Normalization of the function of nasal breathing in infants. New approaches

In case of violation of the structure of the cartilaginous tissue, the patient is diagnosed with a curvature of the nasal septum. This part is the wall between the two sinuses of the nose, which divides the cavity into the left and right parts. The cartilage structure is made of flexible tissue coated with skin. A large number of vessels that feed this part are concentrated on it. In perfect condition, the septum is exactly in the middle of the nasal cavity.

According to statistics, today, almost eighty percent of people have curved nasal septum. In most cases, it shifts slightly from the center and does not bring discomfort. Most often, this pathology occurs in children. With a strong violation of the structure of the septum, it can provoke respiratory disorders and become the root cause of chronic rhinitis. Therefore, if you notice discrepancies, it is important to know the symptoms and treatment of a deviated septum in children.

The wrong structure of the nasal septum is most often diagnosed in adolescents and children. Such a pathology causes the formation of prolonged rhinitis, breathing problems, as well as abundant secretions of a mucous appearance. In addition, with a curved septum, inflammatory problems arise, as well as a tendency to allergic reactions.

jaw expansion

Deviations in the structure of the partition occur at the start of a child's growth.

Usually this process occurs at the age of six, when the patient's molars erupt.

In connection with the expansion of the jaw, the nasal cavity changes. This process becomes main reason deviated septum in children.

Congenital etiology

Among the frequently encountered causes, an innate predisposition is manifested, when, being in the mother's stomach, the formation of the child's nose is wrong. The same reason includes various injuries during birth.

Traumatization

The most common reason is considered nose injury. Violating the structure inside the nose can be a strong blow to one part of the cavity, as well as active games or a serious passion for various martial arts.

Other reasons

Other common reasons include the following signs:

1. The nasal septum may change with a mismatch in the growth of the bones of the skull and a rapid increase in cartilage in the nasal cavity.
2. Due to the pressure inside the nasal cavity due to the penetration of a foreign object or the formation of a tumor or polyp, the septum is primarily affected.
3. With infectious inflammation, a thickening occurs in the nasal part, which leads to a modification of the cartilage.

During the anatomical change, the patient notices that one cavity becomes much wider than the other. This modification leads to many symptoms. If the curvature of the septum is not serious, then the process is not considered a serious pathology.

Symptoms

With the correct structure of the nasal cavity, air enters evenly and penetrates through both parts. When you inhale, oxygen is moistened, warmed and filtered, and then penetrates into the paranasal sinuses.

When the septum is deviated, the inhaled air leads to irritation of the mucous membrane, which leads to various processes in the paranasal sinuses and the Eustachian tube.

Loss is noted among the main signs of a curvature of the septum. With the slow development of the deviation, this dysfunction manifests itself slowly, so the patient does not always notice such a symptom immediately.

Besides, there is a violation of breathing and a constant nasal congestion is manifested.

In some cases, a deviated septum causes or acute. As a result, the patient has pain in the head, stuffy ears, pain in the throat, bleeding.

Pathology in the structure of the nose always causes other inflammations in the mucous membrane associated with the functions of the respiratory organ. Often, a violation in the structure of the septum causes seasonal allergic rhinitis.

Other symptoms include:

• blockage of the right or left nostril;
• but only from one cavity;
• frequent and unexpected nosebleeds;
• dryness of the mucous membrane;
• pain in the front;
• noisy breathing;
• headache;
• snore;
• sleep on one side;
• frequent viral or infectious inflammations;
• swelling of tissues in the nasal cavity;
• airflow obstruction.

However, at the initial stage of the curvature, the patient may not notice the symptoms. Therefore, with a curvature of the septum, the patient may not be aware of his pathology. People with a noticeable curve are at risk for acute sinusitis, frequent bleeding, and other problems. They can only be removed through surgery.

Treatment Methods

When wondering what to do if a child has a deviated septum, the first step is to undergo a diagnosis. You can determine the obvious symptoms without the help of a doctor, but to conduct a comprehensive examination, contact the ENT.

In some cases, a deviated septum can be treated with medication. Drops and nasal sprays will help eliminate tissue swelling and restore air permeability. To restore the functions of the nose completely, it is necessary to wash the nose, as well as taking decongestant medications.

It is worth noting that drug treatment can be justified and effective only in the case of a non-serious pathology. If the patient has a noticeable curvature, doctors prescribe surgical intervention.

During the operation, the patient straightens the cartilage and bones in the nasal cavity. Such therapy is carried out under local anesthesia and only after taking certain medications.

Nasal septum plasty

To repair the septum, the patient can choose plastic surgery. In this case, the surgical effect is carried out through the patient's nostrils. The advantage of plastics is the absence of scars and adhesions on the outer part of the nose, as well as absolute painlessness.

