Anatomy 1.Columellar septum: It is formed of columella containing the medial crura of alar cartilages united together by fibrous tissue and covered on either side by skin. 2.Membranous septum: It consists of double layer of skin with no bony or cartilaginous support . 3.Septum proper: It consists of osteocartilaginous framework,covered with nasal mucous membrane. Nasal septum and its diseases
Nasal septum proper ◼ Cartilage of nasal septum ◼ Perpendicular plate of ethmoid bone ◼ Vomer bone
Deviation of nasal septum(DNS) ❑ This is an important cause of nasal obstruction Aetiology:Trauma and errors of development from the two important factors in the causation of deviated septum. 1.Trauma 2.Developmental error 3.Racial factors 4.Hereditary factors
Types of DNS 1.Anterior dislocation: Septal cartilage may be dislocated into one of the nasal chambers. 2.C-shaped deformity: Septum is deviated in a simple curve to one side. 3.S-shaped deformity: Septum may show a Sshaped curve either in vertical or anteroposterior plane
Types of DNS 4.Spurs: A spur is a shelf-like projection often found at the junction of bone and Cartilage. 5.Thickening: It may be due to organised haematoma or over-riding of dislocated septal fragments
Types of DNS
Clinical Features ❑ 1.Nasal obstruction. ❑ 2.Headache ❑ 3.Sinusitis ❑ 4.Epistaxis. ❑ 5.Anosmia ❑ 6.External deformity ❑ 7. Middle ear infection
❑ Minor degrees of septal deviation with no symptoms are commonly seen in patients and require no treatment.It is only when deviated septum produces mechanical nasal obstruction or the symptoms given above, that an operation is indicated. Treatment
❑ Septal surgury is usually done after the age of 17 so as not to interfere with the growth of nasal skeleton. ❑ Submucous resection(SMR) operation: It is generally done in adults under local anaesthesia. ❑ Septoplasty:It is a conservative approach to septal surgery. In this operation,much of the septal framework is retained, only the most deviated parts are removed. Treatment
❑ Septal Haematoma ❑ Septal abscess: ❑ Bridge of nose collapse: ❑ perforation of nasal septum Complications