How to Approach Nasal Septal Deviations

Gordon H. Sun, MD, MS

December 21, 2015

Case: A History of Nasal Trauma

A 44-year-old salesman presented to his family physician with chronic difficulty breathing through the right nostril. He stated that, perhaps 10 years ago, he collided hard with a friend while playing football in his backyard, resulting in a brisk nosebleed and bruising over his nose. After the nosebleed stopped, the patient noted that he had some trouble with getting enough air through his right nostril. He thought that the nasal obstruction would recover spontaneously, but the symptom has persisted. He denied anosmia, recurrent epistaxis, nasal pain or sensitivity, otalgia, vision problems, or fevers. The patient had no surgical history. He was a nonsmoker and nondrinker and denied illicit drug use. He was not actively taking any medications.

On examination, the patient's vital signs were all within normal limits. The patient appeared comfortable, with a clear voice and no stridor. Eye and ear examinations were unremarkable. Anterior rhinoscopy demonstrated a substantial deviation of the nasal septum to the right, obstructing view of the rest of the nasal vault. No septal perforation was seen. There was no tenderness to palpation of the external nose, and no obvious bony step-off of the nasal bones was appreciated. The remainder of the head and neck examination was unremarkable.

The patient was interested in having surgery to improve his nasal airway, if it wouldn't be too risky. He began to ask questions about how often nasal septal deviations occur and how often complications occur after surgery for a deviated septum.

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