The nasal septum is the piece of cartilage and bone that separates the two sides of the nasal cavity. The turbinates are little bones that project from the sides of the nasal cavity and are covered with a mucosa to warm and moisturize the airflow through the nose. At times the nasal septum may be deviated, thus causing nasal obstruction, nasal pain, recurrent sinusitis and/or recurrent nose bleeds. In addition, the turbinates may be enlarged, thus further contributing to nasal congestion.
Both septal deviations and enlarged turbinates can cause a decrease in airflow through the nose, leading to chronic nasal congestion, mouth breathing or snoring. Some septal deviations can cause sinus blockage with recurrent sinusitis. Others may lead to contact points that may result in nasal or sinus pain. Still others may cause turbulent airflow, drying out the nasal mucosa and sometimes leading to nose bleeds. Nasal obstruction is typically worse at night, due to the increase in nasal blood flow secondary to gravity when lying down. Chronic mouth breathing may worsen snoring or lead to dry mouth and/or sore throat. Usually nasal obstruction is worse on a particular side but may vary from side to side due to other factors, such as colds or allergies.
A deviated nasal septum may be the result of trauma to the nose or may occur from birth. It is not necessary to fracture the bridge of the nose to cause severe deviation of the septum. Often minor trauma to the nose can result in a fracture of the nasal septum. The septum may be deflected to one side or twisted with obstruction of both sides. In addition, a spur of bone may project into the nasal cavity or into a sinus opening. Enlargement of the turbinates is an anatomic variation with no particular cause. Frequently, the turbinates will be enlarged on the side opposite of the septal deviation.
In many cases, a deviated nasal septum or turbinate enlargement causes no problems and needs no treatment. If symptoms are present, a trial of nasal steroids and/or decongestants is usually given. If, however, nasal obstsruction, pain, recurrent sinusitis or recurrent nose bleeds persist, then the septum can be repaired through an outpatient procedure called septoplasty. If the nasal turbinates are enlarged, they can be reduced with an outpatient procedure called turbinoplasty. These two procedures are frequently performed together.
Due to the high incidence of allergic rhinitis, it is not unusual for allergies to co-exist with either a nasal septal deviation or enlarged nasal turbinates. Allergies cause swelling of the nasal mucosa that often makes an anatomic obstruction more noticeable. In many cases, treatment of the allergies with immunotherapy will improve the runny nose and post-nasal drip, but the nasal congestion may remain. In this situation, septoplasty and/or turbinoplasty are often used as an adjunct to allergy shots in order to improve the nasal obstruction.
In other situations, particularly after nasal trauma, a deformity of the nasal dorsum may accompany a deviation of the nasal septum. In these cases, an outpatient procedure called a septorhinoplasty may be performed. With this procedure, the external appearance of the nose is improved in addition to correction of the nasal obstruction.