Nasal Septum

Anatomy
·
Nasal septum consists of three
parts:
(i Columellar septum:

to wired of columella

medial
containing cheva

alar
of cartilages.

iii) Membranous
septum: lies between the columella &

candal border of septal cartilage

iii) Septum proper: Consists

of Osteocartilaginous
covered with nasal membrane
framework, mucous

· Constituents are

(a)
Perpendicular plate of Ethmoid
(b) Xomev

Largeseptal (quadrilateral) cartilage wedge

between the above two bones.

d) Other bones which

make minor contributive

at
periphery are.

crest
-

of Naval bone
-
Nasal spine of Frontal bone

Rostrum of sphenoid
Crest Palatine bones
-

of
Crest maxilla
of
-

maxilla
·
Ant-nasal spine of
 Deviated Nasal Septum (DNS)
Aetiology:
Trauma & Errors
of development
·

( Birth trauma

form the two

important factors in

causation of deviated septum

·

Hereditary factors (several members

of same
family
have deviated nasal septum
may
·

Percentage of Newborn with DNS is between 1-80%

types of DNS :

the
· Deviation
may
involve only cartilage, bone or both.

(a) Anterior dislocation

> c-shaped beformity

I S-shaped deformity
(d) Spurs
(e)
Thickening

C Linical Features:

(i) Nasal obstruction (vii) Repeated Epistaxis

ii) Recurrent sinusitis (viii)
Hypertrophy of Turbinates
viii) Recurrent AOM (On opposite side

Headache
six six Cosmetic deformity.
(*) Slunders neuralgia Anosmia
(x)

(vi) Hyposmia
 Examination of Nose:

(Anterior rhinoscopy. By Thudicum nasal

speculum.
Cold
ii) spatulatest
(iii) Cottle's Test

six Endoscopy (best)

(v) CT Scan

& Cottle's Test)

Treatment:

· Minor
degrees of septal deviation with no
symptoms are

treatment
commonly seen in
patients &
Require no

· For Nasal obstruction:

(Sub-mucosal Resection
of septum) (Not preferred
(a) SYR

be
Septoplasty

S M9R.

·
Killian's incision at the lower

border and mucoperichondrial

of septum
both sides of septum raised.
&

laps on is

Atcm
strip dorsum
on
part of
·

upper
external thin caudal
of nose - a

strip is
left (L-shaped cartilage
with removal
of remaining part of septum

Removing of Cartilage leads to Saddling Nose

·

of
High Risk of perforation.
·
 Septoplasty.
· The incision is made (Hemitransition (
invisions the lower
Freer's on

border &
of septal cartilage
t
he mucoperichondrial flap is raised

completely only on one side

of septum

deviation
·

Only the part of cartilage with is removed.

· More conservative & preferred over SMR.

 Septal Hematoma
Collection Blood under the
of
·

perichondrium or
periosteum
of
Nasal septum.
results
from Nasal trauma
·

Often
or
septal surgery.

Clinical Features:

·
Bilateral Nasal Obstruction

· Frontal headache - a sense

of
pressure
over the nasal
bridge

Treatment;
Small
· hematomas can be
aspirated with a wide bone

sterile needle

hematomas incised & drained

·

larger are
by a small

auteroposterior incision parallel to Naral

floor

Following drainage, nose is

packed
on both sides to
prevent reaccumulation

Antibiotics should
Systemic
be
given
·

abscen.
to
prevent septal

Complication:
in Septal Abscess
(ii) Saddling of Nose (ii) Perforation of septum
 Perforation of Nasal Septum
Most Trauma
·
common cause:
following
Septoplasty
·
Cartilaginous perforation:Granulomatous
conditions

LT5, Leprosy

Bony perforation =
Syphillis & Granulomatosis polyangitis.
abscess
·
Other causes: (a) Septal
(b) Nasal myiasis
lcs Rhinolith
(d) Dregs (Prolonged use
of
steroid sprays (

(e) Idiopathic

Clinical Features:

·
Small perforation Cause
:

whistling sound during

inspiration or
expiration.
·

large perforation:Develop counts which obstruct the nose

or cause serene epistaxis when removed

Management:
(i) Non-surgical: lubricants/ointments. Nasal button

(ii) Surgical Repair: Using flaps

vii) Nasal button can came obstruction.