The whole procedure takes about one hour. After the operation, nasal breathing is restored within eight weeks.

During the rehabilitation period, the patient must use antiseptics and antibacterial drugs, as well as adhere to the medication course prescribed by the doctor.

During recovery, the patient must visit a doctor twice a month. This is necessary to prevent the formation of adhesions and disruption of tissue fusion.

If the curvature manifested itself in the baby, you should wait for eighteen years. Until this age, the child continues to grow and the operation may disrupt the natural growth of the nose.

Septoplasty

AT In certain cases, the patient may opt for reconstructive plastic surgery. When choosing septoplasty, the incorrect structure of the nasal septum is corrected.

The procedure passes through the nostrils, but in extremely difficult moments, doctors can perform the operation with an open method.

When choosing septoplasty, it is necessary to be aware of the formation of scars, scars and adhesions. However, The main goal of the operation is the rapid restoration of breathing.

The rehabilitation period lasts up to seven days. After the operation, there is swelling of the face, bleeding, negative reactions to medications and pain in the nasal cavity. They usually pass on the fifth day.

In the first month after surgery, the patient has pain in the head, swelling, bleeding, often bursting vessels in the nasal cavity. Perfect recovery comes during two months.

Prevention

Unfortunately, there is no way to prevent a deviated septum. But you can protect yourself by avoiding any damage. To do this, when playing actively or participating in contact sports, wear a protective helmet and be extremely careful.

A deviated septum is a very common condition. In fact, a perfectly flat nasal septum is a big exception. But its deformities are not always regarded as a pathology and in most cases do not need treatment.

If the curvature of the nasal septum is expressed strongly enough, then it can lead to a number of complications. In this case, they say about the presence of the disease. Treatment by an otorhinolaryngologist (ENT doctor) is indicated.

According to statistics, the curvature of the nasal septum practically does not occur in childhood. The peak of detection occurs in adolescents aged 13-18 years - a period when there is a rapid growth of the body.

nose anatomy

The structure of the nose:

• nostrils- inlets through which air enters the nasal cavity;
• elementary department of the nasal cavity - a space that is divided into the right and left halves by a vertical nasal septum;
• nasal passages - located posterior to initial department nasal cavity, there are lower, middle and upper nasal passages, which are respectively limited to the upper, middle and lower nasal concha;
• choanae - two openings through which the nasal cavity communicates with the nasopharynx.

• Anterior superior wall formed by the bones of the skull (process of the upper jaw, nasal bones) and nasal cartilages.
• Inferior wall - floor of the nasal cavity, - formed by the palatine processes of the upper jaws (hard, or bone, palate), as well as the soft palate.
• Lateral walls of the nasal cavity formed mainly by the ethmoid bone.
• Nasal septum, which divides the nasal cavity in half, is formed in the back by the vomer, and in the front by cartilage.

nasal turbinates- bone formations that are located in the back of the nasal cavity and divide it into three nasal passages - upper, middle and lower. The superior and middle nasal conchas are processes of the ethmoid bone. Lower turbinate- an independent small bone.

The nasal passages communicate with the paranasal sinuses:

• superior nasal passage communicates with the posterior ethmoid sinuses and the sinus located in the sphenoid bone.
• middle nasal passage communicates with the anterior and middle ethmoid sinuses, with the maxillary sinuses (sinuses located in the bodies of the maxillary bones).

The sphenoid bone is located at the base of the skull and is practically invisible from the outside. She has a body in the form of a cube, from which "wings" extend to the sides. Inside the body is an air cavity - the sphenoid sinus.

Functions of the nasal cavity:

• conduction of air into the nasopharynx and larynx;
• moistening the air with the secretion of glands located in the mucous membrane;
• warming the air flow - the venous plexus located under the mucosa is responsible for this function;
• protection respiratory tract from mechanical irritants: hairs and mucus in the nose trap dust particles and bring them out;
• protection against infection: nasal mucus traps pathogens and removes them from the nasal cavity, has bactericidal qualities;
• The olfactory region of the nasal cavity is responsible for the reception (perception) of odors.

The nasal septum divides the inhaled air into two equal streams, which ensures their linear movement along the respiratory tract. Optimal conditions are achieved for the nasal cavity to perform its functions (warming, cleansing, humidifying the air). If the configuration of the nasal septum is violated, these functions are also violated.

In a newborn baby, the nasal septum is always straight and even. It is still difficult to distinguish between the bone and cartilaginous parts in it: almost all of it is cartilage, in which there are several foci of ossification. Gradually, they turn into bones and grow together. Violation of this process leads to the occurrence of curvature of the nasal septum. The initial causes of emerging violations are not always possible to accurately establish.

