Laser correction of the nasal septum: advantages and disadvantages of the method. Operations to correct the nasal septum: surgical, laser

Every living creature on the planet visually appears symmetrical. However, this is not the case. If you look closely, you can see some deviations from ideal proportionality.

This also applies to the nose plate. Almost 95% of the population is diagnosed with persistent deviation of the nasal septum from midline, and only 5% of patients can boast of its ideal location.

Pathological displacement is accompanied by a number of problems, among which are an unaesthetic appearance and poor oxygen passage through the openings of the nose. Under such circumstances, surgical intervention is the best way to eliminate the defect.

Causes of curvature

The plate serves as a kind of partition and divides the openings of the nose into the right and left “wings”. The nasal septum includes cartilaginous and bone tissue and each person has an individual degree of thickening, a different bend, contact ridges and spines.

Deviations of the septum to one side can be noticed already in adolescence- during the period of intensive growth and formation of an adult organism.

The following factors cause the problem:

abnormal growth of the septal skeleton (the most common cause);
nasal injuries that lead to the development of deformity;
curvature due to other pathological formations in the nasal cavity;
compensatory deformation due to the growth of polyps;
chronic and vasomotor rhinitis;
birth injury.

Experts consider mechanical damage to the nose to be one of the most common causes, and many patients cannot even remember under what circumstances they received it.

Such violations of the integrity of nasal tissues are constantly encountered in childhood. Symptoms for minor injuries are practically absent, and the septum grows together without medical intervention, which leads to its curvature and the formation of bone ridges.

Most patients do not pay attention to the presence of a problem and begin to sound the alarm in an emergency when the deformation prevents them from breathing normally.

When should it be corrected?

Disturbances in physiological nasal breathing can lead to serious health problems, namely:

Chronic inflammation of the nose and paranasal sinuses . The deformed area constantly exerts Negative influence on the mucous membrane, thereby causing swelling and enlargement of the tissues of the nasal passages.
The excretory ducts of the nose cease to function normally, which entails a chronic inflammatory process in all parts of the organ.
Violation of olfactory sensations. Constant swelling of the mucous membrane and congestion of the organ leads to the gradual death of cells and neural connections of the nerve responsible for olfactory sensitivity. As a result, the perception of smells is impaired.
Regular headache. Disturbances in nasal breathing lead to difficulties in the flow of arterial blood to the brain. A person begins to feel a loss of strength, a constant desire to sleep, pain in the neck and head.
Development of chronic atrophic processes in the oropharynx. With a constantly stuffy nose, a person begins to breathe through the mouth.
It is important to note that the inner shell oral cavity cannot perceive the flow of cold air without consequences.

Posterior section of the initial funnel-shaped canal digestive tract begins to dry out, an inflammatory process develops, which invariably leads to various ailments larynx.
Hearing and ear problems. The external respiratory organ and the ears have one connecting link, which is called the auditory tube.
It is responsible for removing excess fluid from the thinnest membrane, protecting the ear from infections and normalizing pressure in the tympanic cavity.

When the nasal septum is deviated, swelling of the mucous membrane occurs, which leads to blockage of the pharyngeal opening of the Eustachian tube. A person's ears become clogged and there is a risk of developing inflammatory processes(all types of otitis).
Impaired air movement through the upper respiratory tract, which makes breathing difficult during night sleep and is accompanied by low-frequency, rattling sounds.

In most cases, a person lives normally with a crooked bone plate in the nose and does not experience any significant changes in health. However, as soon as concomitant complications arise that overshadow the patient’s usual lifestyle, doctors recommend septoplasty.

Is it necessary to resort to surgical intervention if a pronounced deviation of the bone plate is present, but no significant health problems have arisen yet?

In many patients, specialists diagnose a visible deformation, however, one of the passages of the nose ensures normal breathing, that is, it gets used to the imposed load and does not cause discomfort in the patient.

Over time, the functionality of the tissues is impaired, and the person begins to complain of a lack of air and disruptions in the physiological act of breathing. In this case, the doctor will refuse to perform the operation, citing lost time, the patient’s age and a list of contraindications.

If there is a serious deformity, it is advisable to perform the operation between 18 and 40 years of age, that is, before age-related problems and various complications arise.

Types of defects

Experts distinguish several types of deformation:

C-shaped curvature. There is a deviation of the septum to one side in the shape of the letter C.
S-shaped deflection septum from the midline.
Combs. A kind of canopy.
Spikes. Pathological protrusions.
Combination of ridges and spikes.

The deformity can be unilateral or bilateral, that is, it can narrow one or both nasal passages. When a curvature occurs due to injury, sharp corners are formed at the bend.

If a ridge formation is diagnosed, then, as a rule, it is located on the upper marginal portion of the septum and descends to the lower part in the form of a canopy.

Watch the video about the causes of curvature and the consequences of refusing treatment.

Contraindications

Septoplasty is not performed if the following ailments are present:

poor blood clotting;
pathological changes in the body (for example, diabetes, heart failure, etc.), which arose as a result of a long course of the disease or an acute disorder;
mental disorders, genetic abnormalities.

The patient's age is one of the significant contraindications. Septoplasty cannot be performed until adulthood, however, in in case of emergency specialists correct the septum starting from 6–8 years.

In adulthood (50 - 60 years old), they also try to avoid surgical intervention, but if the patient’s health is normal and there are serious problems problems that cannot be eliminated without septoplasty, the doctor decides to take risky actions.

Preparing for surgery

Essentially, the procedure is a surgical operation aimed at correcting a crooked nasal plate that has a vertical orientation.

Any surgery requires serious preparatory measures. Septoplasty is no exception. Before the operation, the patient must pass several tests and undergo certain diagnostic studies:

X-ray of the paranasal sinuses in two projections or layer-by-layer computer study. Allows you to determine the presence of pathological and inflammatory processes in the paranasal sinuses and examine in detail all parts of the nasal cavity.
Clinical analysis of blood and urine, diagnosis of diabetes.
Performance evaluation internal organs blood biochemistry method.
Hemostasiogram (a test performed to study blood clotting).
Determination of Rh factor and blood group.
Fluorography of the chest organs.
The therapist's conclusion.
Tests for HIV infection, syphilis and anthroponotic viral diseases liver (hepatitis B and C).

