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Deformations of the nasal septum, synechia and atresia of the nasal cavity

The etiologic deformation of the nasal septum may be due to physiological, traumatic, and compensatory factors. Physiological curvature occurs when there is a mismatch in the growth of the nasal septum and the bone frame into which it is inserted. The growth of the septum is slightly ahead of the growth of the facial skeleton, so its curvature occurs. In childhood, the physiological curvature of the nasal septum is insignificant and rare; they are more common in young men and adults.

Traumatic curvature of the nasal septum due to improper fusion of its fragments after injury. Compensatory curvature occurs when pressure on the septum from the side of one half of the nose of various formations - polyps, enlarged middle or lower shell, tumor, etc.

K l and n and with to and to kartin and. There are 3 types of deformation of the nasal septum - curvature, crest and spike; their combinations are quite often found. In adults, most often there is some degree of curvature or deviation from the midline of the nasal septum, which usually does not violate nasal breathing, and therefore does not require treatment.

Curvature occurs both in the vertical and horizontal planes in the front and rear sections of the septum.

Deformation of the nasal septum narrows the nasal passages and thereby makes breathing difficult through the nose; the greater the curvature, the more difficult the passage of air through the nose.

However, sometimes a significant curvature of the septum does not cause a noticeable violation of nasal breathing because the air passes quite freely above or under the curvature, and vice versa - a slight curvature of the septum, more often at the entrance to the nose, can dramatically disrupt nasal breathing.

The main complaint of the patient with deformities of the nasal septum is a violation of nasal breathing, but in some cases it indicates a headache, discharge from the nose, periodic pain in the ear, dry throat, etc. The occurrence of headache with deformations of the nasal septum can be explained by the fact that the bent part septum (spike, crest) in contact with the opposite lateral wall of the nose, presses on it, irritating the mucous membrane, which causes reflex symptoms, in particular headache, and sometimes bronchial attacks asthma and epilepsy, genital disorders, etc. In addition, catarrhal and congestive changes in the nasal mucosa may occur, due to both pressure on it of the curved septum and a violation of the patency of the nasal passages. These phenomena can contribute to the development of chronic inflammation in the nasal cavity, nasopharynx, paranasal sinuses, auditory tube, middle ear, usually on the side of the curvature.

D and a n of z deformation of the septum of the nose are established on the basis of the study of rhinoscopic picture. With an insufficient review of the middle and posterior parts of the nose, the nasal mucosa should be anemized with 1% adrenaline solution. Using a button probe, the consistency of the deformation of the septum is determined; it should be borne in mind that a change in the configuration of the septum can be explained not by curvature, but by the presence of a hematoma, abscess, and tumor of the nasal septum.

Surgical treatment of nasal septum curvature - submucosal resection of the curved septum.

Indications for surgery: difficulty in nasal breathing through one and both halves of the nose, due to deformation of the nasal septum, secondary pathological changes caused by curvature of the septum, such as chronic inflammation of the nasal mucosa, otosalpingitis, headache, sinusitis, ethmoiditis, etc. In rare cases, when the deformation of the septum is accompanied by a cosmetic defect in the external nose, at the same time, first submucosal excision of the curved part of the septum is performed, and then the nose is straightened. In childhood, submucosal resection of the nasal septum is possible with appropriate indications; in old age, when the patient is accustomed to the prevailing conditions of nasal breathing, it is usually irrational to insist on surgery.

In elderly people, as a rule, atrophic processes in the nose are expressed, which significantly worsens the conditions for the operation, and in the postoperative period leads to the formation of septal defects.

