Nasal Septal Deviation: Pathophysiology, Management Strategies, and Emerging Approaches in Functional Nasal Surgery

ანოტაცია

Nasal septal deviation (NSD) is among the most frequently encountered structural abnormalities of the facial skeleton and stands as a primary etiology of chronic nasal obstruction. Crucially, symptom severity is rarely a direct reflection of isolated septal anatomy; rather, nasal airflow is governed by a dynamic, intricate interplay between the septum, the inferior turbinates, and the internal nasal valve. This narrative review synthesizes contemporary evidence surrounding the pathophysiology, clinical diagnostics, and therapeutic strategies for NSD, emphasizing a paradigm shift from purely morphological correction toward functional restoration. Comprehensive clinical evaluation increasingly pairs validated subjective patient-reported outcome measures (PROMs),such as the Nasal Obstruction Symptom Evaluation (NOSE) scale,with objective physiological assessments, including rhinomanometry and acoustic rhinometry, though correlation between these modalities often remains modest. Therapeutic interventions span a wide spectrum, from targeted medical regimens managing mucosal inflammation to precise surgical frameworks, including conventional and endoscopic septoplasty, inferior turbinate reduction, nasal valve stabilization, and advanced extracorporeal reconstructions. Furthermore, emerging modalities such as computational fluid dynamics (CFD) modeling and bioabsorbable implants represent a clear movement toward highly individualized, precision-guided patient care. Ultimately, modern rhinology recognizes NSD not merely as a static anatomical deformity, but as a complex, multifactorial functional airway disorder demanding a combined physiological and structural treatment approach.