Causes of deviated septum

Classification of the causes of the curvature of the nasal septum

Physiological causes : associated with heredity and dysplasia of the skull bones.	Traumatic causes	Compensatory reasons: the nasal septum is deformed due to the presence of other pathological formations in the nasal cavity.***
Uneven growth of the skull. The human skull consists of the facial and cerebral sections. The facial skull is formed from the top and mandible, zygomatic, palatine bones, etc. The cerebral part of the skull is represented by the frontal, temporal, parietal, occipital, ethmoid, sphenoid bones. If uneven growth of the facial and cerebral parts of the skull is noted, then the dimensions of the nasal cavity also change. It becomes "cramped" for the nasal septum. As a result, the latter has to bend.	According to statistics, deviated septum is more common in teenage boys and men. This is the contingent among which injuries of the skull and face are most common. As a result of a strong blow, the nasal bones are displaced. It can lead to curvature of the nasal septum, even if it is minor. The most severe deformities are caused by improper fusion of the bones of the nose after a fracture.	Hypertrophy(overdevelopment) of one of the turbinates. The enlarged shell puts pressure on the nasal septum and causes it to shift.
Uneven growth of the skull. The human skull consists of the facial and cerebral sections. The facial skull is formed from the upper and lower jaws, zygomatic, palatine bones, etc. The medulla of the skull is the frontal, temporal, parietal, occipital, ethmoid, sphenoid bones. If uneven growth of the facial and cerebral parts of the skull is noted, then the dimensions of the nasal cavity also change. It becomes "cramped" for the nasal septum. As a result, the latter has to bend.		Polyps and tumors of the nasal mucosa. If they reach a sufficiently large size, they disrupt the breathing of one nostril. Deforming, the nasal septum tries to compensate for this condition.
Excessive development of the rudiment of Jacobson's organ. This cause of the curvature of the nasal septum is extremely rare. Jacobson's organ is developed in reptiles, which, with the help of it, are able to literally “taste the air”. A person has only its rudiment, represented by a cluster of nerve formations behind the olfactory region. If this rudiment is developed excessively, then it limits the space for the growth of the nasal septum, a curvature occurs.		Persistent stuffiness of one side of the nose. The curvature of the nasal septum in this case is an attempt to adapt to breathing through one nostril, to make it more complete.

*** In this case, it is often difficult to figure out whether the violation of nasal breathing is the cause of the curvature of the nasal septum, or its consequence.

Disorders that occur when the nasal septum is deviated

Difficulty in nasal breathing

• Narrowing of the nasal passage on the side of the convexity of the septum. A decrease in the volume of space on one side leads to difficulty in passing the air flow up to the complete inability to breathe through one nostril.
• Violation of air dynamics inside the nasal cavity. Normally, during inhalation, the air in the nose rises and passes through the middle and partially upper nasal passage. During exhalation, it goes into the lower nasal passage. With a curvature of the nasal septum, a violation of the air flow even through one nasal passage leads to difficulty breathing. Despite the fact that the other two nasal passages on the same side may have a normal lumen.
• Narrowing of the nasal passage and respiratory failure on the side of the concavity of the deformed nasal septum. Often, the symptoms here are even more pronounced than on the side of the bulge. As a result of the expansion of the nasal passage, compensatory hypertrophy (growth) of the turbinates occurs. Over time, they become so large that they begin to make breathing difficult.
• The reaction of nerve endings (receptors) of the mucous membrane of the nasal cavity. Normally, the air flow in the nose is uniform. When the nasal septum is deviated, turbulence occurs in it. They irritate sensitive receptors located in the mucous membrane. A reflex protective reaction occurs: the vessels of the mucosa expand, its edema occurs, and a large amount of mucus is released.
• Suction of the wing of the nose to the septum. This is often noted in the curvature of the septum in the front. The wing of the nose constantly adjoins the septum tightly, as a result, the passage of air is sharply hampered.

Changes in the nasal mucosa

As a result of turbulence, the air in the nasal cavity constantly hits the mucous membrane in a certain place. Here she thickens epithelial cells lose eyelashes. Protective functions are violated, the process of cleansing the mucosa from foreign particles and mucus. The secreted mucus dries up, forming crusts.

The mucous membrane of the nasal cavity becomes more vulnerable to pathogens.
Rhinitis develops - runny nose, constant nasal congestion.