Submucosal resection of the nasal septum is carried out, as a rule, in a hospital. Previously, the patient is examined in the clinic, he receives a conclusion about the absence of therapeutic contraindications to surgery from the therapeutic status. Most often, the operation is performed in a supine position under anesthesia. In the left (or right) half of the nose, an arcuate incision of the mucous membrane to the cartilage is made, starting from the bottom to the back of the nose, departing from the outer edge of the nasal septum by 4-5 mm.
Some surgeons make an incision from the side of the greatest curvature of the nasal septum. A nasal raspator is introduced into the incision and the mucous membrane in the region of the curved part of the nasal septum is subcartially separated. Then, along the same line of the incision, the cartilage is dissected to the perichondrium of the opposite side and the mucous membrane is separated through the incision in the cartilage. Using scissors, the cartilage is dissected and the curved cartilage and bone parts of the nasal septum are removed with forceps. Cartilage should not be removed in the immediate vicinity of the nasal bridge, as sinking may occur.

Bone spikes and crests are knocked down by a straight or swallow chisel. Sometimes, in the presence of significant ruptures of the mucous membrane, flat (or straightened) parts of the removed cartilage are returned to their place. The leaves of the mucous membrane are laid along the midline, the common nasal passages are loosely tamped with elastic tampons (a finger from a rubber glove into which foam rubber is inserted) or turundas soaked in hemostatic paste. After a day, the tampons are removed. Over the next 2-3 weeks, reparative processes occur, after which nasal breathing is restored.

Of the other approaches, sublabial and open rhinoplasty methods are also used.

Reduction (mobilization) of the nasal septum according to Voyachek.

With this intervention, breaks, incisions, and displacements of the curvatures in the cartilage and bone parts are made with a chisel, forceps, branches of the Killian mirror with or without mucoperichondria separation.

Partial resection of the nasal septum is the surgeon's desire to maximize the preservation of the structures of the nasal septum with sufficient effectiveness of the intervention (submucosal cristotomy).

After surgery, catgut sutures are placed on the incision area, but often this is not necessary. Elastic tampons are introduced into both halves of the nose. In the postoperative period, a daily toilet of the nasal cavity, anemization of the mucous membrane is performed.

Complications: 1. In the early period: bleeding, hematoma of the nasal septum. As a prophylaxis, an elastic tamponade of the nasal cavity is carried out up to 2 days. In the early postoperative period, acute otitis media may occur as a result of tamponade, intracranial complication. 2. In the late period after surgery, in rare cases, atrophic rhinitis or deformation of the external nose (drooping tip, lowering of the back), perforation of the nasal septum may develop.

More common synechiae in the nasal cavity.

Among the adhesions in the nasal cavity, synechia is distinguished in the type of connecting tissue between the septum and the lateral wall of the nose and atresia - wide adhesions between the lateral and medial walls of the nose, which cover the luminal passages to varying degrees. Congenital atresia can be connective tissue, cartilage and bone.

Synechia and atresia can occur with ulcers of the nasal mucosa, scleroma, lupus, diphtheria, smallpox, typhoid, which are different in etiology, as well as with accidental or surgical injuries of the mucous membrane, after cauterization with caustic substances or galvanocauter.

The diagnosis is established using anterior and posterior rhinoscopy, palpation with a probe, endoscopy. Surgical treatment.

The adhesions in the nasal cavity and the choanal region are dissected or, if possible, excised. To prevent recurrence of adhesions between wound surfaces, rubber or celluloid strips, or tubes, are introduced for the healing period.

Synechiae and fusion in the anterior nose can be removed with a laser or a radio knife. The operation for atresia of the choan is more complicated, the surgical approach is often from the oral cavity through the vestibule of the mouth or the hard palate. With soft (non-bone) atresia, the operation is performed through the nasal cavity.

With congenital bone atresia of the choan, if the bone is too thick, it is drilled with a drill in several places and the holes are kept open for some time using the inserted drainage tubes or tampons. The formed hole can be expanded with a saw, chisel or bone forceps. The membranous adhesions are excised. Through the newly created choanal openings, rubber tubes are inserted into the nasopharynx and fixed with a tamponade of the nasal cavity. Tampons are placed around the tubes. The tubes remain in choana 10-15 days, and sometimes longer.

