SEPTUM DEVIATION (MIDDLE BONE CURVATURE OF THE NOSE):
WHAT IS IT?
Both nostrils are like two parallel tunnels extending from the front to the nasal cavity. The middle partition separating these two tunnels is called "Septum", and the curvatures of this partition are called "Septum Deviation".
WHAT ARE THE FUNCTIONS OF OUR NOSE?
The nose is not just a respiratory organ. In addition to breathing, it has important functions such as filtering, cleaning, heating, humidifying and smelling the inhaled air.
It is very important to be able to breathe through the nose. The main thing is nasal breathing, and mouth breathing is learned later (in the 4th-6th weeks). Congenital disorders that completely cover both nostrils in newborn babies (Choanal Atresia = closed back holes of the nose) are of such importance that they can sometimes lead to death.
When nasal breathing begins, our lungs prepare for this and full use of respiratory air (oxygen) is ensured. This is called the nose-lung reflex (Naso-alveolar reflex). When mouth breathing is done, this mechanism does not work and we cannot fully benefit from the breath we take. This situation is especially evident during exertion. For this reason, athletes with nasal congestion have lower performance and a condition called breathlessness or air hunger occurs. While nasal congestion seems to be a comfort and quality of life problem at young ages, it causes health problems in older ages. Insufficient oxygen intake increases the burden on the heart, especially in people who have problems with heart and lung health at older ages.
REASONS OF NOSE CONGESTION: (It is explained in detail in the relevant section, only "Septum Deviation will be explained in this section)< br /> WHAT IS NASAAL CYCLE (alternate breathing)?
When defining nasal congestion, it is very important to know how a normal nose should breathe. Our nostrils work in turns. Each of our nostrils works in turns as a result of the mucosa (wet nasal skin) covering the nasal cavities and the nasal concha (3 turbinates) located on the sides of the nasal canals, swelling and shrinking by filling them with blood every few hours. nose to blood People with very wide eyes may not notice this. However, in general, during the day, one of our nostrils is more open and the other is more blocked. While the open side provides oxygen intake, the blocked side allows the air to be heated, filtered and humidified. This is called nasal cycle (rotational work).
In addition, our nose may become more stuffy or more open in situations such as environmental temperature, humidity, sudden temperature changes. Likewise, under the influence of gravity, the nostril on the side you lie on becomes blocked, while the side above you opens. People with unilateral nasal congestion due to septum deviation or similar reasons generally show the behavior of lying on the blocked side. In other words, those whose right hole is blocked lie to the right, and those whose left hole is blocked lie to the left. Thus, they unknowingly lie on the already blocked side, leaving the open nostril on top and breathing more easily at night. Apart from all these, in cases such as cold, flu or allergic flu, both nostrils may become blocked as a result of swelling of the mucosa and turbinates, even if there is no deviation. While most patients complain about the blocked side, some people complain about the open side. If a person has been used to one side being blocked for a long time, the "blocking and opening" in the other open nostril will disturb him. In other words, he/she complains about the obstruction of the healthy side where he/she expects to breathe.
HOW DOES SEPTUM DEVIATION OCCUR?
While septum deviations sometimes occur congenitally and developmentally, that is, structurally, sometimes they occur as a result of various nasal traumas. income. This may sometimes even happen due to the baby getting stuck in the mother's womb.
WHAT ARE THE SYMPTOMS?
The main complaint is nasal congestion and inability to breathe adequately. People with nasal congestion have significantly more mouth breathing. As a result, dry throat, air hunger, shortness of breath, choking during exertion and sports, and sometimes snoring may occur. Some patients may experience headaches due to contact points, sinusitis that resists treatment, or a feeling of congestion and pressure in the ear.
WHAT IS THE TREATMENT?
Septum deviations are corrected by surgery. However, there is a rule that every deviation must be operated on. There is no. When a person with nasal congestion and related complaints (mouth breathing, snoring, dry throat, shortness of breath, air hunger) is examined, if there is a curvature that may cause these complaints and if the person's complaints can be improved if corrected, surgery is recommended. In addition, even if it does not prevent breathing, if the curvature prevents the treatment of sinusitis due to its location or causes pain (MCPA = Mucosal Contact Headache), surgery may be recommended.