If the patient has the listed ailments, the doctor carefully evaluates the situation and decides on the possibility of correcting the septum surgically.

In addition, the patient must comply with a number of requirements:

In the presence of infectious respiratory diseases or during periods of acute exacerbation of chronic ailments, septoplasty is not performed. The patient must undergo treatment and come for surgery after full recovery body.
During menstruation, 5 days before and after it, surgical intervention is undesirable. The woman's task is to accurately calculate the average numbers of the cycle.
7 days before the correction of the nasal plate, it is necessary to avoid taking drugs with anticoagulant and non-steroidal anti-inflammatory effects, so as not to interfere with blood clotting.

Carrying out

Classic septoplasty of the nasal septum is performed using a traditional surgical method using anesthesia and a scalpel.

The operation may differ in the specifics of its implementation. In surgical practice, specialists use several types of such operations. Let's look at them in more detail.

Submucosal resection

The method has been used for bone plate correction for more than two hundred years. During this time, the method has won the recognition of the world's leading surgeons and the majority of grateful patients.

The course of the operation consists of making an arcuate incision in the inner shell in the anterior section of the plate.

The surgeon cuts the cartilage tissue along its entire thickness. After this, it is separated and almost completely excised, leaving only the upper section of cartilage tissue with a thickness of no more than 15 mm.

Next, using a special bone trepanning instrument and a hammer, the nasal plate is removed, leaving behind a double layer of inner membrane, perichondrium and periosteum (the fibrous membrane surrounding the bone).

All layers are fixed together using gauze wipes and sterile swabs, which will speed up the fusion process. No suture material is used.

The disadvantages of the method include:

increased morbidity and prolonged recovery period(up to 25 days);
due to the excision of a large area of hard tissue of the nasal plate, complications such as a through hole in the cartilage tissue, saddle deformity (saddle-shaped sunken nose) may occur;
After septoplasty, the functions of the septum are performed by scar tissue. For this reason, there is a violation of the trophism of the internal tissues of the nose, its protective functions weaken, and the patient feels constant dryness in the nasal cavity;
the structure of the septum becomes less strong. With the slightest mechanical impact, it is easy to displace or move, which leads to difficulty breathing.

The undeniable advantages of the method include the absence of the need for expensive equipment. Therefore, every patient who wishes has the right to undergo surgery free of charge at any public medical institution.

Minimally invasive endoscopic septoplasty

This method is more innovative compared to classic septoplasty. The entire process is controlled by an intranasal endoscope.

The surgeon begins with a thorough examination of the nasal cavity and finds the deformed area. A miniature incision is made on the inner shell, through which only curved areas are removed.

During the operation, specialists use the latest microsurgical instruments. The entire operated area is viewed on a computer monitor.

Endoscopic septoplasty is considered low-traumatic in comparison with other types of similar operations. After its implementation, complications such as a through hole in the cartilage tissue and saddle-shaped deformity are excluded. Bleeding and accumulation of pus occur extremely rarely, and the patient recovers quickly.

It is important to note that in complex cases the operation is used with restrictions.

If we consider the two above types, their division will be conditional. Today, surgeons rarely use exclusively submucosal resection. In endoscopic septoplasty, a small portion of the septal tissue is also cut off.

When analyzing the main purpose of both surgical interventions, one can understand that there is no particular difference in the techniques, and they are rightly called the same - septoplasty.

Resection-reimplantation

It is considered the most advanced method of straightening the nasal septum. The technique consists in modeling a curved area, without the use of resection.

The surgeon performs special manipulations using a metal knife and a special device that flattens the defect and gives the tissues the correct shape. Over time, the corrected cartilage takes the desired position.

For all types of septoplasty, the operation lasts no more than an hour. The patient spends 2–5 days in the clinic, depending on the scope of surgical procedures and the age category of the patient. Tampons for fusion are removed on the third day.

Possible complications during septoplasty

During surgery, the specialist uses sterile swabs, which cause unpleasant feeling nasal congestion.

Bleeding often occurs and stops on its own within a few hours. last stage corrections.

If, in addition to modeling the plate, the surgeon resorted to resection, hematomas form under the patient’s eyes, which disappear without a trace after a week.

Postoperative difficulties

In surgical practice, after straightening the nasal septum, the following complications occur:

epistaxis (outflow of blood from the nasal cavity due to disruption of the integrity of the walls of blood vessels);
purulent and serous-purulent inflammation of tissues, abscess of the nasal cavity;
blood tumors;
the appearance of a hole in the nasal plate (perforation);
inflammatory diseases paranasal sinuses;
connective tissue compactions, bone fusions;
dysplasia (deformation of the external nose) or saddle nose shape.

Rehabilitation

After the patient recovers from anesthesia, he will realize that there are tampons in his nasal cavity. In addition, a sterile bandage is a mandatory postoperative attribute. It will act as an absorbent material to absorb the leaking ichor. In the first hours the patient may feel bad taste blood.

Doctors insert special hollow tubes into the nasal openings through which the patient can breathe normally.

The first half hour after waking up, you may feel severe dryness in the mouth, however, you are allowed to drink only an hour and a half after the intervention.

To avoid pain and discomfort when drinking, you can use a special straw.

Eating is allowed after 8 hours, and the patient should not get out of bed, since anesthesia still has a weak effect on the body, and there is a risk of a sudden fall.

Injections are considered a mandatory postoperative measure. antibacterial drugs. In the presence of pain syndrome, while sleeping at night, the patient is injected with an anesthetic.

24 hours after the operation, blood clots accumulate in the hollow tubes, which prevent the normal passage of oxygen. To improve breathing, the medical staff washes the devices every 5 hours.

The body temperature may rise slightly, however, there is no need to sound the alarm. This is a normal manifestation of the body.

