Deviation of the nasal septum. Contract system Perforation of the nasal septum ICD 10

Since a deviated nasal septum causes disturbances in the normal anatomy of the nasal cavity, all conservative measures (vasoconstrictor drops, tablets, breathing exercises) have a temporary and not always pronounced effect.
  For clinical manifestations of a deviated nasal septum, surgical treatment is performed - endoscopic septoplasty. During the operation, no incisions are made on the face. As a result of its implementation, the shape of the external nose does not change. The operation lasts on average from 30 minutes to 1 hour and can be performed under either local or general anesthesia. The operation ends with the installation of special silicone plates - so-called splints and gauze tampons - into the nasal cavity, which are removed the next day after the operation. Thus, the patient only needs to stay in the hospital for 1 day, after which we send him home. For 5-7 days after the operation, it will be necessary to attend special dressings to speed up healing and prevent the formation of adhesions.
  Currently, the only method of treatment for all types of deformities of the nasal septum should be considered submucosal resection. Isolated resection of ridges and spines should be used only in rare cases. Firstly, there are usually combined curvatures, and secondly, with modern technology, a typical resection of the nasal septum is technically much easier than an isolated resection of ridges and spines.
  Some authors suggest that in elderly people, instead of submucosal resection of the nasal septum, end-to-end excision of all its layers is performed. Still, in our opinion, even in old age one should prefer submucosal resection, which does not significantly complicate the operation.
  Indications for resection of the nasal septum. Surgery on the nasal septum is indicated in cases where there are certain disorders listed above, which with sufficient clarity can be put in a causal relationship with existing deformities of the nasal septum. The curvatures themselves, accidentally discovered, no matter how pronounced they are, usually do not serve as an indication for surgery. However, if there is a pronounced deformation of the nasal septum with moderate respiratory distress at a young age, then it must be taken into account that in the future, due to age-related weakening of cardiovascular activity and respiratory muscle tone, these deviated septums can cause the onset of functional disorders. It is more difficult to operate in old age, and an operation designed to functionally reconstruct a complex respiratory apparatus and adapt the entire body to correct nasal breathing may not provide sufficient effect at this age. Therefore, in such cases, it is better to eliminate the deformation of the septum in youth. It is also necessary, in our opinion, to operate if a young person has complete or almost complete obstruction of one half of the nose due to a curvature of the nasal septum, while the patient, thanks to free breathing through the other half of the nose, has no complaints.
  Regarding the permissible age for resection of the septum, we completely agree with L. T. Levin, who performed this operation with success in both children and adults, but how. This author rightly points out that in children and people over 48-50 years of age, the indications for this operation should be significantly narrowed.
  Very often, with more or less significant curvatures of the nasal septum, there is simultaneously hyperplasia of the inferior or middle concha (or concha bullosa), or both of these conchas on the side opposite to the curvature. Often it is on this side that the difficulty in breathing is most severe. This can also be established objectively by the size of the stain from the steam that settles during exhalation on a cold spatula placed at the nasal openings. If in such cases we limit ourselves to only resection of the nasal septum, then we will not get an improvement in nasal patency not only on the side where there is hypertrophy of the conchae, but also on the side of the curvature, since the hypertrophied conchae, pressing on the septum that has become mobile after the operation, will not allow it to take a sagittal position Therefore, in such cases, simultaneously with resection of the septum, a conchotomy (or partial resection of the concha bullosa) should be performed. This is easier and better to do immediately after resection of the septum, unless unusual bleeding or the risk of subsequent synechiae, due to gross violation of the integrity of the mucous membrane of the septum during surgery, forces the conchotomy to be postponed to another session (in a month).
  Often, when the anterior sections of the nasal septum are bent, hypertrophy of the posterior end of the lower concha on the narrowed side is observed (this is established using posterior rhinoscopy before resection of the septum or with anterior rhinoscopy at the end of this operation). If this hypertrophy is pronounced, then it is better to eliminate it immediately.
  If, with a curvature of the nasal septum, the narrow side is more or less satisfactorily passable for air, and the other side is obstructed by hypertrophied turbinates, then it is better to first perform only a conchotomy. If the effect is insufficient, resection of the nasal septum is performed after 2-3 months.
  If there is hypertrophy of the soft tissues of the nasal septum, then they should be excised with scissors (if they are hanging) or (with cushion-shaped hypertrophies) destroyed with a galvanocauter, if possible submucosally. Elimination of hypertrophy of the soft tissues of the posterior sections of the vomer often presents great technical difficulties. They usually become accessible only after resection (or mobilization) of the nasal septum. The destruction of these tissues by galvanocauter must be done with extreme caution, without simultaneously cauterizing the shells in order to avoid subsequent synechiae. It is better to use conchotomes for this purpose.
  Often, when the nasal septum is deviated, there is an asymmetry in the structure of the ethmoid bone. On the side where the septum forms a concavity, the ethmoid labyrinth is increased in size compared to the opposite side.
  In such cases, simultaneously with the operation on the nasal septum, a part of the corresponding ethmoidal labyrinth should be removed, without removing the middle concha, if possible, but only placing it in a more lateral position.
  In addition to the above indications for resection of the nasal septum, this intervention must also be used as a preliminary measure for performing other operations or to ensure better results of these operations.
  Such operations include opening the frontal sinus, ethmoid cells and main sinus, operations on the lacrimal sac, etc.
  In rare cases, resection of the nasal septum is performed in order to be able to insert an ear catheter to clear the eustachian tube.

