Mirror, mirror, is my nose crooked?

Author: Du Jingyan, deputy chief nurse, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Wang Ningyu, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Figure 1 Original copyright image, no permission to reprint

Friends who have watched the drama "Legend of Miyue" must know that there is such an unforgettable character in the drama - Concubine Wei. She is outstanding in appearance, beautiful and kind-hearted, and is deeply loved by the king in the drama. However, Concubine Wei's ending was not good. Her nose was cut off by the king, and she eventually committed suicide in the cold palace. The reason was that she believed the rumors and thought that her nose was crooked, so she became more and more inferior. Every time she met the king, she was not confident and used a fan to cover her nose, which eventually angered the king.

Although the tragic ending of Lady Wei is a bit melodramatic, it also proves that the nose occupies an important position among the facial features. If a person's nose is too crooked, it will give people a feeling of facial distortion and irregular facial features. I have encountered such patients in the outpatient clinic, "Doctor, my nose was injured when I was a child, but I didn't pay attention to it at the time. Now I look in the mirror and feel that my nose is getting more and more crooked. Can it be straightened? I always feel that my nose is blocked. Is it related to my crooked nose?

Yes, a crooked nose not only looks crooked, but it can also cause nasal congestion and other symptoms as you age. The underlying cause is another type of crooked nose: a deviated nasal septum. So, let’s talk about a deviated nasal septum today.

1. What is the relationship between a crooked nose and a deviated nasal septum?

The former refers to the crookedness of the entire nose shape, and the latter refers to the curvature of the nasal septum that separates the left and right nasal cavities inside the nostrils. Simply put, one is external crookedness, and the other is internal deviation.

Almost all crooked noses are accompanied by a deviated nasal septum, but conversely, most people with a deviated nasal septum do not have an obviously crooked nose, so a crooked nose is uncommon, while a deviated nasal septum is common.

2. Crooked nose and deviated nasal septum are both structural deformities.

We once joked that God created humans rather casually, and not everyone's nose, especially the nasal septum, is straight and wide. It is precisely because of this that there are so many different faces for each person and the world is so rich and colorful.

However, if the nasal septum is excessively bent, it becomes a pathological condition. As stated at the beginning of this book, "structure determines form, which in turn affects function." In addition to affecting appearance, obvious deformities can also lead to functional disorders. Severe nasal septum deviation can cause nasal ventilation obstruction, causing symptoms such as nasal congestion, headaches, and nosebleeds.

It can even lead to "secondary disasters". For example, due to the deviated nasal septum, the breathing airflow is not smooth, and the external allergens are excessively deposited in the nasal cavity, which will aggravate the allergic symptoms of patients with allergic rhinitis. In addition, the deviated nasal septum will also hinder the ventilation and drainage of the sinuses, causing sinusitis and other diseases.

Therefore, patients with deviated nasal septum are not only prone to various nasal diseases, but once they are sick, the treatment effect of these nasal diseases will be compromised due to the deviated nasal septum.

3. Why does the nasal septum grow crooked?

The most common cause is nasal septum malformation, which is caused by genetic inheritance. Therefore, it is common to see parents and children suffering from nasal septum deviation at the same time in the outpatient clinic. Here we need to remind everyone that there are many forms of genetic inheritance. Whether genetic inheritance will be manifest, in layman's terms, whether the father will have a deviation and the child will also have a deviation, depends on many factors. If the parents have a deviation and the children do not, just be thankful and don't be confused.

The second is trauma. Severe trauma can not only cause nasal bone fractures and crooked nose deformities, but also lead to nasal septum deviation. In addition, tumors in the nasal cavity can also squeeze the nasal septum and cause deviation.

As for some people's concerns, is it because they often picked their noses when they were young that their nasal septum became crooked? Some people even imagine whether they or their parents can twist the crooked nose or nasal septum through kneading and massage. Listen to my advice, you are not God, you do not have such magical powers. You can only pinch the nose to make it bald and pick the nasal septum to make it bleed, but you can't do anything else.

4. The nasal septum grows inside the nose. How can you know whether it is straight?

That’s a good question, but you can’t expect your magic mirror to tell you.

Generally speaking, a deviated nasal septum caused by trauma will cause nose bleeding and nasal congestion due to ruptured edema of the nasal mucosa. As for congenital deviated nasal septum, in addition to those with severe deviation who have nasal congestion and stuffiness since childhood, it is more common that as the child grows up, the deviation becomes more and more obvious, the nose's compensatory ability becomes worse and worse, and the nose becomes more and more stuffy. Precisely because the maxillofacial and nasal septum are in a state of continuous growth and change before the age of 18, surgical intervention for deviated nasal septum is performed after adulthood. In addition to nasal congestion, a deviated nasal septum can also cause symptoms such as headaches, dry nose, bloody nasal discharge or bleeding.

Therefore, if you have the above symptoms, you can confidently suspect that you have a deviated nasal septum. Of course, the final diagnosis requires a nasal endoscopy or a nasal CT scan.

Figure 2 Original copyright image, no permission to reprint

5. Once a deviated nasal septum is diagnosed, should it be treated?

Just as mentioned above, as long as there are no unpleasant feelings and no symptoms, most nasal septum deviations can be left untreated. Let it accompany you quietly and become your little special feature that sets you apart from others.

If you have symptoms such as nasal congestion, dry nose, headache, nose bleeding, etc., and the doctor has determined that these discomforts are caused by a deviated nasal septum, then you need surgery to correct it.

In addition to this situation that requires surgical intervention, if you also have allergic rhinitis or chronic sinusitis, and drug treatment is not effective, correcting the deviated nasal septum may improve the effectiveness of drug treatment.

If polyps or tumors grow in the nose and need to be removed, the deviated nasal septum is often corrected first before the polyps or tumors can be removed smoothly and thoroughly. This surgery is also called pre-surgery, which is to straighten the deviated nasal septum first to prevent it from interfering with the subsequent tumor removal surgery. Of course, these two surgeries will be performed together, without the need for staged surgery.

There is another situation where the deviated nasal septum affects your sleep. You can only breathe with your mouth open, and you may even snore and hold your breath. Wearing a ventilator cannot improve your sleep quality. In this case, you also need to undergo nasal septum deviation correction surgery.

6. What is septum deviation surgery? What are the results?

This operation is a routine endoscopic sinus surgery.

It is to use an endoscope that is slightly thinner than a chopstick to extend into the nostril, magnify the structure inside the nose, and direct the image to a monitor like a TV screen. The doctor performs the operation while watching the monitor screen. In order to reduce the pain, general anesthesia is usually given. Depending on the difficulty, the operation time is about 20-50 minutes. The operation only makes a small incision at the front of the nasal septum, and there is little bleeding.

The length of hospital stay is generally 3-7 days, depending on the surgical method, hospital, and physical condition. The fastest surgery can be performed in an outpatient clinic under local anesthesia. The surgery will not affect your activities, and you can resume your normal life after 3 days of rest.

Finally, I want to tell my friends who are particularly concerned about their appearance: don’t worry, this surgery will not leave scars on your face.