On the third day, tampons are removed from the nasal cavity, after which the patient is prohibited from emptying the sinuses for 5 days. If there is too much mucus, you can try to suck it in and spit it out through the mouth. From hot drinks and contrast shower In the first days it is better to refuse.

Further rehabilitation at home involves taking antibiotics and therapeutic rinses based on marine prophylactic solutions and antiseptics.

Twice a week visits to the attending physician are required, who will monitor the stages of healing. As a rule, the recovery period lasts no more than 12–14 days. Final result assessed after 2–3 months.

For a month, you should not abuse alcohol, play sports, overwork, or visit saunas.

For details about the postoperative period, watch the video.

Prices

The cost of surgery to straighten the nasal septum will depend on the complexity of the curvature. The average price in the country is 35–60 thousand rubles. If plate modeling is required after a serious injury, the price will increase significantly.

Let's consider approximate cost several types of surgery:

submucosal resection - 35 thousand rubles;
minimally invasive endoscopic septoplasty - 56 thousand rubles;
resection-reimplantation - from 45 thousand rubles.

Causes of nasal septum deformation

The deformity may appear as a result of a dislocation of the nasal septum in a child during childbirth or as a result of uneven development of the body, which does not correspond to the growth rate of the cartilaginous and bone skeleton. With physiological curvature, the septum moves to the side or spines and ridges form on it. Traumatic deformity occurs as a result mechanical damage– with a fracture of the nasal bones. Compensatory curvature of the septum occurs due to simultaneous disruption of the anatomy of several formations in the nasal cavity.

Indications for septoplasty

Indications for septoplasty include:

disturbed nasal breathing caused by a deviated nasal septum;
chronic swelling of the mucous membrane or sinusitis (inflammation of the paranasal sinuses);
pronounced susceptibility to colds;
regular nosebleeds;
itching and dryness in the nose, pain in the face;
noisy breathing, snoring.

Contraindications

Contraindications to septoplasty are the presence of diseases that impair blood clotting, cancer and infectious diseases, and severe diabetes mellitus. Also, the operation is not performed for severe pathologies of internal organs or diseases in the acute stage.

Stages of implementation

Preoperative period. A few days before surgery to correct the nasal septum, stop taking aspirin and other anti-inflammatory drugs, as well as blood thinners. Tests are taken, including a general blood test, ECG, etc. It is prohibited to eat less than 12 hours before the operation.

Surgical intervention. Septoplasty is performed under general or local anesthesia. Incisions are made in the nose, and then a section of the mucous membrane along with the perichondrium is raised to access the cartilaginous part of the septum. All manipulations are performed on the cartilage of the nasal septum. Next, incisions are made to separate the cartilage from the bone part. After this, a section of the mucous membrane rises along with the periosteum, and curved areas are revealed. Fragments of bone and cartilage tissue that prevent the septum from being given a central position are removed. All deformed areas are corrected. The duration of septoplasty ranges from 30 to 90 minutes, depending on the individual structure and condition of the nasal septum.

Postoperative period. On the first day after septoplasty, to avoid bleeding, tampons are placed in the patient’s nose to prevent nasal breathing. The first few days remain minor painful sensations, relieved with analgesics prescribed by a doctor. The duration of the recovery period for nasal breathing ranges from 2 to 6 weeks. A patient with a corrected septum should avoid physical activity, hypothermia and overheating for 4 weeks, exclude alcoholic drinks and hot food from the diet for 2 weeks. In the hospital and after discharge, the doctor performs nasal care, which helps good healing. This stage of treatment is no less significant than the operation itself.

Septoplasty is a surgical procedure that allows you to adjust and correct a deformed nasal septum.

Despite the fact that septoplasty is a surgical procedure, it is the least traumatic operation; in addition, in addition to eliminating the defect and problem, septoplasty allows you to preserve the bone and cartilaginous structure of the nose without changes or damage.

All surgical procedures are performed inside the nose through small incisions, thus, thanks to minor submucosal resection of the septum, its shape is corrected. Based on this, septoplasty in a short time allows:

quickly improve quality of life;
resume nasal breathing;
relieve the patient from numerous problems associated with chronic ENT diseases caused by a deformed nasal septum.

It should be noted that septoplasty does not change the shape of the nose and is not an aesthetic surgical intervention for its correction, but it may well be combined with rhinoplasty.

Causes of nasal septum deformation

The nasal septum is a section of osteochondral tissue that separates nasal cavity into two parts. When it is deformed, a shift in the position of the septum from the midline is noted.

Photo: deformation of the nasal septum

Deformation of the nasal septum can cause a lot of inconvenience to a person, and even provoke a number of chronic diseases. respiratory organs(rhinitis, tonsillitis, sinusitis, frontal sinusitis and the like).

A deviated nasal septum often leads to difficulty breathing through the nose, and almost always to snoring, heavy, uneven breathing.

In some cases, frequent and recurrent nosebleeds are also observed. With a traumatic deviated septum, the shape of the nose is significantly deformed.

There are a number of reasons why the septum becomes deformed. Among them physiological characteristics, as well as traumatic and compensatory causes.

The physiological factor is the most common cause of deformation of the nasal septum. This means that a person’s bone and cartilage tissues acquire uneven growth, and this happens during the development and growth of the entire organism. When physiological reason nasal septum, as a rule, is completely deformed, often displaced to one side, or protrusions called ridges or spines, as well as their combinations and combinations, are formed on it. A less common cause of a deviated nasal septum is a traumatic factor; it is most often found in athletes, but can also be caused by other reasons (fall, bruise, blow).

Photo: deviated nasal septum after injury

Traumatic deviated septum is a mechanical defect of the nose, trauma or fracture, which entails various complications. Even a minor injury, in which the bone is not deformed, but only the cartilage, especially if it occurs in childhood (or an age concomitant with the growth of the body as a whole), leads to a disruption in the development of the osteochondral tissue of the nose, and, accordingly, to a curvature of the nasal septum. Compensatory causes of septal deformation usually include:

presence foreign body in the nasal cavity (for example, piercing);
the presence of polyps, adenoids and other neoplasms in the nasal cavity;
Availability vasomotor rhinitis in humans (swelling of the nasal mucosa).

