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Diseases of the NasalDiseases of the NasalSeptumSeptum

Diseases of the NasalDiseases of the NasalSeptumSeptum

ByBy

Dr. Sanjay Subbaiah.Dr. Sanjay Subbaiah.M.B.B.S., D.L.O., M.S., (E.N.T.)M.B.B.S., D.L.O., M.S., (E.N.T.)

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Deviated Nasal Septum Occurs frequently but treatment requires only if produces

symptoms

Starts around puberty and full development by 20 years

Affects both sexes

Many cases may be hereditary

Trauma may lead to deviated septum

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Developmental :-If the septum grows at a rapid

rate it becomes buckled to accommodate itself commonest cause

High Arched Palate: Lack of descent of the palatemay cause buckling of the cartilaginous part of

septum

Secondary : The septum may become deviated

secondary to a tumor, mass, or polyp in the nose

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Pathology

Deviations smooth deflection which are upper or lower,anterior or posterior or both C or S deviations.

Spurs Bony outgrowths at junction of bony & cartilagenous

part of septum.

Thickening may result from trauma due to overriding ofthe cartilaginous fragments which grow later in double layer

Dislocation the anterior edge of the septal cartilage may

be displaced to one side, causes obstructions.

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Symptoms Could be Asymptomatic

Blocking of the nose

Head ache

Nasal discharge

Epistaxis

Anosmia

Deformity

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Signs

External Nose may be deformed

Anterior Rhinoscopy revels the septaldeviation, secondary hypertophy of the

turbinates

Posterior Rhinoscopy shows no

abnormalities

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Complications Recurrent Sinusitis

Middle Ear infection

Mouth Breathing

Asthma Atrophic Rhinitis

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Differential Diagnosis Hypertrophic Turbinates

Polyps

Septal Heamatoma

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Treatment

Only if there is persistant or recurrent

symptoms due to deviated septum by

submucous resection of the nasal septum

SMR or Septoplasty

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Operation -- Indications

Blocking of the nose

Recurrent upper resriratory tract infection

Recurrent sinusitis

Recurrent epistaxis

Headache

Middle ear infection

Deformity of the nose requires rhinoplasty with SMR

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Contra Indications Acute respiratory tract infections

Children

Bleeding disorders

Diabetes

Syphilis

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Steps Infiltraton

Incision

Elevation of the flaps

Removal of requiste part of nasal septum

Anterior Packing of the nose

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Complications

Immediate Primary Heamorrhage

Damage to the surrounding structures Cerebrospinal fluid Rhinorrhoea

Anesthetic complications

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Delayed compications

Rectionary Heamorrage

Septal perforation

Synechia

Infection

Septal heamatoma

Septal abscess

Flapping septum

Persistent nasal blockage

Nasal deformity

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Difference between SMR & Septoplasty

SMR is radical

Killians incision

Not done in children

Flaps elevated on both sides

Most cartilage removed

Cant correct septal

dislocation

Perforations common

Postoperative deformity likesupratip depression may be

present

Revision surgery difficult

Septoplasty is conservative

Hemitransfixation incision

Done in children

Flap is elevated on concaveside

Most cartilage preserved

Can correct septal dislocation

Perforations rare

Postoperative deformity rare

Revision surgery possible