Deviated Septum

Most patients have some degree of asymptomatic septal deviation, but in some patients it is severe enough to cause symptoms of obstruction. Septal deviation is usually the result of previous nasal trauma. The trauma might have seemed relatively minor at the time or might have resulted in a nasal fracture. Some deviated septums are congenital. Physical examination may clearly demonstrate the septum obstructing the nasal airway if anterior. If more posterior, nasal endoscopy or CT may be necessary to make the diagnosis. Any patient complaining of persistent nasal obstruction deserves further evaluation, especially if the cause is not immediately evident. Symptomatic septal deviation is readily treatable with outpatient surgery.

Septoplasty is done through an intranasal incision, allowing deviated portions of cartilage and bone to be replaced to the midline or removed, resulting in a symmetrically patent nasal airway. Septoplasty is often combined with a turbinate reduction procedure. The procedures are usually well tolerated. Postoperative pain, formerly a greater problem, usually resulted from the need for nasal packing and removal. Newer devices such as soft-silicone (Silastic) splints now cause much less postoperative discomfort than traditional packing.

In pediatric patients, septoplasty is not usually recommended because of concern about disrupting nasal and facial growth, although this risk appears to be low. For this reason, "limited" septoplasty may be considered in select patients.

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