In any case, no matter what factors and reasons are responsible for the deformation of the nasal septum, its correction today lies only in surgical intervention, that is, septoplasty.

Types of septoplasty

In modern medicine, septoplasty of the nasal septum is performed in several ways, in particular endoscopically (conventional surgery) and using laser technology.

In the vast majority of cases, people faced with the problem of a deviated nasal septum prefer a proven method - endoscopic septoplasty.

Laser septoplasty

Laser septoplasty is characterized by correction of the nasal septum using a laser beam. This procedure is often performed under local anesthesia; it is bloodless and practically non-traumatic. In addition, the laser beam has pronounced antiseptic properties, which significantly reduces the risk of infections and complications in the postoperative period. Rehabilitation after laser septoplasty is quick and painless. Tight tampons (turundas) are not used in the postoperative period. After the operation, the patient does not need to stay in the clinic; the operation is performed on an outpatient basis and takes 20-30 minutes. However laser method Septoplasty has a number of contraindications and, in addition, may be ineffective in complex cases when the curvature occurs not only in the cartilage tissue. Therefore, there are reasons why it is worth operating only through classical surgical septoplasty.

Video: laser septoplasty

Endoscopic septoplasty

Endoscopic septoplasty is a gentle, low-traumatic surgical intervention. Resection is performed on the mucous membrane inside the nose, which avoids scars and traces of surgery on the face.

Modern technologies for endoscopic septoplasty not only make it possible to maintain the aesthetic effect and avoid scars, but also make rehabilitation period much lighter and shorter.

Photo: resection of the nasal mucosa

Classic endoscopic septoplasty in modern medicine involves resection of minor areas of the septum that interfere with its normal position and functioning. At the same time, the nasal mucosa is preventively exfoliated, which preserves its integrity and prevents damage. However, there are individual cases, most often these include curvatures due to a traumatic factor, where deformed areas of cartilage tissue must be removed in order to leave the supporting function of the nasal septum unchanged. Typically, endoscopic septoplasty lasts 30 to 40 minutes; Considering the patient’s preparation for surgery, all manipulations can take about an hour. Anesthesia can be either general or local, or combined (for example, local anesthesia of the nose and the introduction of fairly strong intravenous sedation to the patient).

When performing endoscopic septoplasty, the integrity of the nasal septum is completely preserved. Only areas and fragments of tissue are removed that prevent the septum from acquiring a vertical, “correct” position.

Symptoms of a deviated septum, or who is septoplasty indicated for?

The first, and perhaps the main symptom of a deformed nasal septum is difficulty breathing through the nose, whether it is chronic congestion of one or both nostrils. Full breathing through the nose is literally necessary for a person. The inhaled air is moistened and purified precisely in the nasal passages before entering the lungs, which is why the nasal cleansing and filtering functions are so important for human health, in particular the prevention of bronchial diseases (including asthma), heart and other vital organs. A deformed nasal septum prevents normal breathing through the nose, and often makes it completely impossible. But it should be taken into account that in at a young age even with significant deformation of the septum, this symptom may be mild or absent, which makes it difficult for the person to diagnose his pathology, but does not at all negate the fact of its existence.

Photo: normal nasal septum

A deviated nasal septum is the cause of frequent and protracted respiratory diseases in humans, often acquiring chronic forms. People with a deformed nasal septum also often experience recurrent inflammatory diseases respiratory tract and paranasal sinuses. Are developing chronic sinusitis and rhinitis, frontal sinusitis, tonsillitis and otitis are also often observed. Concomitant pathologies of the throat are a very natural process with a deviated nasal septum. This leads to diseases of the pharynx such as pharyngitis and tonsillitis, as well as diseases of the larynx such as laryngitis, which become chronic. Often people begin to self-medicate, constantly using vasoconstrictor drops and drinking antiviral drugs, not even suspecting that the cause of their frequent illnesses and constant nasal congestion lies in another defect that can be corrected by septoplasty.

Photo: deviated nasal septum

People with a deviated septum often experience a symptom such as snoring, which occurs as a result of incorrect natural nasal breathing.

With a traumatic deviated septum, deformation of the entire nose, a complete or partial change in its shape, can also be observed. The tendency to form crusts in the nasal cavity and recurrent bleeding against the background of thinning of the walls of the mucous membrane of the nasal septum can also signal its deformation, and as a result, the loss of natural functions. Among the less common symptoms of a deviated nasal septum are the following:

dry nasal cavity;
allergic reactions;
deterioration of hearing ability.

The last symptom is due to the fact that difficulty in nasal breathing does not provide proper ventilation of the middle ear cavity (tympanic cavity). If any symptom is observed, the most reasonable solution would be to visit an otolaryngologist, who will prescribe correct treatment or refer you for surgery. It should be remembered that when minor violations and deformities of the nasal septum, there are alternative methods of septoplasty - such as laser or radio wave.

Contraindications

As with any operation, there are a number of contraindications to septoplasty. As with any other surgical procedure, absolute contraindication The reason for septoplasty is impaired blood clotting. Also, contraindications include:

diabetes;
diseases of the cardiovascular system;
infectious diseases of various types (including syphilis, hepatitis, etc.);
oncological diseases;
In addition, septoplasty is contraindicated for persons under the age of majority, since the bone and cartilage tissues of the nose are not fully formed until this moment.

Surgery to correct the curvature of the nasal septum

The operation to correct the nasal septum is painless and fairly quick, with minimal trauma and virtually no damage to cartilage and bone tissue. Modern techniques Septoplasty is minimally invasive and allows you to correct dysfunction of the nasal septum with minimal damage and resection. Endoscopic septoplasty is performed mainly endonasally (inside the nose), which guarantees the preservation of the cosmetic effect and the absence of injury to nearby tissues.

Video: modern surgery - deviated nasal septum

How is the operation performed?

