Nasal Septum Deviation (NSD) Surgery for Sceptics

Difficulty breathing through the nose is a very common hurdle affecting a large part of the community. The deviation of the nasal septum is the usual suspect, as this condition is present in 70–80% of the population.

Despite the massive incidence of this deformity, not all those affected by it are experiencing breathing problems. That said, this article targets those with established moderate to severe difficulty breathing through the nose but are skeptical or negative about having the operation to amend the septal deviation.

It has been shown, in my 15-year clinical experience as an ENT doctor, that many people affected by a deviated nasal septum either have accepted the problem and continued their lives or have just been agnostic of it. Young patients, specifically, since the diaphragm, the secondary respiratory muscles, and their overall lung health manage to bypass the nasal obstruction. While sleeping, all those patients are mouth breathers, which is also detrimental to their health.

The first hint of the problem is derived from taking the patient's history. When patients with NSD are asked if their nasal breathing is adequate, the answer is often positive. They even take a deep breath through the nose to prove it. Later, though, when asked about their sleep quality, the same patients reveal that they sleep with their mouths open.

However, as the years pass, their body loses the ability to compensate fully, and the reason for this phenomenon is mainly the additive effect of general health deterioration, bad habits, comorbidities, and genetics. Eventually, later in their life, and, in many cases, not fit for surgery, those patients seek help.

Reading this article will motivate this group of patients to look into this matter more thoroughly and make a well-educated decision in the optimal timeframe. Of course, the role of an ENT doctor in this case is to explain everything related to the nasal septum anatomy, its role in breathing, the reasons behind its deviation, and the surgical procedure's goals.

And that is precisely what I am going to do here!

What is the Nasal Septum, and Why is it Important for breathing?

The nasal septum divides the nose into right and left nasal cavities. It consists of cartilage and bone. The nasal septum plays a critical role in forming the proper anatomy for the nose to achieve its purpose.

The nasal septum and turbinates (inferior, middle, superior) on each side of the nose form a compartmented "box" where the inhaled air is processed in three ways.

• The air is cleaned by the nasal lining ( mucosa). Small particles, allergens, and some microorganisms are trapped in the ever-flowing mucus and are transferred back to the pharynx.
• The air is accelerated and heated by passing through a narrow canal (Bernoulli Law). The normal shape of the turbinates and the presence of a straight nasal septum create the perfect passage for that to happen without obstructing the airflow.
• The secretions of the nasal mucosa humidify the air.

Through this process, the inhaled air becomes less irritating to the rest of the airway (pharynx, larynx, trachea, and bronchi) and reaches the lungs fast and efficiently.

How does the nasal septum become deviated?

The nasal septum is part cartilage and part bone, following a mixed developmental cycle that does not always conclude harmoniously. This means the separate parts of the nasal septum sometimes "do not fit" together. For example, for many individuals, when the development of the face structures concludes at around 18 years of age, the cartilaginous part of the nasal septum has grown too much to attach to its bony part without being deformed. This deformity is presented as a deviation from the midline.

Additionally, during birth labor, as the newborn passes through the narrow confines of the genital tract, its nose gets squeezed, and the cartilage may get displaced to one side, resulting in deviation.

Lastly, a widespread cause of acquired nasal septum deviation is facial trauma. Strong and blunt hits to the nose will most probably dislocate the septum. This is common among martial artists.

What health problems are connected to NSD?

The main health problems associated with nasal septum deviation are

• Inadequate tissue oxygenation. By not having enough air (and thus oxygen) reaching the lungs, the normal function of every cell is obstructed. Nerves and muscles are most affected because they need oxygen more than other tissues. The patient has difficulty exercising and sometimes even performing simple tasks (such as walking) without reaching for air. Loss of concentration, irritability, and mental fog are only some problems caused by low oxygen availability to the brain cells. To bypass the nasal blockage, these patients breathe through the mouth and use their secondary respiratory muscles and diaphragm more strenuously. This may help temporarily, but they get fatigued quickly.
• Cardiovascular Distress. The low oxygen supply to the tissues leads to an excess burden on the heart, which has to pump more blood to cover the deficit. When this situation persists, heart myopathy and hypertension may occur.
• Sleep Apnoea and Other Sleep Disorders. Sleep apnoea is a sleep disorder that is harmful to the general health. It presents as a total disruption of breathing that can last for many seconds. While sleeping, we naturally tend to use our noses to breathe. Our body detects any drops in the oxygen supply and gets alarmed when it falls below a threshold, which results in waking up. This phenomenon can happen many times in an hour, practically negating any attempt at deep sleep. Sleep apnea has been proven to be associated with many disorders like cardiovascular distress, pulmonary hypertension, and a slew of neurological symptoms like loss of concentration, narcolepsy, and irritation. Mouth breathing is a derivative of low oxygenation during sleep and can result in chronic pharyngitis, halitosis (bad smell), and gingivitis. Snoring is also associated with deviated nasal septum in more than 30% of the cases.

What are the goals of the surgical procedure?

The procedure is routinely performed under general anesthesia. An ENT surgeon's mission is to restore the nasal "box" to its optimal shape to function as intended. This is achieved in two main surgical stages.

• Straightening the deviated septum. This is achieved by mobilizing the cartilage and reshaping it to "fit" perfectly in its niche. If necessary, the surgeon trims any deformity of the bony parts to ensure that the baseline is also in line with the cartilage.
• Turbinoplasty. It is the procedure that has the goal of reshaping the inferior turbinates. This is achieved in many ways, including electrocautery, coblation, or radio frequencies.

What to expect after the procedure? When is your nose fully healed?

The patients wake up with their noses packed. The packing will removed in 1–2 days. Some surgeons use silicon sheets to keep the straightened septum in place and avoid commissures. These sheets are removed seven days after the surgery.

After that stage, all the patient has to do is nasal douching and keep their nose safe from direct hits. A bit of oozing, crusting, and congestion is expected but will slowly disappear within 15 days.

Ultimately, the patient will experience the entire procedure outcome about thirty days after surgery.

Are there any complications?

As in any operation, some rare and manageable complications exist. The most common are

• Post-surgical bleeding. It is managed with nasal packing or cautery.
• Tooth numbness. It lessens over time.
• Septal perforation. In most cases, it is not noticeable.

Conclusion

As long as a patient is diagnosed with nasal septum deviation and presents with any health issues mentioned in this article, surgery to correct this deformity is necessary.

The sooner it happens, the less their body will be burdened by the circulatory overload and neurological impairment caused by low tissue oxygenation!