Summary
A deviated nasal septum is the displacement of the nasal septum from the midline. This condition can be congenital or acquired, e.g., from nasal trauma. Affected individuals are often asymptomatic but may present with symptoms of nasal airway obstruction (e.g., difficulty breathing, nasal congestion), external nasal deformity, headaches, and/or epistaxis. Diagnosis is made by direct visualization of a deviated septum using anterior rhinoscopy and/or nasal endoscopy. Imaging is typically not indicated. Treatment includes pharmacological therapy (e.g., intranasal corticosteroids and nasal saline spray) for symptomatic relief and septoplasty for severe and/or persistent symptoms.
Etiology
-
Congenital [1]
- Anatomical variant
- Genetic factors causing growth disturbances
- Increased pressure on the nasal septum in utero
-
Acquired
- Traumatic (e.g., facial fracture, nasal fracture, nasal injury during birth) [1]
- Iatrogenic (e.g., rhinoplasty) [2]
Clinical features
Often asymptomatic. Symptoms include: [3][4]
- Nasal obstruction
- Difficulty breathing through one or both nares
- Nasal congestion [5]
- Snoring, including obstructive sleep apnea [6]
- Headaches and/or facial pain
- External nasal deformity [7]
- Associated complications
- Contralateral nasal turbinate hypertrophy [8]
- Sinusitis [6][9]
- Epistaxis [1][10]
Diagnosis
Clinically significant septal deviation is diagnosed with history and direct visualization. [10]
Direct visualization [10]
- Modalities
-
Findings
- Deviation of the nasal septum from midline
- Compensatory changes in nasal architecture (e.g., contralateral inferior nasal turbinate hypertrophy) [11]
CT scan [10]
- Not routinely indicated [1][10]
- Indications
- Facial trauma: to evaluate for bony injuries (e.g., nasal fractures, facial fractures) [12]
- Unexplained symptoms of nasal or sinus disease : to evaluate for concurrent pathology (e.g., concha bullosa, sinusitis) [10][13][14]
Routine diagnostic and preoperative imaging is not indicated. [10]
Treatment
For the management of patients with acute nasal fractures, see “Treatment” in “Nasal bone fracture.”
Approach [10]
- Asymptomatic deviated nasal septum: Intervention is not indicated.
- Associated nasal or sinus inflammation: Consider a 4-week trial of intranasal corticosteroids and/or nasal saline. [10][15]
- Symptoms not amenable to pharmacotherapy: Refer to ENT for further management and consideration for septoplasty.
Septoplasty [10][16]
Septoplasty is a surgical procedure to repair the bone or cartilage of the nasal septum.
-
Indications [10]
- Symptoms of nasal obstruction that are not amenable to pharmacological treatment
- Frequent epistaxis or facial pain
- Need for other surgeries requiring access to the nose and/or sinuses (e.g., endoscopic sinus surgery)
- Obstructive sleep apnea [10]
- Complications [16]