Let's figure out how septoplasty is done. Before performing the operation, the doctor prescribes a list necessary tests and examinations. In most cases, they are generally accepted for any operation. Before septoplasty of the nasal septum, the patient must undergo some examinations and pass the following tests:

consultation with an otolaryngologist (ENT);
ECG (electrocardiogram);
coagulogram (test for blood clotting);
general clinical analysis blood and urine;
fluorography;
blood test for HIV, syphilis and hepatitis;
blood chemistry;

Septoplasty, like any other operation, includes several stages. First, the patient is prepared for surgery, regardless of the chosen method of anesthesia. Currently, in most cases local anesthesia is used, but some patients still prefer general anesthesia (or have indications for it). Then an endonasal incision is made on the mucous membrane.

Outdated techniques also involved a skin incision, but in modern medicine this practice for septoplasty is practically not used, except in special cases.

The incision is followed by detachment of soft tissues and resection of deformed areas of cartilaginous tissue that make it difficult correct position nasal septum. When all defects are eliminated, the stage of straightening the nasal septum follows, which includes the displacement of bone and/or cartilage fragments. When the operation to straighten the nasal septum is actually completed, absorbable sutures are placed on the mucous membrane. With classic endoscopic septoplasty, the nasal passages are sealed with tight turundas (this is not required with laser septoplasty). Finally, a plaster or fixing bandage is applied to the nose. Tampons are removed on average 24-72 hours after the operation, taking into account the individual characteristics of the septoplasty. Laser septoplasty is an outpatient procedure, performed under local anesthesia and lasts 20-30 minutes. Laser ray provides an antiseptic function, in addition, it coagulates damaged walls and edges of wounds, so the operation is almost bloodless and allows you to rehabilitate without postoperative edema and bleeding. Accordingly, laser correction of the nasal septum does not require sutures. Often tampons are not used either.

Complications and contraindications of septoplasty

Septoplasty is an operation that almost always allows for rehabilitation without complications.

But even with a low probability of complications, it should be understood that septoplasty is still a surgical procedure, and any operation carries certain risks. Complications after septoplasty can mainly be associated with bleeding and/or infectious diseases against their background. You should be aware that some medications taken by the patient before and after surgery may increase the risk of bleeding.

Photo: consultation before surgery

Therefore, before undergoing septoplasty, you should consult your doctor regarding medicines and funds, and in some cases cancel them some time before surgery. Before surgery, it would be a good idea to stop taking antibiotics and use medications aimed at preventing vascular fragility. It is also necessary to quit smoking, since smoking not only complicates the operation process, but also significantly complicates the rehabilitation and healing of tissues after it.

In addition, it is necessary to strictly follow all instructions and prescriptions of the doctor in order to minimize the possibility of complications, as well as to make rehabilitation faster and painless.

In the rarest cases, septoplasty may be accompanied by complications such as changes in the shape of the external nose and its deformation. Even less common is damage to nerve endings and other organs during surgery. Therefore, you should contact exclusively proven and qualified rhinosurgeons who will not make such gross medical errors and will not spoil the patient’s health. However, in general, the percentage of complications after septoplasty is minimal, as is the traumatic nature of the operation.

Rehabilitation and recovery (postoperative period)

The postoperative period (rehabilitation) after septoplasty is also almost painless and quite smooth. On the first day (or several, depending on individual characteristics), special tight tampons are placed in the patient’s nose. They are designed to reduce the postoperative risk of bleeding and stabilize the correct position of the nasal septum. Therefore, you should prepare for the fact that the nose after septoplasty will not breathe while tampons are in it.

Photo: silicone nasal swabs

Some modern clinics now use silicone tampons, which also effectively maintain shape and prevent bleeding, but due to the fact that they are empty from the inside, breathing is not difficult. Their removal from the nasal cavity does not bring any inconvenience or pain to the patient.

During the period after removing nasal tampons, you should also follow the doctor's recommendations regarding hot drinks, smoking, physical activity and water procedures.

All these simple things will have some restrictions that will have to be observed for a speedy recovery and return to functionality. To prevent infections and provide general relief, after septoplasty, various painkillers and antipyretic drugs are prescribed, and, in some cases, injections and drips of antibiotic drugs are given. After removing the tampons, the doctor often prescribes the patient special moisturizing drops for the mucous membrane, since after the operation the nasal cavity becomes quite dry, and clots of mucus and blood accumulate and dry out in it. Of course, you cannot remove them yourself with your hands, so special drops, sprays and solutions help soften this substance and “drive” it out of the nasal passages.

Photo: nasal spray to ease breathing

Most often, such drugs include drops and sprays based on saline and oil solutions. Sometimes the doctor prescribes ointments, including antibiotics, to the patient. As the nasal passages are cleansed and restored, breathing becomes easier, the mucous membrane is completely restored, and the surgical incisions heal. Completely normal breathing usually occurs in the patient within a few weeks. If we talk about laser septoplasty, here rehabilitation proceeds much faster, thanks to the bloodlessness of such an operation. The laser automatically coagulates the incision sites (seals their edges) and also disinfects them due to its strong antiseptic function. Therefore, after laser septoplasty additional treatment, as a rule, is not required, and the insertion of tampons is also not required.

If the patient has chronic and allergic rhinitis, during rehabilitation, relapses may occur, which will require additional prescriptions from the attending physician, and, accordingly, their implementation by the patient himself.

Performance fully returns 8-10 days after surgery. Even if a plaster fixation bandage is installed, by this time the patient is freed from it. There are practically no external bruises and swelling after septoplasty. With proper care of the nose after previous septoplasty, the postoperative period passes quickly and does not cause any discomfort to the patient.

Prices. How much does the operation cost?

The cost of correcting a nasal septum (septoplasty) varies in Moscow clinics from 20,000 to 80,000 rubles, depending on the specialist who will operate, the authority of a particular clinic, as well as the chosen method of septoplasty and anesthesia. average cost septoplasty from a qualified specialist in a good commercial clinic is approximately 40,000-45,000 rubles.

