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Deviated Nasal Septum. Dr. Vishal Sharma. Aetiology. 1. Trauma: blow on nose 2. Developmental:  Birth moulding  High arched palate  Unequal growth b/w skull base & palate 3. Mass in opposite nasal cavity 4. Racial factors: common in Europeans

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deviated nasal septum

Deviated Nasal Septum

Dr. Vishal Sharma

aetiology
Aetiology

1.Trauma: blow on nose

2.Developmental:

 Birth moulding  High arched palate

 Unequal growth b/w skull base & palate

3.Mass in opposite nasal cavity

4.Racial factors: common in Europeans

5.Hereditary: in posterior D.N.S.

types
Types

1. Anterior / caudal dislocation

2. C-shaped deformity

3. S-shaped deformity

4. Septal Spur: shelf-like projection

5. Septal Thickening: organized hematoma

or over-riding of septal fragments

6. Impacted septum: despite decongestion

clinical features
Clinical features
  • Nasal block: present on side of D.N.S.

C/L paradoxical nasal obstruction due to

compensatory inferior turbinate hypertrophy.

2. Recurrent cold: due to associated sinusitis

3. Headache: due to contact with lateral wall (Sluder’s neuralgia), sinusitis

clinical features1
Clinical features

4. Epistaxis: stretched mucosa on DNS  dry crusting & bleeding on removal; stretched blood vessels over spur.

5. Hyposmia: seen in high D.N.S.

6. External nasal deformity

sequelae
Sequelae
  • Sinusitis
  • Mouth breathing snoring, pharyngitis
  • Atrophic rhinitis & myiasis
  • Otitis media
slide16
Edwin Smith Surgical Papyrus (dated 17th century BC): world's oldest surgical document & only surviving copy of a part of an Ancient Egyptian textbook on trauma surgery written in 3500 B.C. Listed are 48 traumatic injury cases, with description of examination, diagnosis & treatment.
  • Treatment of DNS:fracture reduction of DNS with internal pack using grease coated linen & external packing with stiff rolls of linen.
slide18
Bosworth operation (late 19th century):deviated part of septum amputated along with mucosa
  • Asch (1899):full thickness cruciate incisions on septal cartilage
  • Freer (1902):SMR of total septal cartilage
  • Killian (1904):SMR with preservation of dorsal & caudal portion of septal cartilage
  • Metzenbaum (1929):Swinging door technique for caudal septal dislocation
  • Peer (1937):Removal of caudal septum & replacement after its alteration
  • Cottle (1948) :Maxilla-Premaxilla septoplasty
indications for septal surgery
Indications for septal surgery

1. D.N.S.: nasal obstruction / sinusitis /

headache / epistaxis

2. Along with rhinoplasty

3. Harvesting of septal cartilage graft

3. Trans-septal surgeries:

 Hypophysectomy  Vidian neurectomy

4. Hereditary telengiectasia

cottle s line
Cottle’s line

Drawn from frontal spine to anterior nasal spine. Deviations anterior to it can be treated by septoplasty only. Posterior to it by SMR or septoplasty.

complications of septal surgery
Complications of septal surgery

1. Haemorrhage 2. Septal haematoma

3. Septal abscess 4. Septal perforation

5. Saddle nose 6. Columellar retraction

7. Flapping septum 8. Persistent deviation

9. Nasal synechia 10. C.S.F. rhinorrhoea

11. Infection 12. Toxic shock syndrome

septal haematoma
Septal haematoma

Collection of blood under perichondrium

& periosteum of nasal septum.

Aetiology:

1. Nasal trauma

2. Septal surgery

3. Bleeding disorders

clinical features2
Clinical features
  • Bilateral nasal obstruction
  • Sense of pressure over nasal bridge
  • B/L smooth, rounded septal swelling
  • On palpation mass is soft & fluctuant
  • Absence of raised temperature, erythema, swelling & tenderness of skin over nose.
treatment
Treatment

1. Small: wide bore needle aspiration

2. Large:

a. incision & drainage

b. nasal packing (prevent recurrence)

c. systemic antibiotics (prevent abscess)

complications
Complications
  • Thickened nasal septum
  • Septal abscess with cartilage necrosis
  • Saddle nose
  • Supra-tip deformity
  • Septal perforation
septal abscess
Septal abscess

Collection of pus under perichondrium

& periosteum of nasal septum.

Aetiology:

1. secondary infection of septal hematoma

2. following furuncle of nose or upper lip

3. following typhoid or measles

clinical features3
Clinical Features
  • Bilateral nasal obstruction with fever
  • Skin over nose shows raised temperature, erythema, swelling & tenderness
  • B/L smooth, soft, fluctuant septal swelling
  • Septal mucosa congested
  • Submandibular node enlarged & tender
treatment1
Treatment
  • Abscess drained immediately
  • Incision made on most dependent part
  • Pus & necrosed cartilage removed
  • Nasal packing done
  • Systemic antibiotics for 10 days
complications1
Complications
  • Necrosis of septal cartilage
  • Saddle nose
  • Supra-tip deformity
  • Septal perforation
  • Meningitis
  • Cavernous sinus thrombosis
aetiology1
Aetiology

1. Trauma: septal surgery, nose picking,

septal cautery, ornamentation

2. Infection: septal abscess

3. Nasal Irritants: snuff, cocaine

4. Foreign body, Rhinolith, Nasal myiasis

5. Granuloma: TB, leprosy, syphilis, Wegener

6. Malignancy 7. Idiopathic

clinical features4
Clinical features

Small perforation: whistling sound

during respiration

Large perforation:nasal crusting

 nasal obstruction

 epistaxis on crust removal

treatment2
Treatment
  • Treat cause of septal perforation
  • Alkaline nasal douche for crusting
  • Small perforation: closed by mucosal

advancement flaps

  • Large perforation: Silastic obturator, Alloderm. Results of surgery are poor.