Oxygen starvation of organs and tissues

Mouth breathing

Disadvantages of mouth breathing:

• Not moistened and not warmed air enters the lungs: as a result, gas exchange in the alveoli is not carried out as efficiently as during nasal breathing. Less oxygen enters the blood.
• The protective properties of nasal mucus are switched off from work. Increased chance of developing respiratory infection.
• Mouth breathing can eventually lead to adenoiditis - inflammation of the pharyngeal tonsil.

Nerve disorders

Reflex disorders in the curvature of the nasal septum:

• Bronchial asthma- there is a kind of disease, the main cause of which is a neuropsychic imbalance.
• spasms of the larynx, manifested in the form of short attacks of suffocation.
• Convulsive epileptic seizures.
• Reflex sneezing and coughing.
• Dysmenorrhea in women- Violation of the frequency and duration of menstruation.
• Disorders of the eyes, heart and other organs.

Violations from neighboring organs

• Eustachian tube and middle ear disorders. The nasal cavity passes into the nasopharynx, on the mucous membrane of which there are pharyngeal openings of the auditory, or Eustachian, tubes on the right and left. The Eustachian tube connects the nasopharynx with the middle ear cavity (the tympanic cavity, which contains the auditory bones: anvil, stirrup, hammer). Chronic inflammation resulting from a deviated septum allows mucus and infectious agents to enter the auditory tube and tympanic cavity.
• inflammation paranasal sinuses nose - sinusitis. A direct connection between the curvature of the nasal septum and the development of inflammatory processes in the paranasal sinuses has been proven. These patients often develop sinusitis (inflammation of the mucous membrane of the maxillary, or maxillary sinus) and frontitis (inflammation of the frontal sinus).
• Inflammation of the lacrimal ducts and lacrimal sac. The tear that is produced by the lacrimal glands normally flows into the nasal cavity through the nasolacrimal canal. It can serve as a route for the spread of infection.

Types of curvature of the nasal septum:

• deviated nasal septum
• crest
• a combination of two or three types of curvature

• in vertical or horizontal plane
• in the anterior or posterior part of the nasal septum
• one-sided and two-sided
• with the capture of the cartilaginous part of the septum (there are so-called dislocations of the cartilage when it is separated from the bone), the vertical plate of the ethmoid bone (forms the anterior part of the bony nasal septum) or the vomer (forms the back of the nasal septum)
• S-shaped, C-shaped, in relation to the bone crest of the upper jaw.

The development of complications in the curvature of the nasal septum depends on the severity and type of deformation. Almost every adult has a slight curvature, but it does not lead to respiratory failure. There are cases when significant deformations do not interfere with the normal flow of air.

More often there are curvature of the nasal septum in the anterior part. Less commonly, the coulter located behind is captured. The rear edge of the coulter is almost always exactly vertical.

Ridges and spikes are usually located on the upper or lower edge of the opener. They may have different length, are directed in different directions. Sometimes they protrude into the mucous membrane on the opposite side. Most often, spikes and ridges consist only of bone tissue. Sometimes their tops can be represented by cartilage.

But even a slight curvature of the septum in the anterior part can create air turbulence, which then intensifies and significantly disrupts nasal breathing.

Symptoms of a deviated septum

• Difficulty in nasal breathing. The symptom can be in varying degrees: from a slight violation to the complete inability to breathe through the nose (in this case, the patient breathes through the mouth). However, the absence of this complaint is not a sign that the curvature of the nasal septum is also absent. If the deformation occurred at a young age, then the body can compensate for it for some time. The patient does not complain of difficulty in nasal breathing. If a nasal cavity is large, then there is no problem.
• Chronic rhinitis- runny nose. It manifests itself in the form of nasal congestion, constant mucous secretions. Sometimes the patient does not go to the doctor for a long time, because he believes that he has frequent colds, and the whole point is to reduce immunity.
• allergic reactions. The changes that occur in the nasal cavity as a result of the curvature of the nasal septum are always accompanied over time by a violation of local defense mechanisms and immunity. This is manifested not only in a decrease in resistance to infections, but also in the appearance of allergic reactions. Allergic rhinitis is a common problem among individuals with a deviated septum. Chronic rhinitis is betrayal- a condition against which it often develops bronchial asthma. The patient complains to the doctor that nasal congestion and discharge occur mainly during contact with an allergen, for example, pollen from certain plants.
• Headache. A spike, ridge, or deviated nasal septum may come into contact with the nasal mucosa and exert pressure on it. Constant irritation of nerve receptors leads to the development of reflex headaches.
• Dryness in the nose, discomfort and discomfort during nasal breathing. A symptom that develops as a result of prolonged irritation and inflammatory process in the nasal cavity.
• Nosebleeds. They are also the result of irritation of the mucous membrane. On the side where there is a bulge on the nasal septum, the mucous membrane is very thinned. Even with a slight impact, it is easily damaged.
• Snoring at night as a result of nasal obstruction.
• Increased fatigue, decreased performance, reduced resistance to physical activity . These symptoms are associated with impaired nasal breathing and insufficient oxygen supply to the blood from the lungs.
• Frequent infections that occur with symptoms of acute respiratory infections (runny nose, cough, sneezing), fever.
• Symptoms chronic inflammation pharynx and larynx: perspiration, dryness and sore throat, cough.
• Symptoms of inflammation in the middle ear: pain, hearing loss.
• Violation of the shape of the nose. This symptom characteristic of the curvature of the nasal septum of traumatic origin.
• In severe cases, the patient and his relatives note periodic convulsive epileptic seizures, visual impairment, heart pain and increased blood pressure, shortness of breath and other symptoms. They can also be associated with deformities of the nasal septum.
• Deterioration of memory, thinking, absent-mindedness. Schoolchildren with deviated nasal septum have reduced school performance over time.