This amount usually includes anesthesia, the patient’s hospital stay in the clinic (if necessary), subsequent postoperative dressings and sometimes medications (in most cases, they are purchased separately by the patient as prescribed by the doctor). In city hospitals, such an operation is performed free of charge, but the patient pays all costs for anesthesia and medications. In addition, in private clinics the patient has full guarantees that the operation will be successful and the rehabilitation period will proceed under the supervision of a doctor.

FAQ

Among the frequently asked questions about septoplasty potential patients, the most common are the following: 1. Does septoplasty change the shape of the nose? Of course, with a traumatic curvature of the septum, when the deformation is severe, the shape of the nose acquires normal features, the septum becomes horizontal and even, not displaced to one side. If the curvature is purely on the inside, the shape of the nose remains completely the same. In general, septoplasty refers to ENT operations and has nothing to do with plastic surgery and aesthetic medicine. However, very often septoplasty (correction of the nasal septum) is combined with aesthetic rhinoplasty to completely change the shape of the nose, its aesthetic correction and eliminate problems with a deviated septum. 2. Does a deviated nasal septum pose a threat to health and life? A deformed nasal septum, of course, does not pose a direct threat to life. But it causes a number of health problems, which can end very badly and at least pose a threat to the quality of life (ranging from hearing impairment, problems with cardiovascular system, and ending with chronic diseases of the respiratory tract and organs). Besides, frequent illnesses can develop into chronic and severe forms, insufficient air purification through the nasal passages and its direct entry into the lungs can lead to the development of asthma and heart disease, which, in turn, can pose a threat to life and normal life. 3. Is it possible to correct a septum without resorting to surgery? Today, septoplasty is the only way to effectively cope with the problem of a deformed nasal septum. If the deformity is not too complex, it is possible to avoid direct surgical intervention (endoscopic septoplasty) and use the most minimally invasive techniques - laser and radio wave septoplasty. However, even if the case is quite complex, and the curvature concerns not only areas of cartilage tissue, modern medicine allows the use of classic endoscopic septoplasty with minimal trauma and health risks, and also maintains a cosmetic effect (no traces or scars of surgical intervention on the face). 4. Are there any scars after endoscopic septoplasty? All manipulations during endoscopic septoplasty are performed endonasally (inside the nose), including incisions that are made on the mucous membrane. This ensures that there are no scars on the nose after septoplasty. In rare cases, the skin is involved, but this is the exception rather than the rule. If we are talking about septoplasty combined with rhinoplasty (aesthetic correction of the shape of the nose), there are scars if the surgeon performs rhinoplasty in an open way. Septoplasty itself does not involve skin incisions, and no technique (endoscopic, laser or radio wave) requires that any traces remain after the operation. 5. What is the optimal age for septoplasty, and is there an age limit for it? There is no optimal age for nasal septum correction, because... problems can develop at any age, for example, due to trauma, polyps, tumors and other factors. Some people turn to septoplasty in adulthood, and often this can also happen because the symptoms of such a deviation as a deviated nasal septum may not be felt at a young age. As for age restrictions, the operation is not recommended for persons under 16-18 years of age, since the anatomy of the face is such that by this age the osteochondral skeleton of the nose is not fully formed, and surgical intervention may lead not to eliminating the problem, but to its aggravation. 6. Will surgery help if I have been using vasoconstrictor drops for a long time and my normal breathing is impossible without them? It is likely that the curvature of the nasal septum forced me to start using vasoconstrictor drops to ease nasal breathing. However, it should be understood that regular, and even more so constant use similar drugs often leads to irreversible consequences (the mucous membrane atrophies), and here there is little that can help.

It is necessary to cancel such drugs, and the sooner the better.

There are a number of procedures and medications for this. If it is possible to cancel vasoconstrictor drops, but breathing is not restored, careful medical examination, and if the problem is still in the septum, then this problem must be corrected surgically. 7. Is it possible to perform the operation free of charge under compulsory medical insurance? Septoplasty can be performed free of charge under compulsory medical insurance (compulsory health insurance). To do this, you need to contact the medical government institution at the patient’s place of residence. The doctor is obliged to examine the patient and give him a referral to the hospital for consultation and surgery. The patient may incur some costs for anesthesia, medications, equipment for the operation (operation package), etc. If the patient wishes to undergo rhinoplasty (aesthetic correction of the shape of the nose) along with septoplasty, free operation It will not happen either in a private clinic or in a public one. And here the choice is up to the patient - which clinic is better to go to. Of course, prices in government institutions will be more tempting, but it is better to entrust the aesthetic part of the operation to a doctor who has been practicing plastic surgery for a long time and on a regular basis. IN public clinics There are practically no such rhinosurgeons, therefore, regarding aesthetic correction of the shape of the nose, the right choice would be towards private clinics plastic surgery. 8. What anesthesia is it performed under? Regarding anesthesia, with classical endoscopic septoplasty, both types are used - local and general, depending on the indications and wishes of the patient. Some surgeons insist on general anesthesia, since the operation mechanism is not the most pleasant for the patient ( strong pressure on the bone, stretching and correcting the shape of the septum). Other rhinosurgeons practice septoplasty, mainly under local anesthesia. Also, premedication or stronger intravenous sedation is often used before surgery under local anesthesia, during which the patient is practically asleep. With laser septoplasty, only local anesthesia is used, the operation is performed on an outpatient basis, and as a result, the patient can go home on the day of the operation. When combined with rhinoplasty (aesthetic correction of the shape of the nose), different anesthesia is also used, depending on the case and the specifics of the operation. If rhinoplasty involves the bone department, such an operation is under the influence of local anesthesia impossible. If only the cartilaginous part (tip of the nose) is corrected, such an intervention may well be performed under local or combined anesthesia with intravenous administration sedatives. 9. How is it different from rhinoplasty? Often the term “septoplasty” is mistakenly identified with plastic surgery aimed at aesthetic correction of the shape of the nose, rhinoplasty. However, these are completely different operations. Rhinoplasty is performed at the request of the patient and is aimed at correcting the shape of the nose, not related to medical indications or respiratory health problems. Rhinoplasty is performed open or in a closed way, without the participation of the nasal septum and its correction. Aesthetic surgery always has a fee, unlike septoplasty, which is aimed at eliminating breathing and health problems. Besides, Plastic surgery performed at any time at the request of the patient, and septoplasty, as a rule, is performed out of need and objective reasons caused by problems with health and well-being. Correction of the nasal septum does not change the shape of the nose in a global sense, unlike rhinoplasty. Only in the case of a traumatic curvature of the nasal septum, this defect is eliminated by performing septoplasty. However, again, unlike rhinoplasty, this does not bring radical changes in appearance patient's nose. The most common option recently is to combine two operations - correction of the shape of the nose and correction of a deformed nasal septum. In this case, the operation is called “septorhinoplasty”, or is called general term- “rhinoplasty”. When performing a combined operation, the patient receives a smooth septum and gets rid of aesthetic defects(for example, a hump, a wide or drooping tip, wide wings of the nose, etc.). For the patient, the combination of these operations turns out to be beneficial in all respects: a one-time anesthesia, during which all the necessary manipulations are performed, aimed not only at correcting the shape of the nose, but also at correcting septal deformities, simultaneous rehabilitation (from both septoplasty and rhinoplasty), more favorable material costs.
Photo: nose rhinoplasty

