Curvature of a nasal partition

Description:

The nasal partition is the plate dividing a nasal cavity into two approximately identical half. In a front part it is formed by a cartilage, in back a thin bone and is covered on both sides with a mucous membrane.

Curvatures of a nasal partition (laterpositions, thorns, crests) cause disturbance of nasal breath, various on degree, up to its complete cessation. It, in turn, considerably increases tendency to inflammatory and allergic diseases of a respiratory organs, leads to development of neurotic states, headaches, negatively influences cardiovascular and urinogenital systems. Deformation of a nasal partition can be a consequence of an injury of a nose or uneven growth of a facial skull at children's age.

Reasons of a curvature of a nasal partition:

Curvatures of a nasal partition meet at early children's age exclusively seldom. Usually they develop aged from 13 up to 18 years.

Many authors see the reason of a curvature of a nasal partition in the wrong correlation between growth of bones of a facial and cranial skeleton owing to what to a nasal partition it is necessary to be bent as if during the development in a frame, too narrow for it. Others point to the uneven or wrong growth of a skeleton of the partition happening in view of existence of the regions of growth mentioned above.

Some doctors consider that unequal passability of both half of a nose owing to a hypertrophy of the lower sink on the one hand is the reason of a curvature of a nasal partition in the enormous majority of cases. It creates at breath a difference in the air flow pressure upon a nasal partition and causes a deflection it in the narrowed party where pressure (pressure) of a stream is weaker.

All these, as well as other existing theories of an origin of a curvature of a nasal partition, it is impossible to consider convincing as it is not established whether deviations from the next departments are the reason of a curvature of a partition, its investigation or coincidence.

The significant role in the reason of a curvature of a nasal partition, undoubtedly, is played by injuries.

It is well-known that the expressed curvatures of a nasal partition occur at men much more often than at women (according to L. T. Levin, by 3 times). This fact speaks about a significant role of an injury in a partition curvature etiology as men, and in particular boys and teenagers, are exposed to an injury much more often, than female persons.

In rare instances some role in curvatures of a nasal partition is played by too developed rudiment of a yakobsonov of body (in anteroinferior department of a partition).

Pathogeny:

The most frequent symptom at a curvature of a nasal partition is disorder of nasal breath on one or both parties. This disturbance depends not only on direct narrowing of nasal cavities in connection with deformation, but as V. I. Voyachek specifies, also on the wrong air flow, turbulences and existence of places of the lowered pressure. The pathological impulses arriving in this regard from receptors mucous a nose to the central nervous system cause in turn the response to nose vazomotor leading to disturbance of the correct blood circulation in mucous, to swelling of sinks and narrowing of a gleam of a nose.

Besides, as is well-known from works as A. A. Atkarska, Minn, etc., normal the air flow at a breath under purely physical laws goes not on the shortest way on the lower nasal course, and dugoobrazno, rising at first highly up to an average sink above, and then only goes down to a postnaris. On the contrary, at an exhalation the air flow goes on the lower nasal course. Owing to this fact in case of narrowing (from a partition curvature) a nose gleam in its average departments at a free lower part the air flow at a breath has to go violently on an unusual bed, i.e. on the lower nasal course. The same difficulties happen in case of narrowing of the lower nasal course at the time of an exhalation. Therefore free lower or the half-speed does not exclude a possibility of disorder of nasal breath.

Disorder of nasal breath depends even on relationship of a curvature of a nasal partition with sinks. It is known that at a curvature of a nasal partition we often meet a hypertrophy of sinks, a so-called compensatory hypertrophy, and also a hyperplasia of a trellised labyrinth in a wide half of a nose. In certain cases at a curvature of a nasal partition (usually in its front department) at a back rinoskopiya it is possible to note a hypertrophy of the back ends of sinks, mainly lower.

The fact that at a curvature of a nasal partition to one party of the patient often complains of breath difficulty on both sides is explained by these changes, even stronger is frequent on the party of concavity of a partition.

Sometimes at a curvature of a nasal partition, its especially front departments, suction at a breath of the corresponding wing of a nose to a partition is noted owing to negative pressure, with switching off of this half of a nose of the act of breath.
The complicated access to a current of air to olfactory department of a nasal cavity at a curvature of a nasal partition in its upper part leads to disturbance of olfactory function. At the same time in connection with a circulatory disturbance and trophicities of an olfactory nerve there can come disturbance of sense of smell not only respiratory, but also essential, already irreversible character.