Perforation of the nasal septum is a common problem that can lead to dangerous complications. To cope with the disease, you need to contact an otolaryngologist in a timely manner. The specialist will conduct a detailed diagnosis and select adequate therapy.

Etiology of pathology

This term refers to damage to the nasal septum, which is accompanied by the appearance of a through hole in the cartilage.

Symptoms of the disease include a burning sensation, dryness and itching. The disorder may also be accompanied by mucous or purulent discharge.

According to ICD-10, the disease is coded under the code J34.8. Other specified diseases of the nose and nasal sinuses.

Reasons

The key factors that lead to perforation of the nasal septum include the following:

1. Surgical interventions performed by unqualified doctors (for example,).
2. Infections that destroy cartilage.
3. Systemic lesions of connective tissues.
4. Traumatic injuries to the nose of various types, lack of treatment for hematomas.
5. Tumor formations in the nose.

One of the factors in the appearance of perforation is the constant influence of toxins on the nasal cavity. This is most often observed when exposed to harmful production factors.

Inspection of the nose for septal perforation:

Symptoms of perforation of the nasal septum

The appearance of a hole in the nasal septum leads to the following symptoms:

1. Changing the shape of the nose. This sign is observed when a hole of impressive size appears. As a result, the nose collapses and takes on a saddle-shaped appearance.
2. Whistles when breathing. This is observed if the hole is small.
3. Formation of crusts in the perforation area.
4. Constant.
5. Thick or liquid. They may have bloody or purulent impurities and an unpleasant odor.

Diagnostics

Only a doctor can detect perforation by examining the nasal mucosa. For this purpose, the specialist uses a special mirror and bright light.

Diagnosis of perforation of the nasal septum

Conservative treatment

If a person does not have obvious signs of perforation and does not feel discomfort, special therapy is not needed.

Antibiotics

Moisturizing and cleansing

If the hole is small, doctors advise maintaining normal moisture in the mucous membrane. For this purpose special substances are used. It is also worth lubricating your nose with products that contain Vaseline.

If a person experiences serious discomfort due to the appearance of crusts, doctors advise more often. To do this, you can use special substances containing sea water. Emollient ointments and other medications are also used.

Surgery

In difficult situations it will not be possible to do without surgical intervention. This procedure is performed when unpleasant symptoms appear.

Operation Friedman and Fairbanks

Using this method, it is possible to cope with holes no larger than 2 cm. During surgery, not only autografts that are taken from the patient can be used, but also synthetic materials.

Tardi method

This technique allows you to cope with impressive holes - up to 5 cm. The essence of the procedure is that the hole is closed with a part of the mucous epithelium, which is taken from under the patient’s upper lip.

Open surgery to restore a perforated nasal septum:

Prosthetics, implants

In difficult situations, when it is difficult to close the membranes or the lesions are too extensive, the doctor implants an implant into the septum. This remedy does not restore tissue, but helps normalize air flow and helps cope with severe

Forecast

The outcome of the disease depends on the nature of the defect and the timeliness of therapy. If the operation is performed correctly, it is possible to restore the shape of the nose and normalize breathing.

Perforation of the nasal septum is a common pathology that leads to unpleasant symptoms. As a result, the quality of human life is significantly reduced. To avoid such consequences, you need to consult a doctor in a timely manner and strictly follow his instructions.

Popular and accessible information about perforation of the nasal septum and dangerous consequences:

Deviation of the nasal septum (deviation of the nasal septum, deformation of the nasal septum, ridge of the nasal septum, spike of the nasal septum) is a change in its shape resulting from trauma (fracture) or abnormal formation of its osteochondral skeleton, causing difficulty in nasal breathing or the development of changes or diseases neighboring organs (turbinates, paranasal sinuses, middle ear, etc.),

ICD-10 code

• M95.0 Acquired nasal deformity.
• J34.2 Deviation of the nasal septum.