In the case of combining septoplasty and rhinoplasty, both a full version of plastic surgery is possible (with intervention in the bone section and elimination of aesthetic defects in it), as well as manipulations aimed at the aesthetics of the tip (its reduction, narrowing, elevation). Even if the bone part is not involved, any plastic surgery on the nose is called “rhinoplasty,” while septoplasty can get rid of breathing problems, chronic respiratory diseases and other problems caused by a deviated nasal septum.

Photos before and after septoplasty

The concept of “curvature” is one of the degrees (or, rather, even forms) of deformation of the nasal septum. There are other types: “spike” and “ridge”, but simple curvature of the nasal septum is more common than all others.

A deviated nasal septum can occur after a fracture if the bone does not heal properly. Traumatic curvatures are the most common variant of this defect.

Other mechanisms for the formation of curvature are also possible: physiological and compensatory. In the first case, the deformity occurs due to the fact that the nasal septum and other bones of the facial skull grow at different rates (this is not natural process). In the second case, the cause of a deviated nasal septum can be any volumetric formations in this area: tumors, polyps, etc.

Minor nasal septum defects are not accompanied by any symptoms. More severe deformities are always manifested by the main and most important symptom: difficulty breathing through the nose. This sign is constant and is observed in all cases.

Sometimes patients complain of headaches, constant mucus discharge from the nose, and symptoms of chronic inflammation of the nasal mucosa.

The examination is carried out by an ENT doctor. As a rule, to make a diagnosis, it is sufficient to collect complaints and anamnesis, as well as perform anterior rhinoscopy (examination of the nasal cavity using a mirror that reflects light). During the examination, the doctor determines the integrity and density of the nasal septum using a special instrument - a button probe.

If necessary, the mucous membrane is irrigated with a 1% solution of adrenaline: it constricts blood vessels and reduces swelling.

Basic principles of treatment

A deviated nasal septum can only be treated surgically; there are no conservative methods.

Basically, two techniques are used:

Submucosal removal of the deformed part of the septum.
Mobilization of the nasal septum (Wojacek technique).

Never confuse elimination cosmetic defect nose and ENT surgery to treat the deformity. These are completely different interventions with fundamentally different goals, methods and results.

Difficulty in nasal breathing is a mandatory symptom, and only it can be an indication for medical surgery on the nasal septum. The existing cosmetic defect after the intervention can be eliminated, but this is by no means the main goal of ENT surgery.

This is extremely important information: a medical operation (not of a cosmetic nature) can be performed by an otolaryngologist surgeon only if there are complaints of difficulty in nasal breathing!

Contraindications, complications and duration of hospitalization are individual for different surgical treatment options, taking into account the instruments used and operating conditions. That is why it is necessary to consider surgical techniques in detail separately.

Method of submucosal resection (removal) of part of the septum

This operation can be combined with straightening the bridge of the nose, if necessary.

Who can perform submucosal resection (SR) and who cannot?

PR is not performed on older people if the deviated septum arose a long time ago and the person has adapted to the difficulty of nasal breathing: in this case, the operation simply does not make sense. In addition, the nasal mucosa in such patients, as a rule, atrophies, which extremely complicates both the operation itself and the postoperative period.

PR is performed in the hospital, after thorough examination for the presence of any chronic diseases that may serve as a contraindication to surgery. This may be diabetes mellitus, severe liver and kidney diseases, cardiovascular pathologies etc.

You will have to stay in the hospital for some time until your doctor is sure that your health is not in danger. Usually this does not take more than a week, but the issue of discharge is always decided individually.

The PR technique is quite complex, so the operation often has to be performed under general anesthesia. Previously, access for PR was achieved through an incision under upper lip, but now this technique is being abandoned.

The intervention is performed on one nostril: the mucous membrane is dissected to expose the cartilage (the nasal septum consists of two parts: cartilaginous and bone). The incision is quite long, almost the entire length of the septum.

The next stage of the operation is the separation of the mucous membrane from the cartilage. To do this, a special instrument is inserted into the incision, which peels off the mucous membrane from the outermost layer of cartilage - the perichondrium.

Through the resulting incision, the cartilage is dissected (on the other side it also needs to be separated from the mucous membrane). Then the curved parts of the septum, both cartilaginous and bone, are removed using scissors.

This is the most important stage of the operation: you need to choose correctly which part of the septum to remove (if the upper part of the incision is too close to the bridge of the nose, this can cause a lot of complications!).

After removing the deviated part of the septum, the mucous membrane is put in place, and elastic tampons are placed in the nasal cavity (as a rule, this is simply a finger cut off from a sterile glove and filled with foam rubber).