Diagnostics of the curvature of the nasal septum

Visual inspection

Nasal breathing is assessed separately for the right and left nostrils. The patient is asked to close the left nostril with a finger, and a piece of cotton wool or thread is brought to the right. Look at its oscillation during inhalation and exhalation. Then the manipulation is repeated for the left nostril.

To assess the sense of smell, one nostril is also clamped, and a piece of cotton dipped in a solution is brought to the second odorous substance. The patient is asked to take a breath and name the smell. Usually, when the nasal septum is deviated, the sense of smell is reduced, on one or both sides.

Rhinoscopy

How is an anterior rhinoscopy performed?

Anterior rhinoscopy is performed using a special nasal dilator (see picture).
The doctor asks the patient to slightly raise his head, lifts his nose tip and inserts the instrument into the nostril. Using a button probe (see picture), the otolaryngologist can better examine the nasal cavity and assess the consistency of the formations inside.
Anterior rhinoscopy is performed separately for each nostril.

Disorders that can be distinguished from a deviated septum during anterior rhinoscopy:

• polyps mucous membrane
• hematomas- hemorrhages under the mucous membrane, which, reaching large sizes, can make nasal breathing difficult
• tumors in the nasal cavity
• abscess- an abscess.

How is posterior rhinoscopy performed?

Posterior rhinoscopy is an examination of the nasopharynx and nasal cavity from the choanal side. To do this, the doctor asks the patient to open his mouth, moves his tongue with a spatula and inserts a special mirror into the nasopharynx.

Additional instrumental studies in the curvature of the nasal septum

Study	Indications
Skull x-ray	assessment of the condition of the paranasal sinuses; detection of anomalies from the bones of the skull; identification of existing deformities after a nose injury.
CT scan	Identification of ridges and spikes that are located in the back of the nasal septum and are not visible during rhinoscopy.
Endoscopic examination of the nasal cavity It is carried out using a rhinoscope - a thin probe, at the end of which there is a miniature video camera. It is inserted into the nostril and pushed a little deeper. Most patients tolerate the study well. Held local anesthesia nasal mucosa with anesthetic sprays.	Identification of formations in the nasal cavity that are inaccessible for examination during anterior and posterior rhinoscopy.

Laboratory research methods for curvature of the nasal septum

Treatment of deviated septum

Indications for surgery for deformities of the nasal septum:

• Obstruction of nasal breathing on one or both sides. Surgical intervention is absolutely indicated, provided that the difficulty in breathing is caused precisely by the deformation of the nasal septum.
• Chronic rhinitis- inflammation of the nasal mucosa.
• Otitis and eustachitis (inflammation of the middle ear and the auditory, or Eustachian, tube), the initial cause of which is a violation of the shape of the nasal septum.
• Inflammation of the paranasal sinuses (sinusitis): sinusitis, ethmoiditis (inflammation of the cells of the ethmoid bone). Surgery is indicated if these complications are caused by a deviated septum.
• Frequent recurring headaches.
• External cosmetic defects. Sometimes, in rare cases, after fractures, the back of the nose is simultaneously aligned and septoplasty is performed.

Contraindications to septoplasty for deviated septum:

• old age. With age, respiratory failure due to the curvature of the nasal septum is partially compensated. Therefore, the symptoms of the disease become less pronounced. In older people, atrophy of the nasal mucosa occurs, so the operation is difficult, the risk of complications is high.
• Violation of blood clotting. For example, septoplasty is contraindicated in people with hemophilia.
• Severe illnesses of cardio-vascular system.
• Diabetes.
• Mental illness.
• Malignant tumors.
• severe infections.
• The general serious condition of the patient.
• For children and persons over 48 years of age, the operation can be performed, but the indications for it at this age are narrowed.