In newborns, the choanal artesia is often membranous, so it is eliminated by puncture of the valve with the subsequent expansion of a sharp spoon. To avoid relapse, drainages are inserted (tubes from a heterogeneous peritoneum, rubber, etc.)

With massive artesia, intranasal operations are often ineffective. In these cases, operations with external access and with plastic techniques are indicated.
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Deformations of the nasal septum, synechia and atresia of the nasal cavity

  1. Nasal septum diseases
    Curvature of the nasal septum is one of the most common rhinological pathologies. According to literature data (Voyachek V.I., 1953; Soldatov I.B., 1990 and others), it is found in 95% of people. The causes of such frequent deformation may be anomalies (variations) in the development of the facial skeleton, rickets, trauma, etc. Due to the fact that the nasal septum consists of various cartilage and bone structures, limited
  2. Hematoma, abscess, perforation of the nasal septum
    The cause of hematoma of the nasal septum, as a rule, is a nose injury, in which hemorrhage occurs between the cartilage or bone plate of the septum, on the one hand, and the mucous membrane, on the other. In rare cases, the formation of a hematoma is possible with infectious, especially viral, diseases. More often hematomas of the nasal septum are found in middle and older childhood.
    The nasal cavity (cavitas nasi) is the initial section of the respiratory tract and, at the same time, the organ of smell. Passing through the nasal cavity, the air either cools, or warms up, moisturizes and purifies. The nasal cavity is formed by the outer nose and bones of the facial skull, divided by a septum into two symmetrical halves. The nostrils are the front openings in the nasal cavity, and through the choanas are the back openings
  4. Diseases of the external nose and nasal cavity
    Congenital anomalies of the external nose in the form of its complete absence, splitting of the tip of the nose, double nose, etc. are extremely rare and do not have such practical significance as congenital and acquired changes in the nasal cavity, leading to impaired patency of the nasal cavity for inhaled and exhaled air. Narrowing and overgrowing of the nasal cavity. Congenital narrowness is sometimes observed.
  5. Features of blood supply and innervation of the nasal cavity
    Blood supply to the nasal cavity comes from a.sphenopalatina, aa. ethmoidales anterior et posterior, a. nasopalatina (branch fffi ^ jcx ^ / i of the carotid artery). These arteries are anastomosirutotic in the anterior and lower part of the septum with a.alveolans inferior and a.palatina major. Bleeding nose (locus Kisselbachii). It is located in the anterior third of the nasal septum due to the presence of a thick
  6. Clinical anatomy of the nasal cavity
    The nasal cavity (cavum nasi) is located between the oral cavity and the anterior cranial fossa, and on the sides - between the paired upper jaws and paired ethmoid bones. The nasal septum divides it sagittally into two halves, opening anteriorly by the nostrils and posteriorly, into the nasopharynx, by the choanas. Each half of the nose is surrounded by four airy paranasal sinuses: maxillary,
  7. Clinical anatomy and topography of the nasal cavity
    The nasal cavity (cavum nasi) is located between the oral cavity and the anterior cranial fossa. It is divided by the nasal septum into two identical halves, which are opened anteriorly by the nostrils and posteriorly into the nasopharynx - by the choans. Each half of the nose is surrounded by four paranasal sinuses: maxillary, ethmoid, frontal and sphenoid. The nasal cavity has four walls: lower, upper,
  8. Foreign bodies of the nasal cavity
    Most often, foreign bodies of the nasal cavity are found in childhood. Children insert various small objects into their nose - buttons, balls, folded pieces of paper, berry seeds, seeds, etc. Foreign bodies can enter the nose through the choanas during vomiting and through the outer surface of the nose in case of injuries. Part of the nasal cavity may be left behind during surgery or after tamponade
  9. Opening of the nasopharynx, nose and adnexa
