A deviated septum is deflected into the airway and is a very common problem. The septum is composed of bone and cartilage and is the separation between the left lane and the right lane of airflow. The most common point for an obstruction is at the bony cartilaginous junction, which is the weak point. This is where the bone and cartilage can fracture, can cause bone spur formation and impede airflow when pushed laterally into either the left or right airway. A nasal fracture will many times cause a septal fracture, which has to be addressed surgically by reducing and straightening the septum. Many times the anterior caudal portion of the nose is deviated and twisted and a simple base view of the tip of the nose will show an anterior caudal septal deviation.
Polyps can be noted in the nasal passageway, but when they are seen there, it is usually indicative of massive polyps that have spilled out of the sinus cavity. Polyps usually originate inside the sinus cavities first and can cause nasal obstruction. They also block the sense of smell in the ethmoid sinus area. Polyps are usually caused by allergies and it is important to get allergy tested if the polyps are present. The only way to further delineate the extent of nasal polyps is to obtain a CAT scan of the paranasal sinuses.
When a patient has a sinus infection there is usually green or yellow drainage coming out of the ostiomeatal complex area of the nose and / or pooling in the floor of the nasal vault.
Frequently the inferior turbinates are hypertrophic, swollen and edematous from allergies, polyps and pollen dander the patients breathe in. The turbinates are present to warm and humidify air as one breathes in, but can become a nuisance when they are too enlarged and impede airflow dynamics through the nose. These are trimmed surgically, but not removed. Hypertrophy of the middle turbinates is a congenital issue that is called concha bullosa. It is a normal anatomical variant, but it can cause facial pain. An air pocket and sinus cavity actually grows inside the middle turbinate.
Nasal endoscopy is a technique where a lighted endoscope is inserted up into the nasal passageway and / or sinus cavities to note the extent of any further nasal polyps. It is a good way to get an idea of where any anatomical obstructions of pathways for drainage of sinuses occur. This is done as an office outpatient procedure under topical anesthesia.
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