Preparation for septoplasty

AT admissions office the patient is examined and the date of hospitalization is set. Prior to this, it is necessary to pass a standard set of tests. This can be done at a local clinic.

A couple of weeks before the upcoming operation, the patient should refuse bad habits, avoid hypothermia and infections. It is necessary to cure bad teeth and eliminate other foci of inflammation in the body.

Loss during operation a large number blood due to the fact that the nasal mucosa is abundantly supplied with blood. For women, it is better to plan the operation 2 weeks after menstruation.

An additional examination may be scheduled before the operation in the hospital. If the intervention is planned general anesthesia, then on the day of its holding in the morning you can not eat and drink. In an hour, the patient is given premedication - medications are administered that help prepare the body for anesthesia.

Surgery for deviated nasal septum

Surgical intervention does not involve incisions on the face - access is through the nostril. The surgeon dissects the mucous membrane, separates it from the nasal septum, makes a plastic surgery and sutures it.

After the operation, turundas (tampons) soaked in a solution of hemostatic (hemostatic) are placed in the nose. medicinal product. The patient must wear them during the day.

Today, it is widely practiced to install silicone splints in the nose, which help the new septum to maintain the desired shape.

The curvature of the nasal septum in some cases is combined with the asymmetry of the ethmoid bone, a change in the shape and size of the turbinates. These disorders must also be corrected during the operation.

Endoscopic laser septoplasty

Modern technique of surgical correction of deviated nasal septum.

Advantages of laser septoplasty:

• minimal tissue trauma;
• blood loss during surgery is minimized;
• the laser has antiseptic properties;
• minimized rehabilitation measures in the postoperative period.

The main drawback of the laser is that it is not able to eliminate all deformities of the nasal septum, especially its bony part.

Postoperative period

On the 2nd - 4th day, nasal breathing is restored completely.

After the operation, the otolaryngologist regularly examines the patient, removes dry crusts from the nose, rinses with saline or sea salt solution, and conducts a nasal shower.

If in the postoperative period the patient is concerned about pain, then analgesics (painkillers) are prescribed.

Antibiotic therapy is prescribed to prevent infectious complications.

After the patient is discharged from the hospital, he is observed for a month by an ENT doctor in the clinic.

The most common complications after septoplasty surgery:

• formation of large hematomas(hemorrhage) under the mucous membrane;
• nosebleeds;
• perforation of the nasal septum- the formation of a hole, a defect in it;
• submucosal abscess formation- abscess;
• purulent sinusitis;
• nose deformity- most often there is a retraction of his back as a result of the fact that the surgeon performed a resection of the septum too high.

Can a deviated septum be treated without surgery?

Is it possible to prevent deviated septum?

How does a deviated septum manifest in children? What are the treatments?

Causes of deviated septum in children:

• Injuries during childbirth;
• Blow on one side of the nose;
• Discrepancy between the growth rates of the bone and cartilage of the nose in adolescence.

Symptoms of a deviated septum in children:

• Respiratory failure on the affected side. Parents note that periodically one nostril is completely blocked. In some cases, because of this, the child only sleeps on one side in order to optimize breathing.
• Prolonged or chronic colds . Frequent sinusitis and sinusitis are associated with increased susceptibility of mucous membranes to infection. Hypertrophied (overgrown and thickened) mucosa is the basis for the formation of a polyp - an outgrowth that blocks the nasal passage.
• Frequent tonsils (adenoids), which can cause snoring and coughing.
• Headache - sign that the central nervous system is deficient in oxygen.
• Smell disturbance. It develops gradually and is associated with damage to sensitive receptors on the nasal mucosa.

Conservative therapy(treatment without surgery for deviated septum) is the main focus in children under 15 years of age. Its purpose is to restore impaired breathing and the functions of the mucous membrane of the respiratory tract.

• intranasal glucocorticosteroids (Mometasone, Fluticasone, Beclomethasone) eliminate allergic rhinitis and drug rhinitis caused by prolonged use of vasoconstrictor drops. Use once a day, preferably in the morning.
• Cromons . Cromoglin - cromoglycic acid in the form of a spray is used to treat allergic rhinitis 4 times a day.
• Antibacterial drugs (Isofra, Polydex, Bioparox) - topical application antibiotics stops the growth and reproduction of bacteria on the mucous membranes and in the sinuses.
• Sprays mucolytics - (Sinuforte, Rinofluimucil) are used to thin mucus and facilitate its removal from the sinuses.
• Moisturizing sprays - (Salin, Aqua-Maris) moisturize the mucosa, cleanse it of microorganisms, and help strengthen local immunity.
• Vasoconstrictor drops and sprays - (Naphthyzin, Farmazolin, Knoxprey). They constrict blood vessels, reducing swelling of the mucosa, and restore nasal breathing. Drops reduce swelling of the tissues of the nose, increasing the lumen through which air passes.