    For this purpose, the Harke method is considered to be the best, which makes it possible to examine not only the nose and nasopharynx, but also the sinuses of the main bone, frontal sinuses, ethmoid bone cells and the maxillary cavity. After removing the brain and pituitary gland, the front skin flap of the head is separated from the frontal bone to the edges of the orbits and the roots of the nose and discarded on the face. Back skin flap is separated from
  10. Inflammatory diseases of the nasal cavity
    Consideration of inflammatory diseases of the nasal cavity must be preceded by a summary of a number of fundamental principles contained in the capital work of V.I. Voyacheka "Fundamentals of Otorhinolaryngology" (1953), many of which have not lost their significance at present. Inflammatory diseases of the nose V.I. Voyachek suggests considering as a reactive response of the mucous membrane and
  12. Diseases of the nasal cavity
    Cavity diseases
  13. Microendoscopic methods of surgical intervention in the nasal cavity and paranasal sinuses
    There are a number of options for endonasal endoscopic microoperations, however, all the techniques can be combined into two main varieties - these are classic methods according to Messerklinger and Wiegand, they are designed to restore the natural ventilation and drainage paths, with the smallest changes in the anatomical structures and the maximum gentleness of the mucous membrane. Most widely
  14. Atresia of the pulmonary artery with intact ventricular septum
    The pathology frequency is about 0.06-0.07 per 1000 newborns, 1-3% among all CHD, 3-5% among critical CHD. For this variant of the defect, normally formed atria and concordant atrioventricular connections are characteristic; interventricular septum intact. There is no exit from the right ventricle: approximately 75% of cases are due to the complete fusion of the valves
  15. Nose injuries
    Clinical picture Damage to the external nose is very common. The degree of damage to soft tissues, bone and cartilage skeleton depends on the nature of the injury, the direction and strength of the impact. The nasal bones and septum are most often damaged, and fractures of the frontal processes of the upper jaw and the walls of the paranasal sinuses are less common. Sometimes there is damage to the nose with a break in its tip or edge. Injuries
  16. Nose injuries
    Damage to the external nose and walls of the nasal cavity are more often observed in men and in children. Injuries to the skin of the nose are found in the form of a bruise, bruising, abrasion, and injury. During the examination, it must be borne in mind that damage often only appears to be superficial in appearance, but actually penetrates more deeply; in such a wound there may be a hardly detectable foreign body;
  17. Anatomy of the nose
    In clinical and anatomical terms, the nose is divided into external and internal departments. The external nose, nasus externus, is an important anatomical component of the face, largely determining its individual characteristics. The external shape of the nose is compared with a trihedral pyramid. In the outer nose, there are: 1) the root located between both eye sockets, 2) the tip (tip) of the nose, 3) the back
  18. Anomalies in the development of the nose
    Congenital anomalies of the external nose due to impaired embryonic development are relatively rare: this is the absence or insufficient development of the nose, the excessive growth of its parts, the abnormal location and development of the entire nose or its departments. In practice, such congenital malformations as a double nose, splitting of the nose, its formation in the form of one trunk or two
  19. Benign Nasal Tumors
    Benign nasal tumors include papillomas, fibromas, angiomas and angiofibromas, chondromas, osteomas, neuromas, nevi (pigmented tumors), warts. Некоторые авторы относили к доброкачественным опухолям и слизистые полипы, однако эти образования не имеют опухолевой структуры и представляют собой воспалительную и аллергическую гиперплазию слизистой оболочки, так называемые «певческие
  20. Туберкулез носа
    Туберкулез носа, согласно клинической классификации туберкулеза (1973), входит в группу туберкулеза органов дыхания и подгруппу туберкулеза верхних дыхательных путей. Он развивается обычно при наличии туберкулезного очага (чаще всего в легких). Микобактерии туберкулеза (палочки Коха) проникают в полость носа и его наружные покровы эндогенным путем по кровеносным и лимфатическим сосудам.
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