HOW ARE DEVIATION SURGERY PERFORMED?
The surgery can be performed under local anesthesia, local anesthesia with sedation, or general anesthesia (complete sleep). If there is no special reason otherwise, general anesthesia is preferred. Because under local anesthesia, it is possible for pain or bleeding to bother the patient. This may affect the success of the surgery.
The average surgery time is about 30-40 minutes. However, this period may extend up to 2 hours in patients who have previously undergone surgery, broken noses as a result of trauma, or patients who underwent open technique. In other words, the most important factor that determines the duration is the difficulty level of the process. The average surgery duration can only be determined after the examination.
The surgery can be performed in two different ways, called open and closed techniques. The standard method is the open technique. However, in cases of deviations involving the front support area of the nose or if the patient wishes for aesthetic changes during the same procedure, the open technique may be preferred.
In the closed technique, there are no visible incisions or stitches from the outside. These remain completely inside the nose. The stitches do not need to be removed, they dissolve on their own.
In the open technique, the procedure is performed by making a horizontal (usually inverted "V" shaped) incision over the stitch on the front of the nose. At the end of the surgery, there will be three or four thin stitches on the front skin of the middle stitch. These stitches are 7-8. taken on days. Stitch scars disappear completely within 2-3 months. The basic principle of the surgery is to straighten the crooked middle part of the nose. While achieving this, the structures that form the support of the nose must not be damaged, and if they have to be damaged, they must be repaired. Otherwise, shape changes such as collapse or warping of the nose may occur. The middle part of the nose is in the form of a plate, the front half of which is cartilage and the back half of bone. It is covered with oza cover. In order to make the necessary corrections, the mucosa covering the cartilage and bone is removed carefully and without damaging it. After the correction process is completed, the removed mucosa on one or both sides should be supported to stick back into place. Various nasal tampons or suture techniques are used to achieve this and prevent bleeding. In previous times, extra tampons in the form of long fabric strips were placed in both nasal cavities, and there was significant pain and bleeding during their removal. Fears about these tampons still persist today, causing many people to avoid having nose surgery.
Currently used nasal tampons are single-piece silicone sheets or sponge tampons that can swell as they get wet. (photo) Some have tubes that allow breathing, at least partially. Sometimes it is possible to fix the mucosa to the middle compartment with only internal stitches without any tampon. The method to be chosen depends on the preference of the doctor performing the surgery, the type of surgery performed and the general health condition of the patient. Tampons are removed after 1-3 days (usually 2 days). Their removal is extremely easy, painless and bleeding-free. The difficult thing here is not the removal of the tampon, but its presence in the nose for two days. Nose surgery is not a painful procedure. However, some patients may complain of headache.
When tampons are removed, there is a very significant relief and relief. But then the blockage starts again. This is because the nasal mucosa and turbinates swell after taking tempon. It takes 3-4 weeks for the blockages and crusts to completely disappear after surgery. At the end of this period, healing is completed and breathing is achieved at the desired level.
WHAT ARE THE UNDESIRABLE CONSEQUENCES (COMLICATIONS) OF THE SURGERY?
Septum deviation surgeries (septoplasty) are generally problem-free surgeries. However, as with any surgery, it can sometimes lead to undesirable consequences. Bleeding during the healing period, change/deterioration of nose shape, decreased ability to smell, dryness and crusting in the nose and nasal passages, perforation of the middle section of the nose, and recurrence of obstruction symptoms after a while are complications that may be observed. Titi It is possible to minimize these with careful pre-operative preparation, careful surgery performed by competent hands, and good post-operative follow-up and care. However, no matter how flawless the work is done, it is possible to see these complications from time to time even in the most expert hands. Of course, the patient must come for check-ups and dressings in the post-operative period until the recovery is completed and show the care and attention required by the surgery.
WHAT SHOULD BE CONSIDERED AFTER THE SURGERY?
Until your doctor tells you that the recovery is complete. It is important to avoid blows to the nose, not to blow dry nose, not to try to clean it by hand, to avoid aspirin and similar blood thinners, not to smoke, and to avoid heavy physical exercises or work.
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