The nasal septum, or nasal septum, is this vertical wall that separates the two nasal cavities opening onto the nostrils. Composed of an osteocartilaginous skeleton, it can be the site of a deviation or a perforation, with an impact on the integrity of the nasal cavities and the quality of breathing.

The nose is made up of different structures: the clean bone of the nose, the hardest part at the top of the nose, cartilage that forms the lower part of the nose, and fibrous tissue in the nostrils. Inside, the nose is divided into two nasal cavities separated by the nasal septum, also called the septum. This nasal septum is formed of a bony rear part and a cartilaginous anterior part, and is coated with a mucous membrane. It is a richly vascularized area.

The nasal septum symmetrically separates the two nasal cavities, thus ensuring good circulation of inhaled and exhaled air. It also has a supporting role for the nose.

Deviation of the nasal septum

Almost 80% of adults have some degree of nasal septum deviation, most often asymptomatically. Sometimes, however, this deviation can lead to medical and / or aesthetic complications:

• nasal obstruction which may cause difficulty in breathing, snoring, obstructive sleep apnea syndrome (OSAS);
• mouth breathing to compensate. This mouth breathing can in turn lead to drying of the nasal mucous membranes, increasing the risk of ENT pathologies;
• sinus or even ear infections due to stagnant nasal secretions;
• migraines;
• aesthetic discomfort when associated with an external deformation of the nose.

The deviation of the nasal septum can be congenital (present at birth), appear during growth or be due to trauma to the nose (impact, shock).

It can affect only the cartilaginous part or also the bony part of the nasal septum as well as the bones of the nose. It may concern only the upper part of the partition, with a deviation to the right or the left, or be in the shape of “s” with a deviation at the top on one side, on the other at the bottom. It is sometimes accompanied by polyps, small benign tumors of the nasal cavities, and hypertrophy of the turbinates, factors also contributing to poor air circulation in a nasal cavity already narrowed by the deviation.

Perforation of the nasal septum

Also called septal perforation, perforation of the nasal septum most often sits on the anterior cartilaginous portion of the septum. Small in size, this perforation may not cause any symptoms, so it is sometimes discovered unexpectedly during a nasal examination. If the perforation is important or depending on its location, it can cause wheezing when breathing, a change in the voice, nasal obstruction, inflammatory signs, scabs, nosebleeds.

The main cause of perforation of the nasal septum remains nasal surgery, starting with septoplasty. Other medical procedures are sometimes involved: cauterization, placement of a nasogastric tube, etc. The cause can also be of toxic origin, it is then dominated by the inhalation of cocaine. Very rarely, this septal perforation is one of the symptoms of a general disease: tuberculosis, syphilis, leprosy, systemic lupus erythematosus and granulomatosis with polyangiitis.

Treatment of deviated nasal septum

In first intention, a drug treatment will be prescribed to relieve the symptoms. These are decongestant sprays or, in case of inflammation of the nasal cavities, corticosteroids or antihistamines.

If the deviation of the nasal septum causes discomfort or complications (breathing difficulties, frequent infections, sleep apnea), a septoplasty may be performed. This surgical treatment consists in remodeling and / or partially removing the deformed parts of the nasal septum in order to “straighten” it. The intervention, which lasts between 30 minutes and 1 hour 30 minutes, takes place under general anesthesia and generally under endoscopy and by natural means, that is to say nasal. The incision is endonasal, so there will be no visible scar. In some cases however, mainly when the deviations are complex, a small skin incision may be necessary. Minimal, it will be located at the base of the nose. Septoplasty is a functional surgery, as such it can be covered by social security, under certain conditions (unlike rhinoplasty which cannot be).

Septoplasty is sometimes combined with turbinoplasty to remove a small part of the turbinate (nasal bone formation covered with mucous membrane) that can make nasal obstruction worse. If the deviation of the nasal septum is associated with an external deformity of the nose, septoplasty can be combined with rhinoplasty. This is called rhinoseptoplasty.

Treatment of septal perforation

After failure of local care and only after symptomatic septal perforation, surgery may be offered. It is generally based on the grafting of pieces of septal or oral mucosa. The installation of an obturator, or septal button, is also possible.

Different symptoms may suggest a deviation of the nasal septum: nasal congestion (blocked nose, sometimes unilaterally), difficulty in breathing, breathing through the mouth to compensate for the lack of air flow in the nose, sinusitis, bleeding, discharge from the nose, disturbed sleep due to sleep apnea or snoring, ENT infections, etc. When pronounced, it can be accompanied by a deviation of the nose visible from the outside.

Faced with these symptoms, the ENT doctor will examine the internal nasal passages using a nasal endoscope. A facial scan will determine the degree of deviation of the nasal septum.

Septal perforation is visualized by anterior rhinoscopy or nasofibroscopy.