It should be noted that quite often the curvatures of a nasal partition established in youth prove clinically much later, sometimes only at advanced age. It depends on accession of local diseases of a nose and its adnexal bosoms or the general frustration - disturbances from cardiovascular system, lungs and so forth because of which it becomes more difficult for patient to overcome resistance of the narrowed nasal courses at breath.

Curvatures of a nasal partition can give a reason for development of reflex neurosises owing to irritation of the terminations of numerous nerves which so richly supplied a mucous membrane of a nose. It especially belongs to crests and thorns which sometimes vrezyvatsya deeply in sinks. Irritations can cause reflex changes as in the nose (in the form of vasculomotor frustration, hypersecretion, etc.), and in the next and remote bodies.

Rank bronchial asthma, throat spasms, a number of diseases of an eye, disturbance from cardiovascular system as rhinogenic reflex frustration, headaches, epilepsy, a dysmenorrhea, reflex cough, sneezing etc. On our observations, such communication meets quite seldom. Nevertheless the specified neurosises at simultaneous existence of the expressed deformations of a nasal partition raise indications to a resection of a nasal partition or a resection of thorns (we observed the long termination of bronchial asthma after such operation only in one case). However the patient should not give guarantees that after operation all these neurosises will disappear.

Disturbance of ventilation of a nose and secondary rhinitises in connection with deformation of a nasal partition can, however, in rare instances, cause changes from an Eustachian tube and a middle ear, and also disturbance from adnexal bosoms and slezoprovodyashchy ways. The role of deformations of a nasal partition in a pathogeny of acute and chronic sinusitis is almost more important.

To the listed symptoms it is necessary to add still the cosmetic defects coming sometimes at a partition curvature, especially at dislocation of a quadrangular cartilage.

Symptoms of a curvature of a nasal partition:

The curvature of a partition of a nose is shown by the following symptoms:
1. Difficulty of nasal breath. Both moderate disturbance, and total absence of nasal breath can be noted. If the patient has a unilateral curvature of a nasal partition, then disturbance of nasal breath will be noted from the right or left half of a nose. Here it is necessary to stop on small aspect of this symptom. Often, at visit of the ENT specialist, to the patient the diagnosis a curvature of a nasal partition is established that brings it into surprise as, in his opinion, the nose at it breathes well. It is possible to answer it with the fact that at disturbance of nasal breath owing to a curvature of a nasal partition, there is an adaptation of an organism and the nasal cavity compensates this shortcoming at the expense of other structures. Same also the fact that sharp disturbance of nasal breath at the person with the bent partition of a nose can arise at advanced age when compensatory opportunities of an organism are gradually exhausted speaks. People who have a big nasal cavity even at the expressed curvatures of a partition of a nose can have no disturbances of nasal breath as at the expense of it passability of air through a nasal cavity at breath is compensated. In a word - if at you the nose well breathes, it does not mean at all that you can have no curvature of a nasal partition.
2. Snore. Arises as a result of the broken nasal breath.
3. Dryness in a nasal cavity.
4. Chronic inflammatory diseases of adnexal bosoms of a nose (sinusitis) - antritises, etmoidita, a frontal sinusitis.
5. The curvature of a nasal partition can be one of origins of these diseases. At the long course of chronic sinusitis against the background of the bent partition of a nose polypostural changes of a mucous membrane develop, i.e. polyps are formed.
6. Allergic diseases. Disturbance of nasal breath supports a current in an organism of allergic processes, especially at compensatory curvatures of a partition of a nose when at contact of a mucous membrane of a nasal cavity with a partition there is a constant irritation which is capable to provoke attacks of bronchial asthma, allergic cold. The patient feels "inconvenience in a nose", an itch, from a nasal cavity slime is periodically or constantly emitted. Especially brightly these symptoms are shown in the presence at the patient of a combination of allergic rhinitis, a hypertrophy of nasal sinks and a curvature of a nasal partition.
7. Changes of a shape of a nose. At traumatic curvatures of a partition of a nose - dislocations, partition cartilage fractures - the shape of a nose changes. There is mixing of a nose to the right or to the left. As it is already noted, such states are usually combined with fractures of bones of a nose. If adequate treatment is not carried out, then the cartilage grows together incorrectly. These are the main symptoms which allow to suspect a curvature of a nasal partition.

Effects of a curvature of a nasal partition are rather diverse. It is proved that at disturbance of nasal breath there are changes from blood, vascular system, the sexual sphere, the organism is more subject to overcooling and influence of adverse factors of the environment as there is an interrelation between indicators of nasal breath and a condition of immunity. Therefore it is very important to address timely the otorhinolaryngologist and not to risk the health.

