Management of the Deviated Septum

The primary nasal functions include providing airflow, perceiving airflow, and conduction of odorants to the olfactory nasal mucosa. The nasal mucosa provides a protective barrier from daily exposures to dust, allergens, smoke, etc. The design of the nasal cavity has evolved to optimize these functional roles and they are intimately related to the existing anatomy. Even slight narrowing of the internal nasal valves (INV) or external nasal valves (ENV) causes adverse effects. Deviation of the nasal septum is perhaps the most common etiology of nasal airway narrowing. Long-term sequelae of an untreated septal deformity include recurrent epistaxis, poor sleep quality, and even alteration of the normal mucosal function leading to chronic and/or atrophic rhinitis. Terms including the “twisted nose,” the “crooked nose,” or the “deviated nose” have been used to describe the appearance of patients in whom the nasal pyramid has deviated from the midline, usually secondary to extrinsic forces, such as sports injuries, physical altercations, or car accidents. It has been well established that significant septal deviation is nearly always a component of the deviated nose and that the degree of dorsal deviation correlates highly with patient-reported nasal obstruction. Still, it is common for patients to present with no external nasal deformity and significant nasal obstruction due to a deviated nasal septum, nasal valve dysfunction or a combination of the two. It follows that identification of the precise location of obstruction/collapse is critical. Previous nasal surgery, severe septal deviation, caudal septal deviation, and significant nasal valve dysfunction requires manipulation of the cartilaginous framework via open septorhinoplasty to adequately address the nasal airway and prevent residual or new airway obstruction.