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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 reasons for 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, bounded above and below by other elements of the facial skull, the ideal and combined development of all these components are extremely rare, it is the inconsistent pace of development of the facial skeleton that determines one of the main causes of its deformation.

Variations in the curvature of the nasal septum are very different (Fig. 2.7.1). Displacements in one direction or another, S-shaped curvature, the formation of ridges and spikes, subluxation of the anterior quadrangular cartilage are possible. Most often, deformation is observed at the junction of individual bones and a quadrangular cartilage. Particularly noticeable curvatures are formed at the junction of the quadrangular cartilage with the vomer and the perpendicular plate of the ethmoid bone. It must be recalled that the quadrangular cartilage often has an elongated sphenoidal process, directed posteriorly toward the sphenoid bone. The resulting deformations can take the form of long formations in the form of ridges, or short in the form of spikes. The junction of the vomer with the scallop formed at the bottom of the nasal cavity by the palatine processes of both upper jaws is also a favorite localization of deformities. We cannot but mention the insidious form of curvature of the nasal septum, which doctors often underestimate in practical ENT. Such is the curvature of the quadrangular cartilage in its anteroposterior region, which does not interfere with the observation of most of the nasal cavity and even the posterior wall of the nasopharynx. However, it is this variation in the curvature of the nasal septum that can cause breathing difficulties. The latter is due to the fact that the inhaled stream of air, having, as is known, not a sagittal direction from front to back, but forming an arc convex upward, finds an obstacle to its movement in this place.

Deformation of the nasal septum, causing a violation of the function of external respiration, determines a number of physiological abnormalities, which were mentioned when considering the function of the nose.

In the nasal cavity itself, breathing defects reduce the gas exchange of the paranasal sinuses, contributing to the development of sinusitis, and the difficulty of air entering the olfactory gap causes a violation of the sense of smell. The pressure of the ridges and spikes on the nasal mucosa can lead to the development of vasomotor rhinitis, bronchial asthma and other reflex disorders (Voyachek V.I., 1953; Dainyak LB, 1994).

Clinic and symptoms. The most important symptom of a clinically significant curvature of the nasal septum is unilateral or bilateral obstruction of nasal breathing. Other symptoms may include impaired smell, nausea, and frequent and persistent runny nose.

Diagnosis. It is established on the basis of a cumulative assessment of the state of nasal breathing and the results of rhinoscopy. It should be added that the curvature of the nasal septum is often combined with the deformation of the external nose of a congenital or acquired (usually traumatic) genesis.

Treatment. Perhaps only surgical. Indication for surgery is difficulty in nasal breathing through one or both halves of the nose. Operations on the nasal septum are also performed as a preliminary stage preceding other surgical interventions or conservative methods of treatment (for example, to eliminate a crest or spike that interferes with catheterization of the auditory tube).

Operations on the nasal septum are performed under local or general anesthesia. They are technically complex manipulations. Damage to the mucous membrane in adjacent sections of the septum leads to the formation of persistent, practically indestructible perforations. Bloody crusts dry on the edges of the latter. Large perforations contribute to the development of atrophic processes, small ones cause “whistling” during breathing.

IN AND. Voyachek proposed a generalized name for all operations on the nasal septum - “septum operation”. In recent years, the term “septoplasty” has gained popularity.

Among the various modifications of septum operations, two methods that are fundamentally different from each other should be distinguished. The first is a radical submucosal resection of the nasal septum according to Killian, the second is a conservative septum operation according to Voyachek. In the first method, most of the cartilaginous and skeletal skeleton of the septum is removed submucosally (at the same time under the perichondrium and subperiosteum). The advantage of this operation is its comparative simplicity and speed of execution. The disadvantage is the flotation of the nasal septum observed during breathing, which is devoid of most of the bone-cartilaginous skeleton, as well as the tendency to develop atrophic processes. In the second method, only those sections of the cartilage and bone skeleton that cannot be redressed and put in the correct middle position are removed. When the quadrangular cartilage is curved, a disk is cut out by circular resection. As a result, a disk that maintains a connection with the mucous membrane of one of the sides and acquires mobility is set in the middle position (Fig. 2.7.2 and 2.7.3).

With very pronounced curvatures of the quadrangular cartilage, it can be dissected into a larger number of fragments that also retain a connection with the mucous membrane of one of the sides (Protasevich G.S., 1995).

Conservative methods for nasal septum surgery are more surgical interventions.
However, their long duration and possible moderate reactive phenomena in the nasal cavity in the first weeks after the operation are subsequently paid off by maintaining an almost complete nasal septum.

A promising direction of septoplasty in recent years is the formation of the nasal septum skeleton from shredded fragments of auto-cartilage (Rushnevsky IV, 1995) glued together with autofibrin glue developed at K.I. Veremeenko with employees.

Bleeding nasal septum polyp. A disease that is not uncommon in clinical practice. A characteristic feature of it is the appearance in the anterior part of the nasal septum from one side of a gradually increasing polypous mass, which bleeds easily when the probe is touched.

The etiology is not always clear. One of the reasons for the appearance of the polyp is a mucosal injury with fingernails in the area of ​​its increased vascularization. The disease is more common in young people and women during pregnancy and lactation, which indicates a possible value in its formation of endocrine factors.

Morphological examination reveals hemangioma or angiofibroma (Pogosov BC et al., 1983), in more rare cases, granulation tissue (Dainyak LB, 1994).

The clinical picture and symptoms. The main complaint of the patient: difficulty in nasal breathing and frequent, often profuse nosebleeds, recurring with blowing of the nose, finger picking in the nose. Rhinoscopy allows you to detect in the initial part of the nasal septum a polypous formation of red or purplish-red. The polyp knife is usually wide. When probing, the polyp bleeds easily.