Types of curvatures of a nasal partition.
Curvatures of a nasal partition are extremely various as in character, and on localization. They meet in the form of bends on the sagittal and frontal planes, in the form of various ledges - crests and thorns - or as a combination of both deformations. Bends of a nasal partition, as well as ledges, can be bilateral and narrow at the same time various departments of both half of a nose. Mostly With-shaped bends, then the curvatures in the form of a Latin letter S taking most often a quadrangular cartilage meet is more rare a perpendicular plate and the share is even more rare. Curvatures of the most back departments of a nasal partition meet exclusively seldom, and the rear edge of a share almost always keeps strict sagittal situation. Also seldom bends of a perpendicular plate reach close to the nose arch, i.e. to a cribriform plate. Curvatures of a nasal partition of a traumatic etiology mostly are characterized by bends with acute angles. Quite often at traumatic deformations more or less sharp shift of a first line of a quadrangular cartilage which is usually called dislocation is noted. In certain cases injuries there is a sliding of bottom edge of a quadrangular cartilage from a share and then the upper edge of the last as if freely is given in a nasal cavity.
Crests as it was already mentioned, are located mainly on the upper edge, a share, going obliquely in front back and from below up far deep into a nasal cavity.

They quite often come to an end with the acute thorn which is deeply crashing into average, sometimes and the lower sink, обтурируя average and back departments of a nasal cavity and output openings of adnexal bosoms. Besides, crests quite often are located on bottom edge of a share almost at the bottom of a nose, but these ledges usually occupy only the most front departments of a nose. Sometimes the crest goes down in the form of a canopy. Crests and thorns mostly bone, but quite often they contain also a cartilage which forms mainly top, or a lateral part of ledges. All these features easily are explained by embryonic development and further formation of a nasal partition about which it was told above.

Quite often on site a crest the nasal partition on the opposite side forms concavity, sometimes in the form of a deep acute fillet.

It should be noted that the mucous membrane on the convex party of bends of a nasal partition, in particular on ledges, is usually thinned and when separating it is easily torn, and, on the contrary, from the concave party it thicker and easily separates. Mucous, the cover is also more densely spliced on site seams, sometimes in the field of a rudiment of a yakobsonov of body on a quadrangular cartilage and in places of changes at traumatic deformations of a nasal partition.

Diagnosis:

Deformation of a nasal partition can already be established sometimes on external survey - on the basis of scoliosis of a nose, shift of its tip or septum mobile. However, curvatures become clear by the most part at a rinoskopiya. Before everything asymmetry of nasal cavities is evident i.e. that one half of a nose, throughout or in this or that part, is wider another, on one party nasal sinks are well visible, and on another it is worse or are not visible at all.

For detailed survey and for exact definition of character and localization of all bends and ledges of a nasal partition it is necessary to grease repeatedly and carefully a partition and sinks of 5% with cocaine solution with adrenaline. Only after that it is possible to give itself the clear report to configurations of both the partition, and a nose sidewall (sinks, trellised cells etc.) that is absolutely necessary for the solution of a question of operation.

The front rinoskopiya should be added with a back rinoskopiya, at which become clear (the truth, very rare), bends of back department of a share, a hypertrophy of the back ends of sinks, and also existence of a hypertrophy mucous, usually symmetrized, on both sides of back department of a share.

X-ray inspection gives few the valuable additional data concerning deformations of a nasal partition. However such research is necessary in all cases for clarification of a condition of adnexal bosoms of a nose.

Treatment of a curvature of a nasal partition:

As at a curvature of a nasal partition disturbances of normal anatomy of a nasal cavity take place, all conservative measures (vasoconstrictive drops, tablets, respiratory gymnastics) have temporary and not always the expressed effect.

At clinical manifestations of a curvature of a nasal partition surgical treatment – operation endoscopic the septoplasty is carried out. When performing operation it is not made any cuts on a face. As a result of its carrying out the shape of an outside nose does not change. Operation lasts on average of 30 minutes till 1 o'clock and can be carried out both under local, and under the general anesthesia. Operation comes to an end with installation in a nasal cavity of special silicone plates – so-called splint and gauze tampons which are removed the next days after operation. Thus, stay of the patient in a hospital only 1 days then we allow to go home him is necessary. For 5-7 days after operation it will be necessary to visit special bandagings for acceleration of healing and prevention of formation of commissures.

