June 28, 2023
EDUCATIONAL PEARL
Nasal Septal Deviation: Displacement of nasal septum off-center and to one side resulting in narrowing of the nasal canal.
Presenting Symptoms:
Difficulty breathing
Nosebleeds
Facial pain
Noisy breathing during sleep
Awareness of the nasal cycle
Preference for sleeping on a particular side
Headaches (Sluder's syndrome: headaches due to contact of turbinates and septal spurs)
Epidemiology: One of the most common nose deformities. 70-80% of people have a deviated nasal septum; however, most cases are asymptomatic and require no treatment
Etiology/Pathophysiology: Congenital or secondary to trauma (e.g. sports and automobile accidents)
Diagnosis and Evaluation:
Symptoms and History (allergies, medication use, intranasal substance use etc.)
Physical exam:
Direct rhinoscopy or fiberoptic nasal endoscopy evaluating septum, turbinates and mucosa for size, pathology and symmetry. Septal deviation may be characterized using a number of systems (see review linked below)
External nose examination at rest and with respiration
Cottle’s maneuver to assess for nasal valve collapse, but clinical utility is controversial
Imaging: CT may be used for complex and/or traumatic cases
Treatment:
Most people do not need treatment if symptoms are mild
Septoplasty is indicated for individuals with troublesome symptoms including epistaxis, obstructive sleep apnea, facial pain etc.
Often may include other rhinologic procedures including rhinoplasty and turbinate reduction
Quality of life is improved in many after surgery, however patients may be troubled by insufficient relief of obstruction after surgery (an important point of counseling in preoperative evaluation)
Septoplasty. Mayo Clinic. Accessed 26 June 2023. [Link]
Further Readings:
Nasal Septal Deviation Classification Systems
Written by: Alexandria Bao
