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Septum, which divides nasal cavity evenly into two halves, is a structure formed of part cartilage and part bone with mucosal layer covering both sides. Ideal septum is located right on the middle line and divides right and left nasal airways into equal chambers. Yet, the situation is usually far from normal. It is estimated that the 80% of total nasal septums are off-center. This situation usually goes unnoticed since it does not cause any problems. “Septum deviation” means that the septum is deviated from the center line up to a degree to cause problems for the individual.

These problems are listed as below, by "American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS)":

While this problem always exists in noses with advanced-deviation, a secondary disease in less deviated noses might cause problems. For example, a septum deviation, which has not caused any problems previously, might emerge due to nose bleeding caused by hypertension. Deviation, that is inactive out of seasonal allergic rhinitis season, might add on to nasal obstruction by the beginning of allergy season and might lead to recurrent sinusitis with the addition of infection on top of it. Concomitant soft palate and base of the tongue pathologies, sleep apnea might occur. Also the number of papers published, which suggest that septum can induce primary head and face pain due to close contiguity to nasal wall even though it does not cause obstruction, are in rise recently. Patients with such headache cannot benefit from medical treatments and treated unduly for a long period of time, while septoplasty can be the solution. Septum deviation’s solution is either septoplasty or submucous resection (SMR). These techiques are in use by ear, nose and throat specialists for over a hundred years. Its principle is the resection of deviated septum midline and the cartilage without damaging the mucosa and in some cases it is replaced after being straightened or sometimes even straightened inside the nose without being resected.

AAO-HNS ranges septoplasty and SMR indications as follows:

Even though there are objective methods such as rhinomanometry and acoustic rhinometry to measure nasal airways, diagnosis is based on the clinical observation of ear, nose and throat specialist, due to dynamic structure of the nose. As we have mentioned before, absence of sypmtoms at times and the contribution of additional pathologies reduces the value of objective tests and make the the function of these tests more meaningful in the follow-up of treatment’s success. Treatment indications vary depending on patient’s complaints, as it is seen on the above list. It is ascertained that NOSE JOB septoplasty or SMR remarkably increases the quality of life of people with deviation. Nowadays, at most of the FESS (Functional Endoscopic Sinus Surgery) procedures performed due to chronic sinusitis, SMR should also be performed along in order to increase the exposition and/or to fix the obstruction, even though the insurance companies do not cover that charge. COG – ENT study shows that patients who go through SMR added FESS procedure have substantially less sinus infections compared to those who only have FESS procedure without SMR. Septoplasty or SMR done at early stage will contribute to the prevention of possible frequent nosebleeds, recurrent sinusitis or sleep apnea that might occur in the future. Prevention of possible diseases will also provide economical benefit by avoiding the effort and expenses needed for their treatment.

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