The operation is preceded by a thorough examination, blood and urine tests, X-ray or tomography, endoscopic examination, cardiography.

Choice of anesthesia depends on the age of the child and the extent of the operation. As a rule, children under 5 years of age need general anesthesia. For children of school age, the operation is performed under local anesthesia.

essence of the operation. The surgeon makes an incision inside the nose. On the one hand, it separates the mucous sheet from the cartilage. The cartilage itself is then separated from the bone and adjusted. If necessary, bone defects are corrected: spikes, growths, bone ridges, and a space is formed for cartilage installation. In conclusion, the surgeon returns the cartilage, perichondrium and mucous membrane to its place, after which it sutures the wound.

In some cases, when the cartilaginous part of the septum is thinned and unable to support the shape of the nose, there is a risk of subsidence of the nose or omission of its tip. In this case, cartilage fragments are attached to a special polydioxane mesh, which serves as a support for them. The mesh is not felt by the patient and dissolves on its own after about a year. During this time, the cartilaginous septum restores its density and can independently maintain the shape of the nose.

The procedure itself lasts 30-45 minutes. It is quite unpleasant, but painless due to anesthesia. After the operation, you will have to spend 1-2 days in the hospital. At this time, the medical staff should make sure that the recovery is going according to plan, and there is no risk of complications.

Laser treatment of deviated septum. Due to the fact that in children, the curvature mainly occurs in the cartilaginous part, the best option are endoscopic laser surgeries. They are practically bloodless and less traumatic. The laser heats the cartilage to a temperature of 70 degrees, after which the cartilage becomes plastic, and it is aligned. Special tampons are introduced into the nasal passages, which give the septum correct form. However, this treatment has been practiced for only a few years, so there is no data on how heating can affect the condition of the cartilage in the future.

Another option for laser plastic surgery is a traditional operation, which is performed using a laser scalpel. This reduces blood loss and minimizes the risk of developing infectious complications. In addition, the laser tool does less damage nerve fibers, so the child suffers less pain in postoperative period.

Laser surgeries have a significant disadvantage - they are carried out only in large medical centers and their cost often exceeds $1000.

What is the cost of surgery for deviated septum?

In private ENT clinics and medical centers where highly qualified specialists operate (surgeons the highest category and professors), the price of surgery for deviated nasal septum depends on the qualifications of the doctor. So, the operation, together with a preliminary examination, anesthesia and stay in a 1-2-bed ward, will cost 300-700 USD.

Price of laser surgery in private clinics it comes from 500 to 2000 USD. Laser treatment of nasal septal curvature is a bloodless and low-traumatic method, after which the patient can return to a normal lifestyle almost immediately. However, he has one significant disadvantage– laser septoplasty can only be used if the cause of the respiratory failure is the curvature of the cartilage of the nasal septum. In adults, this happens very rarely. In them, cartilage deformations in 90% of cases are combined with bone growths, and in this case the laser will not be enough.

The cost of radio wave septoplasty comes to 1000 USD Instead of a scalpel, a high-frequency radio wave beam is used, which vaporizes soft tissue cells like a laser. The radio wave scalpel coagulates the vessels, preventing bleeding and has a bactericidal effect. According to the method, this intervention is no different from a traditional operation, and the same surgical instruments are used to correct cartilage and bone.

Aesthetic correction deviated nasal septum (rhinoplasty) costs from 600 to 4000 USD, depending on the clinic and the extent of the operation. plastic surgery are not included in the list of CHI, so they are paid in all medical institutions.

How does it feel after surgery for a deviated nasal septum?

When to see a doctor:

• rebleeding;
• strong pain in the nose 5-7 days after surgery;
• temperature rise;
• purulent discharge from the nose.

The long journey, nine months long, is finally over. After a difficult birth, in the arms of her mother, a little man is the meaning of her whole life. Mom's eyes, dad's dimple on the cheek, tiny nose ... the cutest and most beautiful baby in the world!

Despite the outward similarity with adults, the children's body is arranged somewhat differently. First of all, this concerns the respiratory organs, the main difference of which in a newborn is anatomical and functional immaturity. Along with narrow nasal passages and the inability to breathe through the mouth, many children are diagnosed with a deviated septum.

