазухе the nose.
  • Deviation type “Turkish saber” – comb-shaped, in the back
    части the nose.
  • Combed deformations in the horizontal plane, in both
    nostrils.
  • �”Crumpled” partition – a set of distortions in different
    planes.

TOакой вид может принимать деформированная перегородка (по
Lopatin)

  • thickening;
  • C-shaped curvature;
  • crest;
  • S-visible deviation;
  • spike;
  • dislocation of 4-coal cartilage and their combination.

Virtually every adult has a negligible
искривление носовой bulkheads, которые не obstruct
normal air flow. But with a more significant defect
there are complications that depend on the type and severity
deformations.

  • More often there are deformations in the front part, and even
    slight curvature can create air turbulence
    significantly violate nasal breathing.
  • Ridges and spikes are usually located on the bottom or bottom
    edge of the vomer and consist of bone tissue (tops of cartilage), have
    different lengths, can be directed in different directions or go
    in the mucosa on the opposite side.

Main symptoms, complaints

Modern statistics show: 90% of adults with
examination revealed this pathology. However, not everyone has it.
causes complaints. In many cases, its course is asymptomatic. TO
The main complaints of the disease include:

 Rhinitis and sinusitis

With this pathology, the patient is much more likely to have sinusitis.
(frontalitis, ethmoiditis, antritis, sphenoiditis), at penetration
infections in the paranasal sinuses than in a person without such
defect. And also in 3% of cases allergic
rhinosinusopathy, in 15% of vasomotor rhinitis.

According to some authors, the majority of patients (with
deformity of the nasal septum requiring surgery) has
concomitant pathology, namely chronic sinusitis (in 47%
cases), which is accompanied by:

  • nasal congestion;
  • secretions of mucous or mucopurulent character;
  • tearing and sneezing;
  • nasal voices.

Snoring, sleep apnea

  • Often, patients with this pathology complain of snoring
    (according to statistics, men are 2 times more likely than women).
  • However, snoring is not only a nuisance to the sleep of others.
    people. These patients have short-term sleep conditions.
    episodes of respiratory arrest – apnea (see the causes of snoring and
    treatment).
  • Patients often complain of daytime sleepiness, headache
    pain, failure in school and at work, increased arterial
    pressure (due to impaired blood supply to the heart and brain).

Obstructed nasal breathing

This feature can be expressed in varying degrees, from weak
violations of nasal breathing until its complete absence, when a person
forced to breathe through the mouth. Cases when nasal breathing are frequent
difficult, not because of the curvature of the nasal septum, but when
presence of turbinate hypertrophy. When this happens
growth of tissues of the lower turbinate, and as a result,
narrowing of the lumen, there is a weak nasal breathing. Person
turns to the ENT, and he diagnoses the nasal septum curve
(since it is crooked in the majority). After surgery nose all
still not breathing. In such cases, the excess tissue should
remove by laser.

Other symptoms

  • Decreased sense of smell – impaired ability to smell,
    up to the complete absence of smell.
  • TOровотечения из носа — деформация вызывает истончение слизистой
    shell, especially in the lower part, where the vascular
    plexus. As a result, any injuries, even banal picking
    in the nose can cause heavy bleeding.
  • Frequent sore throats and bronchopulmonary diseases – with mouth breathing
    the air is not cleaned of dust and germs, which allows them to get into
    lungs and provoke frequent colds, as well as bronchial
    asthma.
  • Dry nasal mucosa is the cause of dryness in
    The nose is as follows: with a strong curvature of the septum
    nasal mucous membranes may come into contact with each other, breaking
    the work of cilia and cells secreting mucus.
  • Periodic headaches – are reflex in nature,
    associated with mucosal irritation.
  • Congestion and tinnitus, hearing loss due to
    the spread of the inflammatory process to the middle ear through
    Eustachian tube. In advanced conditions may develop
    hearing loss
  • Dry mouth – if a person is forced to breathe through his mouth (when
    severe deformation), with moisture from the mucous membrane
    evaporates, and dry mouth appears.
  • TOосметические дефекты — у детей, вследствие патологии,
    develops adenoid type of face – parted mouth, abnormal
    bite, nasal voice. TOосметические дефекты носа также возможны
    after injuries and bruises.

TOак выявляют патологию

Technique Description
X-ray of the nose

The state of the paranasal sinuses, the possible presence of
abnormalities of the bones of the skull or nasal deformities are detected
partitions.

It is carried out in four standard positions:

  • Waters position;
  • позиция TOолдуэлла;
  • lateral projection;
  • from the chin to the top of the skull.
TOомпьютерная томография

This study is especially important to identify spikes and
ridges located in the posterior regions and in the hypertrophy of the nasal
shells.

It also helps to identify comorbid diseases (chronic
sinusitis, cysts of the paranasal sinuses) that can be cured
simultaneously with a partition.

Magnetic resonance imaging Examination is prescribed if a tumor or polyp is suspected.
nasal cavity or middle ear.
Rinoendoscopy Technique показана для лучшего осмотра задних отделов носовых
sinuses Required with anesthesia
fibroelastic endoscope.
Rhinoscopy The study allows you to inspect the eve of the nasal cavity and
более глубокие отделы partitions. For a detailed picture of the sick
vasoconstrictor drops are instilled before rhinoscopy (0.1% solution
xylometazoline).
Rhinometry Acoustic rhinometry allows you to identify the degree and localization
obstacles to the flow of inhaled air, that is, the degree of congestion
the nose. Based on the measurement of airflow in the nose.

