NASAL SEPTUM

LATERAL WALL
LITTLE’S AREA
WOODRUFF PLEXUS
INTERNAL CAROTID SYTEM
EXTERNAL
CAROTID SYTEM

1. Sphenopalatine artery
2. Greater palatine artery (septal)
3. Superior labial artery (septal)
 Located at the
Little’s area
 1 cm above nasal
floor
 1 cm behind ant
end of vestibule
1.Local- nose/nasopharynx
2.General
3.Idiopathic –childhood/adult
NOSE NASOPHARYNX
1. Trauma (nasal fracture,violent sneeze,fingernail,post 1. Adenoiditis
surgery)

2. Infectious (nosepicking,acute,chronic) 2. Juvenile angiofibroma

3. Foreign body 3. Malignant tumors

4. Neoplasms of nose +
paranasal sinuses
5. Atmospheric changes
(Caisson dx)

6. Deviated nasal septum

7. Septal perforations
1. Cardiovascular system –HPT, arteriosclerosis

2. Disorder of blood and blood vessels -coagulopathy ,blood dyscarias

3. Liver disease –alcoholic liver disease (2.7.9.10)

4. Drugs –herbal medicines, anticoagulant, antiplatelet, aspirin

5. Mediastinal compression –tumors , ↑venous pressure in nose

6. Acute general infection –influenza,malaria,dengue,measles

7. Vicarious menstruation
Rare autosomal
dominant
Any time of life ,most
common in early adult
life + recurrent
epistaxis
ANTERIOR

 Blood flow from front of nose when

patient in sitting position.

POSTERIOR

 Mainly blood flows back into the

throat
 Patient may swallowed- coffee
coloured vomitus
 Collection of blood under mucoperichordium of nasal septum

 Causes:
 Nasal trauma
 Surgery
 Bleeding disorders

 Clinical presentation:
 Bilateral nasal obstruction: difficulty in breathing
 Frontal headache
 Sense of pressure in nasal bridge

 Examination:
 Smooth and rounded swelling
 Soft and fluctuant

 Treatment:
 Small: aspirate by sterile needle
 Large: incise and drain
 Systemic antibiotic

 Complication:
 Septal abscess
 Fibrosis and necrosis
 Collection of pus between mucoperichondrium and septal cartilage

 Cause: 2nd infection of septal hematoma

 Clinical presentation:
 Severe bilateral nasal obstruction
 Pain and tender over nasal bridge
 Fever and chills
 Frontal headache
 Redness/swelling of skin

 Examination:
 Smooth bilateral swelling
 Fluctuation
 Septal mucosa is congested
 Submandibular LN enlarged and tender

 Treatment:
 Incise and drain
 Suction
 Systemic antibiotic

 Complications:
 Necrosis
 Septal perforation
 Meningitis
 Cavernous sinus thrombosis
 Any injury to the nose or related structure that may result in bleeding, a physical deformity, a
decreased ability to breathe normally because of obstruction, or an impaired sense of smell.

Causes:
1) Fingernail trauma (nose pricking,
obsessive compulsive disorder)
2) Injuries (mva, sports, personal
accidents, fight, post-surgery)
3) Maxillofacial trauma
4) Nasal intubation
5) Foreign bodies
6) Forceful nose blowing
7) Violent sneeze
 Clinical features :
1. Swelling of nose. Appears within few hours and may obscure details in examination
2. Periorbital ecchymosis
3. Tenderness
4. Nasal deformity. Nose may be depressed from the front side, or the whole of the
nasal pyramid deviated to one side.
5. Crepitus and mobility of fractured fragments
6. Epistaxis
7. Nasal obstruction due to septal injury or hematoma
8. Lacerations of nasal skin with exposure of nasal bones and cartilage may be seen in
compound fractured.
 Commonly in children aged 2-3
years.
 Can be classified :
1) Inorganic (metal objects,
buttons, plastic objects)
2) Organic (wood, paper, cotton-
wool, rubber, polystyrene
beads)
• May lie undetected for many
weeks, no symptoms, and
accidentally found during
examination.
• Local inflammatory reaction will
take place, and nasal discharge is
produce at affected region.
• Becomes purulent and foul-
smelling, sometimes
bloodstained.
• Secondary inflammatory response of nasal
vestibular skin (vestibulitis) may develop as a
result of constant nasal discharge.
• For these reasons, any foul-smelling of
unilateral nasal discharge in a child, with or
w/o excoriation of vestibular skin, should be
assumed due to foreign body until proven
otherwise.
Late presentation of nasal foreign body
 Such retained foreign bodies may eventually present with unilateral nasal congestion,
epistaxis, discharge.