For heavy bleeding, tampons soaked in a special hemostatic paste are used.

The next day, the tampons can be removed, and after 2-3 weeks the surgical wound will heal completely. During the same period, nasal breathing, which was impaired due to a deviated septum, gradually begins to become easier.

Mobilization of the nasal septum according to Vojacek (redressation)

The Vojacek operation is much less traumatic than submucosal resection. Mobilization involves “breaking” the septum into several fragments. Once these fragments have stabilized, the septum straightens.

Fractures of bone or cartilage do not always require even dissection of the mucous membrane. In some cases, it is enough to simply break the septum in several places using forceps or a special “chisel”.

This operation ensures the integrity of the nasal septum. This is what makes Wojacek mobilization the most effective and “anatomical” intervention.

If, for some reason, the mucous membrane or perichondrium was dissected during the operation, the incisions are stitched with catgut. This suture material, which resolves after some time: there is no need to remove sutures after surgery.

Mobilization according to Vojacek, like PR, ends with packing of the nasal cavity.

Postoperative period

Regardless of which technique was chosen by the doctor to straighten the nasal septum, the nasal passages must be tamponed for the first day (sometimes two days). Tampons are placed loosely into the nasal cavity, but, nevertheless, nasal breathing is impossible in the first day after the intervention.

Some patients have a hard time with the inability to breathe through their nose: they complain of a sharp lack of air and attacks of suffocation. This is, for the most part, due to the mental reaction to the operation, so this complication is eliminated by taking sedatives.

After the operation, until discharge from the hospital (and later at home), you need to carefully clean the nasal cavity. In the first 3-4 days, “anemization” of the mucous membrane is also carried out - irrigating it with an adrenaline solution to narrow the blood vessels and reduce swelling.

Complications

Surgical treatment of deviated nasal septum is rarely accompanied by the development of complications. Carrying out operations in a hospital setting and subsequent monitoring of the patient reduces the risk of complications to a minimum, but you need to remember them.

Complications are classically divided into early and late.

Early complications are usually associated with injuries during the intervention: these are hematomas or heavy bleeding. Their occurrence is unlikely if filling the nasal cavity with elastic tampons was carried out correctly and in a timely manner (immediately after the end of the operation). If, according to a preliminary examination, a patient has a tendency to bleed, tamponade is accompanied by the use of local hemostatic agents.

Before surgery, such patients, among other things, are given prophylactic administration of vikasol, synthetic vitamin K, which increases blood clotting.

Another early complication is an acute otitis media that occurs due to nasal tamponade. This is possible if non-sterile tampons are used, or the tamponade technique is violated.

This could also be the reason intracranial complications operations (brain abscesses or meningitis), but they do not occur in people with good immunity.

Late complications occur very rarely. May form atrophic rhinitis- This chronic inflammation the mucous membrane of the nasal cavity, the blood circulation of which was disrupted during surgery.

Sometimes the intervention leads to the shape of the nose changing even more: the nasal bridge becomes retracted. This complication is characteristic only of submucosal resection, and occurs when too large a portion of the septum is removed.

Much more often, adhesions occur between the nasal septum and the opposite wall of the nasal cavity. Sometimes fusion can be observed over a large area - then they are called atresia. Fusions or atresias can also be treated surgically: this is a safe and painless operation that does not even require hospitalization.

Conclusion

A deviated nasal septum is, of course, not fatal. dangerous disease, but it can worsen the quality of life very, very much.

If you experience constant difficulty breathing through your nose, which is in no way related to a cold or allergies, be sure to consult an ENT doctor.

Only breathing through the nose can ensure a normal supply of oxygen to the body. Passing through the nasal passages, the air is moistened and purified, and this is an extremely important point.

You should not endure difficulty breathing through your nose and get used to breathing through your mouth - this is fraught with a lot of consequences. See a doctor in time: two days of discomfort after the intervention are worth it so that you can breathe freely for the rest of your life!

Humans have two types of breathing: nasal and oral. The first is more complete, since the nasal cavity performs important functions for the body. The air passing through it is moistened, cleansed of harmful impurities, and warmed. Therefore, if the nasal septum is curved, a number of undesirable consequences appear for the entire body as a whole. There are diseases that lead to disruption of nasal breathing, but the main thing is still deformation of the structures of the nasal cavity.

surgery or treatment?

Correct treatment and accurate diagnosis determined by an ENT doctor. To do this, he examines the nasal cavity using special instruments. May need X-ray. However, a number of symptoms that the patient can determine independently may indicate a deviated nasal septum. Surgery may sometimes be simply necessary. But before that, you will still need to go to the doctor and get permission for it. In some cases, an ENT specialist can prescribe treatment that is simple and effective. But you should not be afraid of surgical intervention. Many people go through a similar operation and live happily after it.

surgery and treatment

The operation to correct the nasal septum involves removing curved cartilage and bone areas that impede the passage of air. To do this, an incision is made inside the nose. After the operation it is not visible. Despite surgical intervention, the mucous membrane covering the nasal septum is preserved. But this procedure is outdated, as it has its negative consequences. Today doctors choose more modern methods and perform surgery using new equipment.

Deviated nasal septum: surgery. Endoscopic septoplasty

With the help of endoscopic septoplasty, it has become possible to straighten those areas that are curved. All visible cuts will be completely absent here. Using special devices and a small camera, the doctor can observe everything that happens on any part of the nose. This virtually eliminates tissue trauma. In this case, the tension of the internal cartilage is changed by applying incisions.

Deviated nasal septum: laser surgery

One of the treatment options for a deviated nasal septum is Sometimes this is the only possible way help the patient. Here, the surgeon can use a laser to change the shape of the curved cartilage. This method is convenient for isolated curvature, which is difficult to operate in another way. But there are some contraindications, so this method is not suitable for everyone. You should definitely listen to the opinion of the doctor who prescribes this procedure. For each person with a deviated nasal septum, surgery (reviews about it may be ambiguous) should be selected individually. Everything will depend on the severity of the condition and symptoms.