NASAL SEPTUM abnormalities :

- SEPTAL DEVIATION
- SEPTAL HEMATOMA
- SEPTAL ABSCESS
- SEPTAL PERFORATION
SEPTAL DEVIATION
- Normal Septum  midline  divide Nasal Cavity
into 2 equal spaces
- Deviated Septum  2 inequal spaces

ETIOLOGY  - Traumatic  - intra uterine

- perinatal
- accident/sport
- Mis  GROWTH & DEVELOPMENT
of the nasal septum &
face
TYPES :
- Cartilagineus site – bony site
- mild, moderate & severe deviation
Type : 1. C form
2. S (sigmoid form)
3. Spine & Spur forming
4. With synechiae to the middle
turbinate
- With or Without Signs & Symptoms
SIGNS & SYMPTOMS
- Mainly NASAL OBSTRUCTION  Uni/Bilateral
- Headache  Vacuum/Pressure
- Paranasal sinus ostia obstruction
-Nasal bleeding (epistaxis)
-Compensatory inferior nasal turbinate
hypertrophy

DIAGNOSIS - Anterior Rhinoscopy

- Nasal Endoscopy
MANAGEMENT :
- No signs & symptoms  No Surgery !!
- With signs & symptoms  complications 
Necessary for SURGERY :
- Sub-mucosal resection (S.M.R.)
- Septoplasty
- Functional Septal Correction Surgery
- Turbinectomy
COMPLICATIONS :
- Paranasal sinusitis
- Recurrent nasal bleeding
- Compensatory inferior nasal
turbinate hypertrophy
SEPTAL HEMATOMA & SEPTAL ABSCESS

- Usually BILATERAL !

- ETIOLOGY:
- Mostly traumatic or iatrogenic causes
- Blood dyscrasias (rare)

Hematoma/blood between Septal cartilage/bone and

the mucoperichondrium/ mucoperiostium  may cause
 Cartilaginous atrophy & necrosis and Blood provide a
good bacterial medium  secondary infection 
SEPTAL ABSCESS
SIGNS & SYMPTOMS :

- Total bilateral nasal obstruction (PANIC SITUATION)

- Nasal pain : > Septal abscess
- Headache
- Smelling loss
- Subfebrile

DIAGNOSIS : Aspiration – Anterior Rhinoscopy & Palpation

 MANAGEMENT/THERAPY : An URGENT Case !!

- One septal side incision  for drainage & evacuation

of blood/pus
- Avoid bilateral incision or do it on different levels
- Drain
- Nasal packing (several days)
- Oral antibiotics sensitive to Staphylococcus Aureus
(TSS) and Sinusitis pathogens !
COMPLICATIONS :

- Saddle nose deformity

- Septal perforation
- Septal thickening/fibrosis
- Thrombosis sinus cavernosus
(Septal Abscess)
SEPTAL PERFORATION
ETIOLOGY : - MOST COMMON  Iatrogenic & Trauma
- Septal abscess
- Specific infection  Syphylis, Tuberculosis,
Leprosy & Rhinoscleroma
- Inflammatory etiologies :
- Wegener’s granulomatosis
- Sarcoidosis
- Lupus
- Vascular collagenic diseases
- Neoplasms/Malignancies
- Rhinolith
SIGNS & SYMPTOMS
- Nasal irritation
- Whistling
- Epistaxis  Crustae released
- Nasal foetor
- Large size perforation  Hyponasality

DIAGNOSIS : Anterior Rhinoscopy &

Nasal Endoscopy
MANAGEMENT :
- Small perforation  no problem 
NO SURGERY !!
- Nasal Irrigation
- Septal Buttons
- Closure with Sliding Mucosal Flaps
> 2 cm  Difficult to closure !