Now the only method of treatment of all types of deformations of a nasal partition should be considered a submucosal resection it. The isolated resection of crests and thorns should be applied only in rare instances. First, usually there are combined curvatures, secondly, at the modern equipment a typical resection of a nasal partition technically much easier, than the isolated resection of crests and thorns.

Some authors suggest to make at people of advanced age instead of a submucosal resection of a nasal partition through excision of all layers it. Nevertheless follows, in our opinion, and at advanced age to prefer a submucosal resection which not much more complicates operation.

Indications to a resection of a nasal partition. Operation on a nasal partition is shown in cases when there are defined, listed above frustration which with sufficient clarity can be put in a causal relationship with the available deformations of a nasal partition. The curvatures in itself which are accidentally found as if they are expressed were, usually do not serve as the indication to operation. However, if there is an expressed deformation of a nasal partition with moderate disorder of breath at young age, then it is necessary to consider that further, in connection with age weakening of cardiovascular activity, a tone of respiratory muscles, etc. these curvatures of a partition can serve as the reason of approach of functional frustration. It is more difficult to operate at advanced age, and the operation counted on functional reorganization of the difficult respiratory device and adaptation of all organism to the correct nasal breath can not give sufficient effect at this age. Therefore in such cases it is better to eliminate deformation of a partition in youth. Follows, in our opinion, also to operate if the person of young age has full or almost full obturation of one half of a nose owing to a curvature of a nasal partition while the patient thanks to free breath through other half of a nose of complaints does not show.

Concerning admissible age for a septectomy we quite agree with L. T. Levin making this operation with success both to children, and adults, but as. fairly this author specifies, at children and at persons 48-50 years of the indication for this operation considerably have to be more senior are narrowed.

Very often at more or less considerable curvatures of a nasal partition at the same time there is a hyperplasia of the lower or average sink (or concha bullosa), or both of these sinks on the party opposite to a curvature. Quite often on this party breath difficulty appears the strongest. It can be established and objectively in spot size from the steam which accumulated at an exhalation on the cold pallet put to nasal openings. If in such cases to be limited only to a resection of a nasal partition, then we will not receive improvement of passability of a nose not only on the party where there is a hypertrophy of sinks, but and on the party of a curvature as hypertrophied sinks, otdavlivy the partition which became mobile after operation, will not allow it to adopt to make sagittal situation therefore follows in such cases along with a septectomy and a turbinotomy (or a partial resection of concha bullosa). It is easier and better to make it at once after a septectomy if only unusual bleeding or danger of approach further of synechias, owing to gross violation of an integrity mucous a partition cover during operation, do not force to postpone a turbinotomy for other session (in a month).

Quite often at a curvature of front departments of a nasal partition the hypertrophy of the back end of lower is observed: sinks on the narrowed party (it is established by means of a back rinoskopiya to a septectomy or at a front rinoskopiya upon termination of this operation). If this hypertrophy is sharply expressed, then it is better to eliminate it right there.

If at a curvature of a nasal partition the narrow party is more or less well passable for air, and other party of an obturirovan hypertrophied sinks, then it is better to make at first only a turbinotomy. At insufficient effect make a resection of a nasal partition in 2-3 months.

If there is a hypertrophy of soft tissues of a nasal partition, then it is necessary to excise them scissors (if they trailing) or (at subauriculate hypertrophies) to destroy by a galvanocauter if it is possible in the submucosal way. Great technical difficulties are often presented by elimination of a hypertrophy of soft tissues of back departments of a share. Usually they become available only after a resection (or mobilization) a nasal partition. Destruction of these fabrics a galvanocauter should be made with extreme care, without cauterizing at the same time sinks in order to avoid the subsequent synechias. It is better to use conchotomes for this purpose.

Quite often at a curvature of a nasal partition asymmetry of a structure of a sievebone is noted. On that party where the partition forms concavity, the trellised labyrinth is increased in sizes in comparison with the opposite side.

In such cases follows along with operation on a nasal partition to make removal of a part of the corresponding trellised labyrinth, without deleting whenever possible average sink but only having put it in more lateral position.

Except the listed above indications to a resection of a nasal partition, this intervention should be applied also as a preliminary action to performance of others of operation or to ensuring the best results of these operations.

Opening of a frontal sinus, trellised cells and the main bosom, operation on a dacryocyst, etc. belongs to such operations.

In rare instances the resection of a nasal partition is made to have an opportunity to carry out an ear catheter for blowing off of an Eustachian tube.