Epidemiology of deviated nasal septum

A perfectly straight nasal septum in an adult is extremely rare. In most cases, it has physiological bends and thickenings. Thickening of the nasal septum in the area of ​​the articulation of the cartilage of the nasal septum with the anterior edge of the perpendicular plate of the ethmoid bone is considered normal. Another thickening is located in the basal sections - in the area of ​​​​the connection of the lower part of the cartilage of the nasal septum with the upper edge of the vomer and premaxilla. Small smooth C- and S-shaped deviations are also not considered pathology.

The prevalence of deviated nasal septum as a nosological form is difficult to determine, because it does not depend on the shape and degree of deformation itself, but on the symptoms that this deformation causes. The presence of even pronounced deformation may not manifest itself clinically if the width of both halves of the nasal cavity is equalized due to the adaptive capabilities of the surrounding structures, primarily the inferior and middle turbinates. These anatomical formations, located on the lateral walls of the nasal cavity, can change their shape and size; inferior nasal turbinates - due to vicarious hypertrophy or, conversely, a decrease in the volume of cavernous tissue, middle ones due to pneumatization or changes in the shape of the bone frame.

Due to the lack of a clear formulation of what exactly should be considered curvature (deformation), statistical information on the prevalence of this disease varies on a very wide scale. Thus, R. Mladina and L. Bastaic (1997), examining the prevalence of deviated nasal septum in the population , identified it in almost 90% of adults. A.A. Vorobiev and V.M. Morenko (2007), during an examination of 2153 adults, revealed a curvature of the nasal septum in 58.5% of those examined (39.2% of women and 76.3% of men). What is clearly meant here is the simple presence of one or another form of deformation, revealed by anterior rhinoscopy, and not the symptoms caused by it. R. Mladina (1987) tried to compare the prevalence of deviated nasal septum and its variants in different ethnic groups. Based on a survey of 2,600 randomly selected people in different countries of the world, the author was unable to identify differences in the prevalence of various types of nasal septum deformities in people belonging to different ethnic groups and living in different geographical areas. The incidence of deviated nasal septum in various diseases is of particular interest. Thus, in chronic rhinosinusitis, clinically significant deformations of the nasal septum were found in 62.5% of the examined patients (A.S. Lopatin, 1989).

Screening for deviated nasal septum

Performing anterior rhinoscopy in combination with the active collection of patient complaints during preventive examinations is considered a completely reliable and sufficient method for identifying deviations of the nasal septum.

Classification of deviated nasal septum

In the history of otorhinolaryngology, several attempts have been made to classify various types of deformities of the nasal septum. The classification of M. Cottlet, which is based on the localization of deformation, is considered classic. The author identifies five anatomical zones of the nasal septum and, accordingly, five types of deformation depending on its predominant localization. This classification has its pros and cons. The advantages include the differentiation of some clinically important types of deformities that require technically different surgical approaches, in particular deviation of the nasal septum in the anterosuperior sections (in the area of ​​the nasal valve) and ridges in the posteroinferior sections (in the area of ​​the suture between the upper edge of the vomer and the perpendicular plate of the ethmoid bone, in which also penetrates the sphenoid process of the cartilage of the nasal septum). The disadvantage of the classification is that it is difficult to determine the nature of deformities that cover all or several anatomical sections, in particular complex post-traumatic curvatures.

R. Mladina proposed another classification of deformities of the nasal septum, in which seven main types of deformities are distinguished:

1. a slight lateral displacement of the nasal septum in the area of ​​the nasal valve, which does not interfere with its function;
2. a slight lateral displacement of the nasal septum in the area of ​​the nasal valve, disrupting its function;
3. deviation of the nasal septum opposite the anterior end of the middle turbinate;
4. a combination of types 2 and 3 on opposite sides of the nasal septum;
5. the location of the ridge in the anterior-basal sections of the nasal septum on one side, the opposite side is straight;
6. the location of the ridge in the anterior-basal sections on one side, the “gorge” on the opposite side;
7. combinations of all of the above types of deformities (usually the so-called crushed nasal septum with post-traumatic deformities).