What is this pathology, and why is the curvature of the nasal septum dangerous? Consider the causes of this pathology in childhood and ways to solve this problem.

Deviated septum in children: complications in childhood.

Difficulty in nasal breathing is a common problem in infants. Due to the fact that the newborn does not know how to breathe through his mouth, not only the feeding process is disturbed, but also the night's sleep.

Many parents explain nasal congestion in a child with dry indoor air, frequent colds, and pollution. environment. Undoubtedly, these factors can cause deterioration of inhalation through the nose, but temporarily. Difficulty breathing through the nose of a permanent nature occurs with such a feature as the curvature of the nasal septum.

The nasal septum divides the nasal cavity into two parts, forming the left and right nasal passages. Formed from bone and cartilage tissue, the nasal septum in children is quite malleable and soft, which makes it vulnerable to injury and damage.

Why does a deviated septum appear in a child?

The final formation of the nasal septum occurs closer to 10 years of age. Normally, a slight deformation of the nasal septum is acceptable, which should not interfere with normal nasal breathing.

As a rule, the pathological curvature of the nasal septum in children is a consequence of:

• Trauma during childbirth;
• Growth retardation of the bones of the skull on the background rapid growth cartilaginous tissue of the nose;
• Barrier pressure foreign body or a polyp growing in the nasal cavity;
• Inflammatory processes that provoke a thickening of the nasal septum in the cartilage area;
• Curvature of the nose after a fracture, sometimes dislocation.

The timing of determining the curvature of the nasal septum to a greater extent depends not on age, but on the severity of symptoms.

Signs of deviated septum in children.

Disturbed breathing through the nose.

A characteristic symptom of a deviated septum will be difficulty breathing through the nose, often on one side. Older children with nasal congestion breathe through their mouths, newborns and infants are deprived of this opportunity. Breathing through the mouth is more shallow, which means that the body does not have time to get enough oxygen. In addition, only with nasal breathing, the air is fully moistened, cleansed and warmed.

With a significant curvature of the nasal septum on inspiration, the child has retraction of one of the nostrils. This means that the free nasal passage works "for two".

Inflammatory diseases of the upper respiratory tract.

Frequent colds, sinusitis, sinusitis, allergic rhinitis often develop against the background of a deviated nasal septum. This is due to the fact that the nasal mucosa becomes thinner, dries up, becomes loose and vulnerable to the penetration of viruses, bacteria and allergens.

Mucosal edema, frequent nosebleeds.

Night snore.

Children with a deviated septum in their sleep do not just snore, but really snore. As a result, the nights pass restlessly, mother and child do not get enough sleep. In the absence of proper treatment against the background of inadequate rest, the child develops angina pectoris, headaches, impaired attention and memory.

External signs of a deviated nasal septum: change in the shape of the nose with a shift to the left or right.

With a slight deterioration in breathing, the curvature of the nasal septum makes itself felt closer to 12-18 years of age.

Diagnosis of the curvature of the nasal septum.

It is not difficult to determine how critical the curvature of the nasal septum in a child is, it is enough to make an appointment with an otolaryngologist. The doctor examines the nasal cavity using a special device - a rhinoscope, determining the degree of curvature of the nasal septum.

Whether the nasal septum is deviated or not, you can find out with the help of:

• radiography of the bones of the skull;
• computed tomography;
• magnetic resonance imaging.

It is worth noting that most of the above studies at a younger age are performed strictly according to indications.

Deviated septum in a child. How to normalize breathing?

The only most effective way restoration of nasal breathing with a curved septum is a surgical intervention. Septoplasty, or straightening of the nasal septum, is performed at the age of 16-18 years, when the bones of the skull are already fully formed. It is acceptable to perform septoplasty in more than early age if there are good reasons for it.

The nasal septum is a bone-cartilaginous plate that divides the nasal cavity into two halves. Septal curvature is a change in the shape of this plate, in which it deviates from the median position.

Why does the nasal septum deviate

This can happen for two reasons:

1. the result of a nose injury. Any mechanical impact (impact, compression) can cause displacement of the nasal septum;
2. congenital change of the septum; when the bones of the skull ossify, a bony ring is formed (like a hole in the nose of the skull on a pirate flag), and the nasal septum continues to grow.

What is dangerous curved septum

First of all, the curvature disrupts nasal breathing. Thus, the nose ceases to perform its functions:

• warm, humidify the air, that is, prepare it for entry into the lower respiratory tract;
• stand as an outpost on the path of infection, since the nasal mucosa is saturated with substances and cells that fight infection.

With impaired nasal breathing, a person begins to breathe through his mouth, and unprepared, unpurified air enters the throat along with bacteria, causing various respiratory diseases.