Septal Spur correction as a treatment for Migraine headache.
Migraine-type headaches are a very debilitating disorder and have multiple etiologies. The presence of a septal bony spur in the nose can account for a large number of these migraine-type headaches.
A large number of headache sufferers of this kind would benefit from a septoplasty procedure. Repairing the deviated septum is a relatively simple procedure, which takes only 20-30 minutes. During this surgical procedure, the bone spur is removed and the septum is straightened so the contact point that creates the headache is eliminated.
There are numerous types of headaches that can be classified into primary and secondary. Primary, or benign headache disorders are common and include:
1-Migraine with or without an aura.
2-Tension type headaches, which are episodic or chronic.
3-Cluster headaches.
4-Rebound headaches.
5-Contact Point headache- These include nasal causes of headaches such as deviated septum and bone spurs impinging on the lateral wall of nose causing severe migraine.
About Deviated Nasal Septum and Septal Spur
The septum is a midline partition inside the nose comprised of cartilage anteriorly and bone posteriorly. It divides the right nostril from the left nostril and aids in supporting the nose. Within the nose there are three pairs of turbinates along the lateral nasal wall. These turbinates are vascular erectile structures that can become engorged and swell in response to allergies, flu, sinus problems, etc. There are several nerves which innervate the internal nose, namely the anterior ethmoid nerve the branches of the nerve of the pterygoid canal and nasal palatine nerve which innervate the septum. Along the lateral nasal wall the sphenopalatine ganglion and the anterior ethmoid nerve innervate the turbinates and the lateral nasal wall.
Septal Spur Trigger Migraine
Trauma to the nose at any time can contribute to the development of a septal spur. A septal spur is a sharp bony projection that can impinge on the lateral nasal wall and the turbinates, irritating nerves and referring pain to the head. The location of these headaches is typically around the forehead, temples, top of the head, or can be located around the eyes, nose, and cheek regions.
The nose is the most traumatized part of the face because it projects away from the face, thus it is the first structure to be traumatized in an accident. Again, the nose does not have to be broken, but the simple jarring effect can place stress on the septum. The thin bone within the nose can fracture and develop bone spurs. Just as bone spurs in the feet and vertebrae can cause pain, bone spurs in the nose can also cause pain to the head which result in chronic migraine-type headaches in some patients.
Pre op investigation
ENT surgeon examines the nose with the application of a topical decongestant spray in order to obtain a clear view of the entire nasal airway. It is with this examination that septal spurs can most commonly be diagnosed. When a septal spur is not obvious on exam, a CT scan of the sinuses can demonstrate a septal spur and other nasal and sinus conditions that cause headaches. A CT scan of the sinuses can be of key importance in demonstrating other subtle contact points within the nose that can cause headaches.
Nasal Endoscopy using fibre optic light is also then performed.
Surgical Procedures-Traditional Septoplasty
Intranasal surgery can potentially eliminate headaches. When a septal spur has been diagnosed, the surgical procedure to remove it is called a septoplasty. With this procedure, a small incision is made inside the nostril, and the mucous membrane is elevated off of the septum. The septal spur is removed to relieve the pressure point. The turbinates can be pushed aside to eliminate any other contact points with the septum.
If congestion is a major problem, the turbinates can be trimmed to allow for improved breathing. Once the septum is straightened, the mucosal flaps are approximated with a dissolvable suture. There is no need for intranasal packing unless there is excessive bleeding during the operative procedure. In the past, patients who under went septoplasty had their noses packed tightly with gauze and during the first post operative visit. When the gauze was removed these patients described excruciating pain. Surgical techniques have progressed over the years, and now if packing is required, it usually consists of a soft sponge that applies gentle pressure to the nose in order to minimize bleeding.
LAS-Laser-Assisted Septoplasty
Laser septoplasty is a simple, relatively new surgical procedure which is done for a deviated nasal septum. A deviated nasal septum can be the cause for many clinical symptoms. They are sinusitis, sleep apnea and also cosmetic disfigurement .Migraine headaches are also caused by contact spots from septal spur on the lateral wall of Nose. The laser septoplasty has now proved to be the best treatment for a deviated nasal septum which may be minimal to moderate. But for gross deformities of the septum traditional septoplasty is the only answer.
Many individuals have normal nasal septum and do not need laser septoplasty at all. But for many other patients experience a deviated nasal septum that significantly affects their life and their breathing habits.
The surgical procedure of laser septoplasty is very simple and less time consuming. The laser septoplasty is done under local anesthesia or under GA along with other nasal surgical procedures. The laser septoplasty is an efficient procedure where there is minimal or no bleeding. This is very comfortable for the patient and the operating surgeon too. There is no post operative wound infection with the laser septoplasty.
The use of a laser in correcting a deviated nasal septum is a relatively new procedure and has gained acclaim because of its speed and rapid recovery time. Unlike a surgical septoplasty in which the nasal cavity is cut open and the nasal septum removed or straightened, laser septoplasty uses a CO2 laser to remove the excess amount of cartilage that grows as a result of a deviated septum. The cartilage removed is larger than normal as a result of a deviated septum. The removal of this cartilage allows the patient to have increased air-flow through their nose without the harmful effects of a regular septoplasty procedure.
The main advantage that laser septoplasty has over regular septoplasty is the recovery time. The patient can return to his day to day activities on the same day after taking some rest. There is no need to stay in the hospital either.
But the laser septoplasty involves the usage of specially designed devices which some surgeons may not be able to afford and also it requires some experience to work with the laser. Thus the cost of the laser septoplasty procedure as such is costlier when compared to the traditional septoplasty.
The post operative care for laser septoplasty is also minimal. All the patient needs is a little amount of analgesics to alleviate the pain which is minimal. Also the patient needs to take some antibiotics to avoid post operative infections which are also minimal. There is no need of nasal packing to avoid bleeding. There is minimal or no post operative bleeding with the laser septoplasty.
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