TOогда необходима операция при искривлении носовой
bulkheads

It is not difficult to guess that the treatment of nasal curvature
bulkheads возможно только оперативным путем. Indications for
surgical intervention is not the fact of curvature
носовой bulkheads, а операция необходима если искривление
pronounced and leads to patient nasal obstruction
respiration, discomfort, associated diseases. TO изменению
носовой bulkheads следует подходить очень строго:

  • breathing or not breathing nose – that is, whether the function of the nose is preserved
  • weigh ratio risk or benefit in each
    case
  • take into account the age of the patient.

In recent years, doctors have concluded that the operation
children under 4-5 years of impractical. Child over 5 years old
intervention is performed only if there are complaints. Operation on
реконструкции носовой bulkheads называется риносептопластика.

Современная операция коррекции искривленной носовой bulkheads
much more sparing than a similar operation 20-30 years ago.
Today, only a small comb on the
partition, and the entire partition, no one removes, as was done
earlier.

TOак подготовиться к риносептопластике?

Rhinoseptoplasty does not require special preparation. 2 weeks before
operations should abandon bad habits, minimize
risk of infection and hypothermia. It is also advisable to visit
dentist and cure bad teeth, eliminate other possible
foci of inflammation in the body. Before surgery, the patient is recommended
conduct standard studies:

  • general clinical blood examination;
  • the study of the hemostasis system (coagulogram);
  • research on HIV and syphilis;
  • Consultation of the therapist and anesthesiologist.

Since the operation may cause significant blood loss,
it is more expedient for women to conduct it in the middle of a cycle (after 2
weeks after menstruation). The patient is usually prescribed a cleansing
enema for the night, asking him not to eat after 18.00 on the eve of the operation.
An hour before the intervention the patient is given premedication – introduction
drugs that help prepare the body for anesthesia.

Are there any contraindications to rhinoseptoplasty?

Absolute contraindications to the operation does not exist. TO
relative include:

  • elderly (over 65 years) age (patients have a harder time
    anesthesia);
  • pregnancy, lactation;
  • decrease in blood clotting (as a big risk
    bleeding);
  • malignant neoplasms (cancer, sarcoma);
  • high blood pressure (risk of heart attack and
    stroke);
  • acute respiratory infections (surgery is possible not earlier than
    one month after recovery;));
  • during the flowering of herbs (during the exacerbation of allergic
    rhinitis).

Rhinoseptoplasty technique

The operation is performed under general endotracheal anesthesia.
(introduction of the endotracheal tube into the trachea and supply of anesthetic gas) and
with local anesthesia (injection of local anesthetics –
Novocain, lidocaine). There are several types of rhinoseptoplasty:

Endoscopic septoplasty

Such an operation is indicated for patients with non-traumatic
curvatures. Using a fibroendoscope helps prevent
complications such as bleeding and education
hematoma.

Laser septochondrokorrektsiya

The operation is bloodless and safe for the sick. Founded
on the fact that the cartilage under the action of laser radiation can change
your form. The operation is performed on an outpatient basis, not
requires hospitalization in the ENT department. Its advantages:

  • minimal blood loss
  • minimal tissue trauma
  • rehabilitation and the postoperative period is much more
    soft
  • laser has antiseptic properties

Недостаток лазера – не все деформации носовой bulkheads он
able to adjust, especially the bone part.

Technique resection-reimplantation

Curved cartilage and bone are cut out, then
straightened on a special flattener and implanted back
under the mucosa. The advantage of the operation is that
own fabrics usually take root well and restore
septum, preventing the development of perforation.

TOлассическая подслизистая резекция по TOиллиану

The operation is rather outdated, its essence is to remove
искривленного костно-хрящевого пласта partitions. This resection
has many side effects:

  • the partition becomes mobile and can vibrate when
    breathing;
  • nose can sag, taking saddle shape;
  • patients after surgery often do not disappear complaints
    (nasal congestion, mucous discharge);
  • the partition can be perforated.

Possible complications after surgery

  • postoperative formation adhesions, synechiae;
  • перфорация bulkheads носа;
  • allergic reaction to anesthesia (laryngeal edema, fall
    blood pressure, cardiac arrest);
  • paralysis of the oculomotor nerves, blindness;
  • lattice plate injury that threatens to leak
    cerebrospinal fluid from the nasal cavity;
  • hematoma or abscess formation between mucosal sheets
    shells;
  • violation of smell, up to its complete absence;
  • deterioration of the function of the mucous membrane (degenerative
    changes).

In the postoperative period, patients are usually recommended:

  • washing with salt solutions (aqua-maris, aqualor) from 2-3 days
    – to moisturize the mucous membrane;
  • avoid heavy physical exertion;
  • do not fly in airplanes (due to a sharp change in atmospheric
    pressure);
  • for 2-3 months not to undergo abrupt climate changes, not
    supercool and not overheat, do not visit the baths and saunas.

Можно ли предотвратить искривление носовой bulkheads?

Special preventive measures for this pathology, to
Unfortunately, does not exist. Doctors advise on getting a nose injury
immediately contact the emergency room for timely reposition
bone fragments. Athletes, it is desirable to wear special facial
masks to prevent trauma.

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