The diagnosis is established on the basis of the anamnesis and anterior rhinoscopy.

Treatment is only surgical. The polyp should be removed along with the adjacent mucous membrane and perichondrium of the nasal septum. After removal, it is desirable to perform electrocautery or cryoapplication of the mucous membrane along the edge of the wound surface with subsequent tamponade of the corresponding half of the nose. The removed polyp is sent for histological examination.

Front dry rhinitis. Perforating nasal septum ulcer.

Anterior dry rhinitis refers to the so-called limited atrophic rhinitis. It occurs in the anterior part of the nasal septum at the site of frequent trauma to the mucous membrane caused by various reasons. Among them: the habit of picking a finger in the nose, excessive radical interventions on the nasal septum and with resection of the lower nasal concha, as well as repeated cauterization of bleeding vessels on the mucous membrane by various means.

Dry front rhinitis is observed in persons working in the chemical, flour, stone and woodworking industries, etc., as well as in persons dealing with occupational hazards of military labor.

Clinic and symptoms. Patients with this pathology are practically healthy people and may not experience noticeable troubles. However, there may be complaints of a feeling of dryness in the nose, drying of the crusts in anticipation of the nose, which necessitates their removal.

Rhinoscopically in the anterior part of the nasal septum, a limited area of ​​a dry, thinned mucous membrane that has lost its normal moist shine and covered with dry crusts is determined. In the future, a through defect in the nasal septum may occur at this site. Perforation is usually small, has a rounded shape. It often closes with dry crusts, which, if removed, may cause bleeding, as well as "whistling," noticeable with forced breathing.

The diagnosis is established on the basis of anamnesis and anterior rhinoscopy. In doubtful cases, it is necessary to differentiate with tuberculosis, syphilis and Wegener's disease. A perforating ulcer with dry anterior rhinitis has minor reactive inflammatory phenomena in the circle without any infiltrates. Tuberculous ulcer is surrounded by saped edges with sluggish granuces. Syphilitic ulcer is not limited to the cartilaginous part, but passes to the bone section of the nasal septum. Syphilitic ulcer in most cases is accompanied by an unpleasant odor from the nose. In Wegener's disease, perforation extends to a significant part of the nasal septum, widely capturing the cartilage and bone sections. Perforation is covered with massive brown-brown crusts, removed from the nose in the form of casts.

The condition of patients with the mentioned general diseases progressively worsens. To clarify the diagnosis, a general clinical examination, serodiagnosis, biopsy is necessary.

Treatment of limited anterior dry rhinitis, including complicated by perforation of the nasal septum, is based on the same principles as the treatment of atrophic rhinitis (see treatment of atrophic rhinitis).

Surgical closure of perforation of the nasal septum, proposed by individual authors, is hardly advisable. Such an operation, carried out in the area of ​​atrophied tissues, can lead to the formation of even larger perforations. Prevention and improvement of working conditions is important.
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Nasal septum diseases

  1. 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, physiological
  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.
  3. Ventricular septal defect.
    This is a hole in the interventricular septum, creating a message between both ventricles (Fig. 12). One of the most common congenital heart defects. It accounts for 20 to 30% of cases of cardiac abnormalities. It can be located in the membranous, muscle or supraventricular parts of the septum. The defect can be in the form of an oval, round and conical hole.
  4. Atrial septal defect
    Definition An atrial septal defect is a congenital heart disease in which there is a message between the two atria that develops as a result of the abnormal development of the primary and secondary atrial septa and endocardial pads. The atrial septal defect in combination with stenosis of the left atrioventricular foramen is called Lutambache syndrome. Epidemiology
  5. Ventricular septal defect
    Ventricular Septal DefcCt (VSD) Ventricular septal defect is the most common heart defect and accounts for 30% of all congenital heart defects in children. The pathogenesis of the formation of many symptoms in this defect is the antipode (opposite) of Fallot disease. What is the essence of the disease? A ventricular septal defect (VSD) causes abnormal
  6. Ventricular septal defects
    They can be located in the membrane or muscle part of the septum with a hole diameter of 1 to 30 mm. High defects can be combined with an abnormally developed valve of the aortic or atrioventricular valve. Blood is discharged from the left ventricle to the right. Hemodynamic disorders can usually occur in the second to fourth month of life, when pulmonary resistance decreases. In the first phase
  7. Ventricular septal defect
    Congenital malformation of the interventricular septum, resulting in a message between the right and left ventricle. This anomaly is relatively easy to diagnose, but the true frequency of the defect, oddly enough, is unknown. So, a significant increase in the diagnosis of BC was noted after the introduction of echocardiographic techniques into widespread practice, and then color Doppler scanning,
  8. Ventricular septal defect
    A defect in the interventricular septum is localized in the membrane or muscle part of the septum, but it also happens that the septum is absent. If the defect is located above the gastric ridge, at the aortic root or directly in it, then aortic valve insufficiency is associated with this defect. Hemodynamic disturbances are determined by its size and the ratio of pressure in the large and small
    The transverse septum is usually located on the border between the upper '/ 3 and the lower 2/3 of the vagina. This is additional evidence that the upper '/ 3 vagina is formed from the Muller ducts, and the lower 2/3 - from the urogenital sinus. The partition may be full or partial. If it is complete, then with the advent of menarche, symptoms of vaginal obstruction appear, since blood does not
  10. Atrial septal defect.
    It is characterized by the presence of a hole in the interatrial septum due to the absence of septal tissue (Fig. 17). This is one of the most common heart defects. Its frequency, according to clinical data, is 10-15% of all congenital heart defects. Anatomically distinguish: 1) defects of the secondary septum (Ostium secundum), which can be located centrally in the oval window,
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