Since any classification in medicine not only systematizes the available information about any group of diseases, but also the choice of an adequate treatment method is based on it, it is advisable to use a working scheme that allows not only to distribute all curvatures of the nasal septum into certain groups, but also makes it possible choose the most appropriate method of surgical correction of this deformity. Thus, C-shaped deviation, S-shaped curvature and ridge or spike of the nasal septum, as well as their various combinations, should be distinguished. However, there is another separate group, including complex post-traumatic deformations of the nasal septum, which do not fit into any of the above categories.

Causes of a deviated nasal septum

According to the etiological principle, deformations of the nasal septum can be divided into main groups at the bottom: post-traumatic and resulting from anomalies in the formation of the osteochondral skeleton.

Symptoms of a deviated nasal septum

The main symptom of a deviated nasal septum is difficulty in nasal breathing, which can be unilateral or bilateral. With a pronounced displacement of the nasal septum to the right or left (especially in the anterior sections), the patient complains of difficulty or lack of breathing through the corresponding half of the nose, but this is completely unnecessary. Often, the subjective feeling of insufficient breathing through one or another half of the nasal cavity does not correspond to the shape of the nasal septum. More often, difficulty in nasal breathing is either constant, equally pronounced on both sides, or intermittent due to the nasal cycle.

Treatment of deviated nasal septum

Restoring nasal breathing

Surgical correction of curvatures is usually performed in a hospital.

Surgical treatment of deviated nasal septum

Depending on the identified variant of the deformity, the corresponding method of surgical correction is selected (for example, for a C-shaped deformity - laser septa with an eraser or septoplasty using the principles of biomechanics; for isolated ridges/spines in the posteroinferior regions - endoscopic submucosal resection).

The nasal septum is a wall that consists of cartilage at the front and thin bone at the back. It divides the nasal cavity into two halves. A deviated nasal septum can cause various problems with nasal breathing, and sometimes can cause it to stop completely.

All this can increase the tendency to various allergic and inflammatory diseases of the respiratory system, lead to neurotic conditions, headaches, and negatively affect the cardiovascular and genitourinary systems.

The following main types of deviated nasal septum are distinguished:

• Direct deviation of the nasal septum
• Crest
• Mixed, can combine 2 or 3 curvature options.

A deviated nasal septum can occur in such varieties as:

• in horizontal or vertical plane
• one-sided or two-sided
• from the front partition or from the rear part
• with capture of a certain area of ​​the septum.

The most common deviation of the nasal septum is concentrated on the anterior side.

Deviated nasal septum: ICD code 10

A change in the shape of the nasal septum appears as a result of an abnormal development of the facial skeleton or injury. The altered part often has cartilaginous or bone thickenings in the form of a spike or ridge.

Deviated nasal septum: ICD 10 code – J34.2 Displaced nasal septum. Types and causes of deviated nasal septum

Deviation of the nasal septum is divided into traumatic, physiological and compensatory, depending on the reasons that caused it.

• Physiological curvatures appear due to uneven growth of bone and cartilage tissue.


• Traumatic curvatures occur as a result of mechanical damage. They may also be accompanied by fractures of the nasal bones. In babies, traumatic curvatures can occur at birth, and during childbirth, the child may experience dislocation of the cartilage of the nasal septum. Even a slight injury to the septum during growth can lead to its abnormal growth in the future.


• Compensatory curvatures are a combination of anatomical disorders of several formations of the nasal cavity. The most common disorder is an enlargement of the nasal turbinates, which are constantly in contact with the septum, resulting in the formation of a curvature of the nasal septum over time.

Symptoms of the disorder
The main symptoms include the following:

• Difficulty breathing through the nose.
• Snore.
• Dry nose.
• Chronic diseases such as sinusitis, sinusitis, ethmoiditis.
• Allergic reactions.
• Deformation of the shape of the nose.

As a result of a violation of the form, changes in the vascular system, blood, and genital area can occur. The immune system also suffers; the human body is more susceptible to aggressive environmental factors and hypothermia.

To prevent all these consequences, it is necessary to contact an ENT specialist in a timely manner. A change in the shape of the nasal septum is established during an external examination, but for the most part it is revealed during rhinoscopy.

How to treat a deviated nasal septum

If you have a disorder such as a deviated nasal septum, treatment at home is impossible. This is a violation of the anatomy of the nose, so it can only be treated surgically. The operation, which is called septoplaty, is a plastic operation, is performed endonasally - through the nose, no incisions are made on the facial skin.

This operation is performed in a hospital as planned. Anesthesia is local, but if the patient wishes, general anesthesia can be used. The operation is performed in children from 14 to 16 years of age, but in case of severe breathing problems – from 6 years of age. The duration of the operation is 15-30 minutes. Complications after it are extremely rare.